Ultrasound-guided drainage of peritonsillar abscess: shoot with your hockey-stick

Prokofieva, Ann; Modayil, Veena; Chiricolo, Gerardo; Ash, Adam; Raio, Christopher

doi:10.1007/s11739-015-1343-0

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…In addition, timely diagnosis and treatment is key in reducing the risk of deep neck space infection in the retropharyngeal and parapharyngeal spaces; such infection is associated with significant morbidities, including airway compromise, descending mediastinitis and Lemierre's syndrome. 2 Many methods, some more creative than others, [3][4][5][6] have been described to enhance access, or improve visualisation and safety in the context of quinsythis is indicative of the universal difficulties experienced by practitioners. While our method of oropharyngeal endoscopy mandates two practitioners and relies on equipment that may not be readily available in all healthcare settings, we believe it provides several important advantages for patients, trainers and trainees, as highlighted below.…”

Section: Discussionmentioning

confidence: 99%

Peritonsillar abscess drainage: using oropharyngeal endoscopy as a therapeutic adjunct and training tool

2021

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Background Peritonsillar abscess, or quinsy, is one of the most common emergency presentations to ENT departments, and is the most common deep tissue infection of the head and neck. In the UK, junior members of the ENT team are regularly required to independently assess, diagnose and treat patients with peritonsillar aspiration or incision and drainage. Issue Inexperienced practitioners can stumble at several obstacles: poor access due to trismus; poor lighting; difficulty in learning the therapeutic procedure; and difficulty in accurately documenting findings and treatment. Solution To counter these and other difficulties, the authors describe the routine use of video endoscopy as a training tool and therapeutic adjunct in the management of quinsy.

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Section: Discussionmentioning

confidence: 99%

Peritonsillar abscess drainage: using oropharyngeal endoscopy as a therapeutic adjunct and training tool

2021

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“…Another limitation of our technique is the use of a special neurosurgical transducer, which is not traditionally used in Emergency Medicine or Otolaryngology. A linear Hockey Stick transducer is more commonly available and will actually provide better image resolution of the tonsils due to more transducer crystals and higher frequency, compared to the Burr-Hole transducer (see Figure 5 ) [ 23 ]. Most ultrasound manufacturers have Hockey Stick transducers available, and we have good experiences with equipment from both GE (GE_Healthcare Chicago, Chicago, IL, USA) and BK Ultrasound (Analogic, Peabody, MA, USA) in our departments.…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique for Intraoral Ultrasound-Guided Aspiration of Peritonsillar Abscess

2018

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Peritonsillar abscess (PTA) is a common complication to acute tonsillitis. The treatment is drainage of the abscess, but many needle aspirations are unsuccessful due to a low diagnostic accuracy based on oral examination only. In this article, we describe how intraoral ultrasound can be added to improve the diagnostic work-up of PTA and present a novel technique for ultrasound-guided aspiration of PTA, using a small pencil-shaped transducer. We present our first clinical experiences with this technique and describe how it could be integrated in a clinical setting to guide safe and successful needle aspirations of PTA.

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“…However, physical exam alone has not been shown to reliably differentiate between PTA and cellulitis, and blind needle aspiration has a reported false negative rate of 10–24%. 2 – 3 The addition of intraoral ultrasound can improve diagnosis (sensitivity 89–95%; specificity 79–100%) 4 and aid in the safe performance of needle aspiration. In a prospective, randomized, controlled trial comparing the diagnostic accuracy of emergency providers for detecting PTA or cellulitis using intraoral ultrasound or landmark technique, ultrasound established the correct diagnosis more often and led to more successful aspiration of purulent material than landmark technique.…”

Section: Introductionmentioning

confidence: 99%

Development of a Novel Ultrasound-guided Peritonsillar Abscess Model for Simulation Training

Plitt

Biffar

2018

WestJEM

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IntroductionPeritonsillar abscess (PTA) is the most common deep space infection of the head and neck presenting to emergency departments.1 No commercial PTA task trainer exists for simulation training. Thus, resident physicians often perform their first PTA needle aspiration in the clinical setting, knowing that carotid artery puncture and hemorrhage are serious and devastating complications. While several low-fidelity PTA task trainers have been previously described, none allow for ultrasound image acquisition.6–9 We sought to create a cost-effective and realistic task trainer that allows trainees to acquire both diagnostic ultrasound and needle aspiration skills while draining a peritonsillar abscess.MethodsWe built the task trainer with low-cost, replaceable, and easily cleanable materials. A damaged airway headskin was repurposed to build the model. A mesh wire cylinder attached to a wooden base was fashioned to provide infrastructure. PTAs were simulated with a water and lotion solution inside a water balloon that was glued to the bottom of a paper cup. The balloon was fully submerged with ordnance gelatin to facilitate ultrasound image acquisition, and an asymmetric soft palate and deviated uvula were painted on top after setting. PTA cups were replaced after use. We spent eight hours constructing three task trainers and used 50 PTA cups for a total cost <$110.ResultsForty-six emergency medicine (EM) residents performed PTA needle aspirations using the task trainers and were asked to rate ultrasound image realism, task trainer realism, and trainer ease of use on a five-point visual analog scale, with five being very realistic and easy. Sixteen of 46 (35%) residents completed the survey and reported that ultrasound images were representative of real PTAs (mean 3.41). They found the model realistic (mean 3.73) and easy to use (mean 4.08). Residents rated their comfort with the drainage procedure as 2.07 before and 3.64 after practicing on the trainer.ConclusionThis low-cost, easy-to-construct simulator allows for ultrasound image acquisition while performing PTA needle aspirations and is the first reported of its kind. Educators from EM and otolaryngology can use this model to educate inexperienced trainees, thus ultimately improving patient safety in the clinical setting.

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Ultrasound-guided drainage of peritonsillar abscess: shoot with your hockey-stick

Cited by 6 publications

References 6 publications

Peritonsillar abscess drainage: using oropharyngeal endoscopy as a therapeutic adjunct and training tool

Peritonsillar abscess drainage: using oropharyngeal endoscopy as a therapeutic adjunct and training tool

A Novel Technique for Intraoral Ultrasound-Guided Aspiration of Peritonsillar Abscess

Development of a Novel Ultrasound-guided Peritonsillar Abscess Model for Simulation Training

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