Peritonsillar Abscess (PTA) Management: A Literature Review Comparing Different Approaches of PTA Drainage

Background: Peritonsillar abscess (PTA) is the most common deep infection of neck space that occurs in adults and is potentially life threatening if not treated appropriately. The surgical treatment of peritonsillar abscess that is not complicated with upper airway obstruction still remains controversial. Objectives: This review attempts to explore the controverseries between different types of management and compare the efficacy of needle aspiration, tonsillectomy and/or incision and drainage. Methodology: This study was done in King Abdulaziz University. All researches, between 1988 to 2015 were recruited and reviewed in this study. Results and conclusion: Studying the three accepted methods of draining: incision and drainage, abscess tonsillectomy, or needle aspiration, Incision and drainage is an efficient and safe procedure to treat peritonsillar abscess. As well as it is superior to Needle aspiration in terms of the post-procedure pain score. It can be performed as the first-line treatment of peritonsillar abscess. Quinsy tonsillectomy can offer several advantages, by allowing full evacuation of the abscess cavity, effectively relieving symptoms, but holds risk in general anesthesia intubation. and also higher post-operative complication like Peritonsillar abscess make it not a favorable step.

Peritonsillar Abscess (PTA) Management: A Literature Review Comparing Different Approaches of PTA Drainage

Background: Peritonsillar abscess (PTA) is the most common deep infection of neck space that occurs in adults and is potentially life threatening if not treated appropriately. The surgical treatment of peritonsillar abscess that is not complicated with upper airway obstruction still remains controversial. Objectives: This review attempts to explore the controverseries between different types of management and compare the efficacy of needle aspiration, tonsillectomy and/or incision and drainage. Methodology: This study was done in King Abdulaziz University. All researches, between 1988 to 2015 were recruited and reviewed in this study. Results and conclusion: Studying the three accepted methods of draining: incision and drainage, abscess tonsillectomy, or needle aspiration, Incision and drainage is an efficient and safe procedure to treat peritonsillar abscess. As well as it is superior to Needle aspiration in terms of the post-procedure pain score. It can be performed as the first-line treatment of peritonsillar abscess. Quinsy tonsillectomy can offer several advantages, by allowing full evacuation of the abscess cavity, effectively relieving symptoms, but holds risk in general anesthesia intubation. and also higher post-operative complication like Peritonsillar abscess make it not a favorable step.

Hemorrhage Risk After Quinsy Tonsillectomy

BACKGROUND: The goal of the study was to evaluate the incidence and possible predictive factors of post-tonsillectomy hemorrhage (PTH) in patients with peritonsillar abscess, treated by acute abscess tonsillectomy. METHODS: A retrospective cohort study was performed on 205 patients who underwent bilateral abscess tonsillectomy under general anesthesia. Age, sex, smoking habits, history of recurrent tonsillitis or prior peritonsillar abscess, current medical treatment, side of the peritonsillar abscess, initial treatment, surgeon's experience, procedure duration, intra- and postoperative anti-inflammatory medications, and side of bleeding were analyzed. RESULTS: Bleeding occurred in 27 patients (13%). Ipsilateral hemorrhage was observed in 8 patients (4%) and contralateral hemorrhage in 19 patients (9%). The higher incidence of PTH in the side contralateral to the abscess was found to be statistically significant ( P = 0.02). Male gender ( P = 0.042), smoking ( P = 0.009), and aspirin intake ( P = 0.008) were statistically significant factors associated with an increased PTH risk. CONCLUSION: The risk of bleeding following abscess tonsillectomy seems higher than reported in elective tonsillectomy. This high incidence is mainly due to patients with prior aspirin intake or to bleeding in the side contralateral to the abscess. Postoperative bleeding could be reduced by performing a unilateral acute abscess tonsillectomy in selected patients. An algorithm is proposed for the management of peritonsillar abscess based on age, prior history of pharyngo-tonsillar infections, aspirin intake, and clinical improvement after initial drainage and antibiotherapy.