Trends and complications in the management of peritonsillar abscess with emphasis on children

Abstract

The initial success rates of NP or ID are both very high (>90%) and the overall recurrence rate is low, particularly in children. Only for selected subgroups, patients may profit from TAC, which was clearly not associated with an increased risk of bleeding in our pediatric population.

Indications for tonsillectomy stratified by the level of evidence

“…Especially peritonsillitis is difficult to differentiate and sometimes requires needle aspiration or incisional drainage to be distinguished. Unexperienced physicians have difficulties in this regard, in particular if the PTA is located in the retrotonsillar space, so that the findings can be interpreted also in a false-negative way [288]. According to Templer, diagnosis of PTA is based on the evidence of pus, otherwise the term of peritonsillitis should be used [289].…”

“…Moreover, the is no waiting time required for ID. 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].…”

“…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]. …”

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

“…Sonography is mandatory to assess the risk of splenic rupture. A different approach is indicated in patients presenting with peritonsillar abscess and is indicated in cases not responding to previous incision drainage or needle aspiration, a history of recurrent episodes of tonsillitis, an age less than 40 years or complications related to the abscess [98], [99]. Rosenfeld and Green reported a changing trend concerning the indication for TE with hyperplasia prevailing tonsillitis [100].…”

Peritonsillarabszess mit tödlichem Verlauf - Diagnostische und therapeutische Aspekte

“…Neben systemisch entzündlichen Spätkomplikationen wie beispielsweise dem rheumatischen Fieber, Arthritis oder Myokarditis kann es in der Folge einer eitrigen Tonsillitis zur Ausbildung von Intratonsillar-, Peritonsillar-oder auch Retrotonsillarabszessen kommen [2]. Die Inzidenz von Peritonsillarabszessen beträgt in Deutschland 24 000 Betroffene im Jahr [3]. Unabhängig von der Geschlechtszugehörigkeit manifestieren sich Peritonsillarabszesse am häufigsten zwischen dem 20. und 30.…”