Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

Bovo, Roberto; Barillari, Maria Rosaria

doi:10.1007/s00405-014-3454-z

Cited by 15 publications

(20 citation statements)

References 38 publications

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“…The PTA group's age distribution in our study was similar to that reported in the literature. The distribution of gender in our study differs from previous studies which have demonstrated male predominance [17][18][19]. The age of the other subgroups (AT, CT) could not be analysed reliably, because they were formed based on the age range.…”

Section: Discussioncontrasting

confidence: 91%

The presence of minor salivary glands in the peritonsillar space

Kaltiainen

Wikstén

Aaltonen

et al. 2017

Eur Arch Otorhinolaryngol

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Peritonsillar abscess (PTA) is traditionally considered only a purulent complication of acute tonsillitis (AT), but may be related to infection of minor salivary glands. We analysed the presence of peritonsillar minor salivary glands and inflammation patterns in 114 adult tonsils representing three patient groups: recurrent AT, chronic tonsillitis (CT), and PTA. Samples acquired from elective tonsillectomies were stored in formalin, and after preparation were microscopically examined for inflammation and fibrotic changes. Clinical features and histological characteristics were compared between the groups. Of all tonsils, the minor salivary glands were present in 77 (67.5%). Glands located near the tonsillar tissue showed signs of infection in 73 (94.8%), while only 3 (15.0%) of 20 glands located deeper in the peritonsillar space were infected. Compared to patients with recurrent AT and CT, those with PTA more often presented with periductal inflammation, p < 0.011 (PTA 82.1%, AT 42.9%, and CT 63.6%). The majority of our 114 tonsillectomy specimens, collected from patients with AT, CT, or PTA, presented with infected minor salivary glands, and inflammation of the peritonsillar space glands was evident. To further elucidate the association between these glands and PTA, tonsillar samples should be collected and analysed from patients during the acute phase of infection.

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Section: Discussioncontrasting

confidence: 91%

The presence of minor salivary glands in the peritonsillar space

Kaltiainen

Wikstén

Aaltonen

et al. 2017

Eur Arch Otorhinolaryngol

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“…We found 38 studies reporting a total of 113 patients with PTA-associated DM [ 67 – 104 ]. The median age was 52 years and there was a significant male preponderance (65%, 34/52, p = 0.04, Binomial probability test).…”

Section: Resultsmentioning

confidence: 99%

Complications of peritonsillar abscess

Klug

Greve

Hentze

2020

Ann Clin Microbiol Antimicrob

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Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum , the current findings suggest that viridans group streptococci, S. aureus , Prevotella , and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.

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“…As recommended by The American College of Radiology–American Society of Neuroradiology–Society of Pediatric Radiology , we did not alter the scan length in the caudal direction to ensure reliable diagnosis of potentially life-threatening complications of cervical abscesses in the upper thorax, such as mediastinitis [5]. Although in our study cohort no patient was diagnosed with mediastinitis, since this is a relatively rare complication [29], we still consider it relevant not to shorten the scan range in the caudal direction in favor of patient dose reduction.…”

Section: Discussionmentioning

confidence: 99%

Effect of reduced z-axis scan coverage on diagnostic performance and radiation dose of neck computed tomography in patients with suspected cervical abscess

et al. 2017

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PurposeTo evaluate the effect of reduced z-axis scan coverage on diagnostic performance and radiation dose of neck CT in patients with suspected cervical abscess.MethodsFifty-one patients with suspected cervical abscess were included and underwent contrast-enhanced neck CT on a 2nd or 3rd generation dual-source CT system. Image acquisition ranged from the aortic arch to the upper roof of the frontal sinuses (CTstd). Subsequently, series with reduced z-axis coverage (CTred) were reconstructed starting at the aortic arch up to the orbital floor. CTstd and CTred were independently assessed by two radiologists for the presence/absence of cervical abscesses and for incidental and alternative findings. In addition, diagnostic accuracy for the depiction of the cervical abscesses was calculated for both readers. Furthermore, DLP (dose-length-product), effective dose (ED) and organ doses were calculated and compared for CTred and CTstd, using a commercially available dose management platform.ResultsA total of 41 abscesses and 3 incidental/alternative findings were identified in CTstd. All abscesses and incidental/alternative findings could also be detected on CTred resulting in a sensitivity and specificity of 1.0 for both readers. DLP, ED and organ doses of the brain, the eye lenses, the red bone marrow and the salivary glands of CTred were significantly lower than for CTstd (p<0.001).ConclusionsReducing z-axis coverage of neck CT allows for a significant reduction of effective dose and organ doses at similar diagnostic performance as compared to CTstd.

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Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

Cited by 15 publications

References 38 publications

The presence of minor salivary glands in the peritonsillar space

The presence of minor salivary glands in the peritonsillar space

Complications of peritonsillar abscess

Effect of reduced z-axis scan coverage on diagnostic performance and radiation dose of neck computed tomography in patients with suspected cervical abscess

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