Permucosal Needle Drainage of Peritonsillar Abscesses: A Five-Year Experience

Abstract

\s=b\ Forty-one patients with proved peritonsillar abscesses were treated during a five-year period with needle aspiration as the sole initial surgical treatment. Ninety percent (37/41) of the patients' abscesses resolved without further invasive therapy. All but two of the patients were treated as outpatients. Fifty percent (21/ 41) of the patients were treated by nonotolaryngologists. These data indicate that outpatient needle aspiration is the simplest, most cost-effective therapy for peritonsillar abscess. (Arch Otolaryngol 1984;110:104-105) Peritonsillar abscess is one of the most common abscesses of the head and neck. It is seen in both sexes and has been reported in patients from 7 to 70 years of age.1 The classic recommendation for treatment has been incision and drainage and hospitalization followed in one to three months by a tonsillectomy. Abscess tonsillectomy is an additional ac¬ cepted treatment for peritonsillar abscess.2 5 More recently, however, two initial reports6·7 detailed the first treatment of peritonsillar abscesses For editorial comment see 103.with needle aspiration alone com¬ bined with antibiotic therapy. This article is a follow-up of one of those reports, which now includes a fiveyear experience with this approach. PATIENTS AND METHODSFifty-four patients with the presumptive diagnosis of peritonsillar abscess had nee¬ dle aspirations during a five-year period at the University of New Mexico Hospital, Albuquerque. The patients were treated in an ambulatory care setting either in the emergency room or the otolaryngology clinic. The aspiration was accomplished using a 10-mL syringe with an 18-gauge spinal or a 3.81-cm needle. It was per¬ formed at the point of maximum bulging. If no pus was obtained, a second aspiration was accomplished 1 cm lower. A third aspiration was not attempted. All the patients, except two, were treated as out¬ patients with oral antibiotics (usually pen¬ icillin G potassium) and pain medication. They were followed up in the otolaryngolo¬ gy clinic. RESULTSThirteen of the needle aspirations yielded no pus. The abscesses of all of these patients, except the two who were unavailable for follow-up, re¬ solved while they were receiving oral medication. Pus was drawn from the abscesses of 41 patients, and they were the only ones considered to have a true peritonsillar abscess. Of those, 37 abscesses resolved without further treatment; four abscesses did not resolve, and they required further therapy. Of those four, one patient had an abscess tonsillectomy and three underwent classic incision and drainage. The average amount of pus removed was 4.5 mL; the average res¬ olution time was 2.6 days. COMMENT

National audit of the management of peritonsillar abscess

“…Both these methods have been demonstrated to be equally clinically effective. [6][7][8][9][10][11][12][13][14] There are, however, significant differences in the mode of treatment used according to the caseload managed, with departments treating more than 20 patients a year more likely to use aspiration. Moreover there appears to be geographical variations in the choice of mode of treatment, with significantly more surgeons in England and Wales using incision and drainage.…”

“…6 Moreover, there are several studies that have demonstrated the effectiveness of outpatient treatment. 9 14 15 This difference may be due to the differences in set-ups and outpatient support mechanisms of the health services in the two countries, or may be driven by economic factors. It, however, highlights an area that requires further study, and we are currently in the process of evaluating out patient treatment in the UK setting.…”

“…It is one of the commonest causes of acute admission to the otorhinolaryngology wards in the UK. 5 However, the literature describes several different forms of treatment of the condition, with differences in the initial managementnamely aspiration, incision and drainage, or abscess tonsillectomy [6][7][8][9][10][11][12] ; in the type and route of antibiotic treatment 13 14 ; as well as in the settings (whether inpatient or outpatient 9 14 15 ). There appears to be no agreement on the optimal or prevalent treatment for peritonsillar abscesses.…”

Indications for tonsillectomy stratified by the level of evidence

“…During the last decades, the results of NA and ID were repeatedly reported, even their application in children [288]. The advantages of NA, introduced by King in 1961 [357], encompass: easy-to-learn, easy-to-perform, rapid confirmation of a clinical suspicion, minimal trauma, good tolerance, immediate relief, no surgical/anesthesiological risks, low pain intensity [301], [304], [305], [358]. However, some disadvantages have to be mentioned, such as: painful procedure, aspiration of leaking pus, potential risk of painful re-draining, and the risk of damaging the internal carotid artery [288].…”

“…Because of the moderate quality of the identified studies, only answers with recommendation grade C could be given for questions 2 and 3. Among those 42 publications, there were only 5 level I trials [263], [304], [345], [363], [364], the remainder were classified as level IV including 13 case series with only one treatment modality [301], [302], [303], [305], [314], [343], [358], [374], [375], [376], [377], [378], [379], 12 case series comparing different therapies [261], [264], [307], [308], [366], [380], [381], [382], [383], [384], [385], [386], and one economic analysis [301]. Concerning recurrence rates and indication, the authors found 2 level II studies [309], [313] and 13 level IV trials [301], [303], [310], [311], [312], [314], [343], [350], [361], [372], [387], [388], [389].…”