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Predictors of intratonsillar versus peritonsillar abscess: A case-control series.
- Source :
-
The Laryngoscope [Laryngoscope] 2019 Jun; Vol. 129 (6), pp. 1354-1359. Date of Electronic Publication: 2018 Dec 19. - Publication Year :
- 2019
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Abstract
- Objectives/hypothesis: An uncommon phenomenon in relation to the peritonsillar abscess (PTA) is the intratonsillar abscess (ITA) or formation of an abscess within tonsillar parenchyma. This study sought to characterize our experience with diagnosis and management of ITAs in the context of the PTA patient population.<br />Study Design: Case-control series.<br />Methods: This is a single-institution retrospective review of patients treated at the University of Michigan between 2000 and 2017.<br />Results: Six hundred fifty-five adult patients were identified. The incidence of ITA within the PTA population was 7% (n = 43). Patients with ITA had lower mean white blood cell count (P = .03), lower proportion of trismus (P < .0001), otalgia (P = .007), vocal changes (P < .0001), and fewer incidences of acute progression of symptoms (P = .0007). On multivariable analysis, ITA patients were noted to be older, present with a longer duration of symptoms, and have greater incidence of neck pain and lymphadenopathy. Drainage was attempted in fewer ITA patients and was rarely successful (15%) in comparison to successful drainage for PTA patients (69%) (P < .0001).<br />Conclusions: Symptomatology differs for ITA, as fewer present with the classic PTA symptoms of otalgia, trismus, and voice alterations. The lack of classic symptoms likely leads to delayed presentation. A greater number of ITA patients presented with neck pain and lymphadenopathy. In the ITA population, aspiration attempts were more infrequent and less successful in yielding purulence. Given infrequent yield of pus and low overall recurrence rate, the diagnosing clinician should consider medical management in this distinct patient population.<br />Level of Evidence: 4 Laryngoscope, 129:1354-1359, 2019.<br /> (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)
- Subjects :
- Adult
Female
Humans
Incidence
Male
Michigan epidemiology
Middle Aged
Palatine Tonsil surgery
Peritonsillar Abscess epidemiology
Peritonsillar Abscess surgery
Radiography
Recurrence
Retrospective Studies
Young Adult
Drainage methods
Palatine Tonsil diagnostic imaging
Peritonsillar Abscess diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1531-4995
- Volume :
- 129
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Laryngoscope
- Publication Type :
- Academic Journal
- Accession number :
- 30569506
- Full Text :
- https://doi.org/10.1002/lary.27615