Skip to main content

Advertisement

Log in

Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The Veneto region’s database of hospital discharge records was queried for ICD-9 codes corresponding to: peritonsillar abscess (PTA), PTA incision and drainage, tonsillectomy, pharyngeal-retropharyngeal abscess, cervical phlegmon, cervical abscess, and mediastinitis recorded from 1997 to 2006. All these codes were considered to identify cases of PTA recurrence and severe infectious complications occurring in conservatively treated patients. Among 4,199 patients whose PTA was incised and drained on admission to hospital, 1,532 were treated with tonsillectomy, while 2,667 were treated conservatively (without tonsillectomy). Abscess tonsillectomy was carried out almost exclusively in children (0–14 years of age), and only in 40 young and adult patients (0.95 %). The relapse rate after a single episode of PTA was 11.7 %, while potentially fatal complication occurred in 0.41 % of cases. Incidence of PTA hospital admission has remained stable in the considered period despite a 45 % reduction in the tonsillectomy rate. In conclusion, our data seem to show that conservative treatment for PTA is not associated with a significant risk of recurrence (and becomes minimal after 6–12 months), provided that patients have not suffered from previous PTA episodes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sunnergren O, Swanberg J, Molstad S (2008) Incidence, microbiology and clinical history of peritonsillar abscesses. Scand J Infect Dis 40:752–755

    Article  PubMed  Google Scholar 

  2. Powell EL, Powell J, Samuel JR, Wilson JA (2013) A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother 68:1941–1950

    Article  PubMed  CAS  Google Scholar 

  3. Klug TE (2014) Incidence and microbiology of peritonsillar abscess: the influence of season, age, and gender. Eur J Clin Microbiol Infect Dis 33:1163–1167

    Article  PubMed  CAS  Google Scholar 

  4. Gavriel H, Golan Y, Lazarovitch T, Eviatar E (2014) Bacteriology of peritonsillar abscess in patients over 40 years-a neglected age group. Eur Arch Otorhinolaryngol [Epub ahead of print]

  5. Gavriel H, Vaiman M, Kessler A, Eviatar E (2008) Microbiology of peritonsillar abscess as an indication for tonsillectomy. Medicine (Baltimore) 87:33–36

    Article  Google Scholar 

  6. Passy V (1994) Pathogenesis of peritonsillar abscess. Laryngoscope 104:185–190

    PubMed  CAS  Google Scholar 

  7. Kordeluk S, Novack L, Puterman M, Kraus M, Joshua BZ (2011) Relation between peritonsillar infection and acute tonsillitis: myth or reality? Otolaryngol Head Neck Surg 145:940–945

    Article  PubMed  Google Scholar 

  8. Georgalas C, Kanagalingam J, Zainal A, Ahmed H, Singh A, Patel KS (2002) The association between periodontal disease and peritonsillar infection: a prospective study. Otolaryngol Head Neck Surg 126:91–94

    Article  PubMed  Google Scholar 

  9. Klug TE, Rusan M, Clemmensen KK, Fuursted K, Ovesen T (2013) Smoking promotes peritonsillar abscess. Eur Arch Otorhinolaryngol 270:3163–3167

    Article  PubMed  Google Scholar 

  10. Wikstén J, Blomgren K, Eriksson T, Guldfred L, Bratt M, Pitkäranta A (2014) Variations in treatment of peritonsillar abscess in four Nordic countries. Acta Otolaryngol 134:813–817

    Article  PubMed  Google Scholar 

  11. Ormond A, Chao S, Shapiro D, Walner D (2014) Peritonsillar abscess with rapid progression to complete airway obstruction in a toddler. Laryngoscope 124:2418–2422

    Article  PubMed  Google Scholar 

  12. Johnson RF, Stewart MG, Wright CC (2003) An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg 128:332–343

    Article  PubMed  Google Scholar 

  13. Marom T, Cinamon U, Itskoviz D, Roth Y (2010) Changing trends of peritonsillar abscess. Am J Otolaryngol 31:162–167

    Article  PubMed  Google Scholar 

  14. Wikstén J, Hytonen M, Pitkäranta A, Blomgren K (2012) Who ends up having tonsillectomy after peritonsillar infection? Eur Arch Otorhinolaryngol 269:1281–1284

    Article  PubMed  Google Scholar 

  15. Powell J, Wilson JA (2012) An evidence-based review of peritonsillar abscess. Clin Otolaryngol 37:136–145

    Article  PubMed  CAS  Google Scholar 

  16. Kronenberg J, Wolf M, Leventon G (1987) Peritonsillar abscess: recurrence rate and the indication for tonsillectomy. Am J Otolaryngol 8:82–84

    Article  PubMed  CAS  Google Scholar 

  17. Simonato L, Baldi I, Balzi D, Barchielli A, Battistella G, Canova C, Cesaroni G, Corrao G et al (2008) Objectives, tools and methods for an epidemiological use of electronic health archives in various areas of Italy. Epidemiologia e Prevenzione 32:1–134

    Google Scholar 

  18. ISTAT: Regione Veneto Administrative Health Databases. [www.demo.istat.it/pop1]

  19. Costales-Marcos M, López-Álvarez F, Núñez-Batalla F, Moreno-Galindo C, Alvarez Marcos C, Llorente-Pendás J (2012) Peritonsillar infections: prospective study of 100 consecutive cases. Acta Otorinolaringol Esp 63:212–217

    Article  Google Scholar 

  20. Mak C, Spielmann PM, Hussain SS (2012) Recurrence of peritonsillar abscess: a 2-year follow-up. Clin Otolaryngol 37:87–88

    Article  PubMed  CAS  Google Scholar 

  21. Alaani A, Griffiths H, Minhas SS, Olliff J, Lee AB (2005) Parapharyngeal abscess: diagnosis, complications and management in adults. Eur Arch Otorhinolaryngol 262:345–350

    Article  PubMed  CAS  Google Scholar 

  22. Huang TT, Tseng FY, Liu TC, Hsu CJ, Chen YS (2005) Deep neck infection in diabetic patients: comparison of clinical picture and outcomes with non-diabetic patients. Otolaryngol Head Neck Surg 132:943

    Article  PubMed  Google Scholar 

  23. Windfuhr J (2002) Malignant neoplasia at different ages presenting as peritonsillar abscess. Otolaryngol Head Neck Surg 126:197–198

    Article  PubMed  CAS  Google Scholar 

  24. Rokkjaer MS, Klug TE (2014) Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature. Eur Arch Otorhinolaryngol [Epub ahead of print]

  25. Simon LM, Matijasec JW, Perry AP, Kakade A, Walvekar RR, Kluka EA (2013) Pediatric peritonsillar abscess: quinsy versus interval tonsillectomy. Int J Pediatr Otorhinolaryngol 77:1355–1358

    Article  PubMed  Google Scholar 

  26. Albertz N, Nazar G (2012) Peritonsillar abscess: treatment with immediate tonsillectomy: 10 years of experience. Acta Otolaryngol 132:1102–1107

    Article  PubMed  Google Scholar 

  27. Khayr W, Taepke J (2005) Management of peritonsillar abscess: needle aspiration versus incision and drainage versus tonsillectomy. Am J Ther 12:344–350

    Article  PubMed  Google Scholar 

  28. Tachibana T, Orita Y, Abe-Fujisawa I, Ogawara Y, Matsuyama Y, Shimizu A, Nakada M, Sato Y, Nishizaki K (2014) Prognostic factors and effects of early surgical drainage in patients with peritonsillar abscess. J Infect Chemother 20(11):722–725

    Article  PubMed  Google Scholar 

  29. Chiappini E et al (2012) Management of acute pharyngitis in children: summary of the Italian National Institute of Health Guidelines. Clin Ther 34:1442–1458

    Article  PubMed  CAS  Google Scholar 

  30. Koshy E, Murray J, Bottle A, Aylin P, Sharland M, Majeed A, Saxena S (2012) Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates? Arch Dis Child 97:1064–1068

    Article  PubMed  Google Scholar 

  31. Segal N, El-Saied S, Puterman M (2009) Peritonsillar abscess in children in the southern district of Israel. Int J Pediatr Otorhinolaryngol 73:1148–1150

    Article  PubMed  Google Scholar 

  32. Novis SJ, Pritchett CV, Thorne MC, Sun GH (2014) Pediatric deep space neck infections in U.S. children, 2000–2009. Int J Pediatr Otorhinolaryngol 78:832–836

    Article  PubMed  Google Scholar 

  33. Lau AS, Upile NS, Wilkie MD, Leong SC, Swift AC (2014) The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991–2011. Ann R Coll Surg Engl 96:307–310

    Article  PubMed  CAS  Google Scholar 

  34. Al-Hussaini A, Owens D, Tomkinson A (2013) Health costs and consequences: have UK national guidelines had any effect on tonsillectomy rates and hospital admissions for tonsillitis? Eur Arch Otorhinolaryngol 270:1959–1965

    Article  PubMed  Google Scholar 

  35. Wasson JD, Prinsley PR (2011) Tonsillectomy: variation in practice reflecting regional variation in disease presentation. Clin Otolaryngol 36:522–524

    Article  PubMed  CAS  Google Scholar 

  36. Mehanna HM, Al-Bahnasawi L (2002) A White. National audit of the management of peritonsillar abscess. Postgrad Med J 78:545–547

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  37. Herzon FS, Martin AD (2006) Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep 8:196–202

    Article  PubMed  Google Scholar 

  38. Risberg S, Engfeldt P, Hugosson S (2008) Incidence of peritonsillar abscess and relationship to age and gender: retrospective study. Scand J Infect Dis 40:792–796

    Article  PubMed  Google Scholar 

  39. Ong Y, Goh Y, Lee Y (2004) Peritonsillar infections: local experience. Singapore Med J 45:105–109

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Bovo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bovo, R., Barillari, M.R. & Martini, A. Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?. Eur Arch Otorhinolaryngol 273, 225–230 (2016). https://doi.org/10.1007/s00405-014-3454-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-014-3454-z

Keywords

Navigation