scholarly journals Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis

2017 ◽  
Vol 99 (1) ◽  
pp. 31-36 ◽  
Author(s):  
D Yap ◽  
AS Harris ◽  
J Clarke
Keyword(s):  
Sore Throat ◽  
Hospital Admissions ◽  
Significant Negative Correlation ◽  
Peritonsillar Abscess ◽  
Significant Rise ◽  
Retropharyngeal Abscess ◽  
Annual Number ◽  
Recurrent Tonsillitis ◽  
Parapharyngeal Abscess ◽  
Acute Hospitals

INTRODUCTION Sore throat and tonsillitis place a significant burden on the National Health Service. National guideline criteria for gauging the severity of sore throat and tonsillitis have reduced the number of tonsillectomies performed, which is thought to have increased the rate of tonsil-related infections. METHODS Data was extracted from the prospective Patient Episode Database of Wales and analysed to determine the annual number of tonsillectomies for recurrent tonsillitis, adjusted for population changes. Admissions to acute hospitals for tonsillitis, peritonsillar abscess and deep neck space abscesses were also examined. RESULTS Between 1999 and 2014, hospital admissions for tonsillitis rose three-fold (r=0.968), while admissions for peritonsillar abscess rose by 48% (r=0.857) and retro or parapharyngeal abscess admissions also increased (r=0.709). In contrast, the number of tonsillectomies per 100,000 population gradually decreased (r=-0.16). There was a positive correlation between the incidence of tonsillitis and admissions for peritonsillar abscess (adjusted r2 0.631; p=0.015) and retropharyngeal abscess (adjusted r2 0.442; p=0.00254). There was a statistically significant negative correlation between the incidence of tonsillitis and the number of tonsillectomies performed (adjusted r2=-0.07; p=0.0235). CONCLUSIONS The significant rise in tonsillitis in Wales raises the question as to whether we should revisit the criteria for tonsillectomy. The perceived cost saving from limiting certain procedures should not prevent healthcare policymakers from considering all other evidence. The rise in peritonsillar, retropharyngeal and parapharyngeal abscess is alarming, as they are associated with significant morbidity and mortality.

scholarly journals The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991–2011

2014 ◽  
Vol 96 (4) ◽  
pp. 307-310 ◽  
Author(s):  
AS Lau ◽  
NS Upile ◽  
MD Wilkie ◽  
SC Leong ◽  
AC Swift
Keyword(s):  
Sore Throat ◽  
Length Of Hospital Stay ◽  
Admission Rate ◽  
Clinical Effectiveness ◽  
Cross Sectional Study ◽  
Peritonsillar Abscess ◽  
Significant Rise ◽  
Cross Sectional ◽  
Emergency Admissions ◽  
Parapharyngeal Abscess

Introduction Sore throats and tonsillitis represent a considerable health burden as well as a significant source of expenditure for the National Health Service (NHS). As part of the recent NHS savings drive, the introduction of ‘procedures of low clinical effectiveness’ (PoLCE) lists has reinforced a large reduction in the number of tonsillectomies performed. We carried out a cross-sectional study of trends in emergency sore throat admissions in the context of the number of tonsillectomies performed. Methods Hospital Episode Statistics (HES) data were extracted. Office for National Statistics data were also used. Results Between 1991 and 2011, the overall tonsillectomy rate fell by 44%. In the same time, the admission rate for tonsillitis rose by 310% (Pearson’s r=–0.67, p=0.01). The peritonsillar abscess admission rate rose by 31% (r=–0.79, p<0.01). Between 1996 and 2011, the overall tonsillectomy rate fell by 41% and the retro and parapharyngeal abscess admission rate rose by 39% (r=–0.55, p=0.026). There was a 14% overall increase in tonsillectomy and sore throat associated bed days. This was despite the large fall in tonsillectomy numbers and the reduction in length of hospital stay. Conclusions Efforts to reduce the tonsillectomy rate are correlated with a significant rise in emergency admissions. The rise in the retro and parapharyngeal abscess rate is perhaps most alarming given the very high mortality of these conditions. Bed day data suggest that no net saving has been made despite the new measures.

scholarly journals The impact of the environment on patient experiences of hospital admissions in palliative care

2015 ◽  
Vol 8 (4) ◽  
pp. 485-492 ◽  
Author(s):  
Jackie Robinson ◽  
Merryn Gott ◽  
Clare Gardiner ◽  
Christine Ingleton
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Prognostic Indicators ◽  
Care Needs ◽  
Acute Hospitals ◽  
Almost All ◽  
The Impact ◽  
Palliative Care Needs

ObjectiveTo explore the impact of environment on experiences of hospitalisation from the perspective of patient's with palliative care needs.MethodsA qualitative study design using longitudinal semistructured, face-to-face interviews were used to elicit the views of patients with palliative care needs admitted to hospital in 1 large urban acute hospital in New Zealand. The sample comprised of 14 patients admitted to hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need.ResultsAlmost all participants described a range of factors associated with the environment which impacted negatively on their experiences of hospitalisation. This included challenges with the physical surroundings, the impact on social relationships with other patients, families and health professionals and the influence of the cultural milieu of the hospital setting.ConclusionsEmulating the ‘ideal’ environment for palliative care such as that provided in a hospice setting is an unrealistic goal for acute hospitals. Paying attention to the things that can be changed, such as enabling family to stay and improving the flexibility of the physical environment while improving the social interplay between patients and health professionals, may be a more realistic approach than replicating the hospice environment in order to reduce the burden of hospitalisations for patients with palliative care needs.

scholarly journals Foreign body of the esophagus, complicated by retropharyngeal abscess and mediastinitis

1981 ◽  
Vol 62 (5) ◽  
pp. 64-65
Author(s):  
V. V. Baityakov ◽  
V. V. Fedotov ◽  
A. I. Bocharov
Keyword(s):  
Foreign Body ◽  
Sore Throat ◽  
General Condition ◽  
Severe Pain ◽  
Soft Tissues ◽  
Fish Bone ◽  
Retropharyngeal Abscess ◽  
Anterior Surface ◽  
Interscapular Region

T., 55 years old, choked on a fish bone while eating. After 2 days, she was admitted to the ENT clinic with complaints of sore throat, hoarseness, sharp difficulty in swallowing and breathing. The general condition of the patient is severe, the neck is enlarged due to edema of soft tissues, the skin is pale, on the anterior surface of the chest there are massive subcutaneous hemorrhages. The patient retains a forced position, cannot lie on the couch on her own. Palpation of the neck and interscapular region causes severe pain. Temperature 39.3 .

Increasing Use of Anticoagulants in Germany and Its Impact on Hospitalization for Tooth Extraction

2021 ◽  
Author(s):  
Olga von Beckerath ◽  
Knut Kröger ◽  
Frans Santosa ◽  
Ayat Nasef ◽  
Bernd Kowall ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Hospital Admissions ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Annual Number ◽  
Hospitalization Rates ◽  
Defined Daily Doses ◽  
Hospital Referral ◽  
History Of

Abstract Objectives This article aimed to compare nationwide time trends of oral anticoagulant prescriptions with the time trend of hospitalization for tooth extraction (TE) in Germany from 2006 through 2017. Patients and Methods We derived the annual number of hospital admissions for TE from the Nationwide Hospital Referral File of the Federal Bureau of Statistics and defined daily doses (DDD) of prescribed anticoagulants in outpatients from reports of the drug information system of the statutory health insurance. Results From 2005 to 2017, annual oral anticoagulation (OAC) treatment rates increased by 143.7%. In 2017, direct oral anticoagulants (DOACs) represented 57.1% of all OAC treatments. The number of cases hospitalized for TE increased by 28.0 only. From all the cases hospitalized for TE in Germany in 2006, 14.2% had a documented history of long-term use of OACs. This proportion increased to 19.6% in 2017. Age-standardized hospitalization rates for all TE cases with long-term use of OACs increased from 6.6 in 2006 to 10.5 cases per 100,000 person-years in 2014 and remained almost unchanged thereafter. Conclusion Our comparison showed that the large increase in OAC treatment rates in general from 2006 to 2017 had only a small impact on hospitalized TE cases with long-term use of OAC which flattens since 2014.

Pediatric Upper Airway Obstruction

2018 ◽  
Author(s):  
Michael W. Chan ◽  
Suzanne M. Schmidt
Keyword(s):  
Foreign Body ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Peritonsillar Abscess ◽  
Foreign Body Aspiration ◽  
Upper Airway Obstruction ◽  
Diagnosis And Treatment ◽  
Retropharyngeal Abscess ◽  
Anatomic Location ◽  
Bacterial Tracheitis

Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis,  and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses.   This review contains 5 figures, 13 tables, and 32 references Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor

scholarly journals Bilateral Peritonsillar Abscess in an Infant: An Unusual Presentation of Sore Throat

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Mariana Manzoni Seerig ◽  
Letícia Chueiri ◽  
Janaina Jacques ◽  
Maria Fernanda Piccoli Cardoso de Mello ◽  
Martin Batista Coutinho da Silva ◽  
...  
Keyword(s):  
Sore Throat ◽  
Soft Palate ◽  
Rare Case ◽  
Peritonsillar Abscess ◽  
Respiratory Obstruction ◽  
Acute Tonsillitis ◽  
Laboratory Evolution ◽  
Bilateral Presentation ◽  
History Of ◽  
Loss Of Appetite

Introduction. Peritonsillar abscess is considered a suppurative complication of acute tonsillitis. It is usually unilateral and clinically evident bilateral presentation is uncommon. The condition affects mainly children older than 10 years and young adults. Herein we present a rare case of bilateral peritonsillar abscess in an infant.Presentation of Case. A 1-year-old boy presented with a two-day history of worsening sore throat, loss of appetite, vomiting, and fever. Examination of the oral cavity and oropharynx revealed enlarged and inflamed tonsils and a bilaterally congested and bulging soft palate. CT scan confirmed the hypothesis of bilateral peritonsillar abscess. Antibiotic therapy was instituted and after 5 days only slight regression of swelling of the soft palate was observed. He underwent a surgical procedure for draining the abscesses. After the procedure, he presented good clinical and laboratory evolution and was discharged home.Discussion. Although peritonsillar abscesses are considered common complications of acute tonsillitis bilateral cases are extremely rare, especially in early childhood. The diagnosis is based on history and physical examination and the treatment remains controversial among otolaryngologists.Conclusion. Bilateral peritonsillar abscess should be diagnosed and treated promptly and adequately to prevent respiratory obstruction and to avoid dissemination into the deep neck spaces.

Ultrasound-guided transoral drainage of a paediatric parapharyngeal abscess

2014 ◽  
Vol 128 (12) ◽  
pp. 1120-1122 ◽  
Author(s):  
A Delides ◽  
E Manoli ◽  
M Papadopoulos ◽  
T Nikolopoulos
Keyword(s):  
Case Report ◽  
Parapharyngeal Space ◽  
Oral Route ◽  
Retropharyngeal Abscess ◽  
Abscess Drainage ◽  
Neck Ultrasound ◽  
Guided Surgery ◽  
Parapharyngeal Abscess ◽  
First Case ◽  
Oral Approach

AbstractObjective:To report and discuss the surgical use of ultrasonography for draining a parapharyngeal space infection in a child.Case report:The use of image-guided surgery for draining a parapharyngeal abscess has been previously reported, with computed tomography for an intra-oral approach and ultrasound for an external approach. We present the first case report of a four-year-old child with a retropharyngeal abscess and a deep parapharyngeal abscess in whom neck ultrasound was used to assist intra-oral drainage.Conclusion:Neck ultrasound may be used in paediatric patients to visualise access to the parapharyngeal space through the intra-oral route for abscess drainage.

scholarly journals Intramural oesophageal abscess: an unusual complication of tonsillitis

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-226010
Author(s):  
Natasha Amiraraghi ◽  
Lorna C Ewan ◽  
Shayan Ansari ◽  
Kevin Robertson
Keyword(s):  
Epstein Barr Virus ◽  
Retropharyngeal Abscess ◽  
Unusual Complication ◽  
Common Condition ◽  
Viral Origin ◽  
Barr Virus ◽  
Parapharyngeal Abscess ◽  
Inpatient Management ◽  
Epstein Barr ◽  
Modern Medical Practice

Tonsillitis is an extremely common condition, usually it is self-limiting, of viral origin, and managed conservatively in general practice. Rarely patients require inpatient management, usually when bacterial infection is present or when the cause is virulent organisms such as Epstein Barr virus. Complications can be divided into non-suppurative; sepsis, scarlet fever, rheumatic fever, glomerulonephritis and Lemierres disease, and suppurative; quinsy, parapharyngeal abscess and retropharyngeal abscess, respectively. Anecdotally, there is concern that modern medical practice that counsels vigilance against overuse of antibiotics, could lead to increased complications of tonsillitis. We report a case of an otherwise healthy man who presented with dysphagia, odynophagia and neck pain following a sore throat. Despite antibiotic treatment he developed an intramural oesophageal abscess, to our knowledge, an unreported complication of tonsillitis.

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