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Erschienen in: European Archives of Oto-Rhino-Laryngology 12/2016

20.06.2016 | Head and Neck

Cranial tonsillotomy for peritonsillar abscess: what a relief!

verfasst von: Jochen P. Windfuhr, M. Nematian, S. Ziogou

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 12/2016

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Abstract

Peritonsillar abscess (PTA) is a common infection of the oropharynx resulting in painful swallowing, sometimes associated with fever, trismus and a typical voice alteration. Several draining methods have been suggested, including needle aspiration (NA), incision and drainage (ID), or abscesstonsillectomy. However, a gold standard of surgical therapy still does not exist. The aim of this study was to evaluate the outcome in patients who had undergone ID supplemented by cranial tonsillotomy (IDTT) as first-line treatment. A retrospective chart review of all patients who had undergone IDTT at our department in 2015 was performed. Demographic data, clinical findings, pain intensity on a 10-point visual analog scale, operation time and routine bloods before and after IDTT were collected. In addition, a 10-point visual analog scale (VAS) was utilized to measure personal satisfaction 2 weeks and 2 months after surgery. A total of 104 procedures were performed in 65 male and 38 female patients (median age 35 years), including one patient with a contralateral PTA 2 weeks after IDTT. Three patients had experienced abscess formation after admittance for antibiotic treatment of acute tonsillitis. 57.7 % of all patients denied intake of antibiotic therapy in their history at initial presentation. Patients were hospitalized for 3 days (median). The median pain intensity (VAS) within the first three postoperative days was 2, 1 and 1, respectively. Two weeks and 2 months after surgery patients were highly satisfied with the procedure (median value 10). Bleeding complications did not occur. IDTT is a novel surgical concept and associated with great patient comfort. It is safe, easy to learn and associated with an early return to normal diet and physical activity. These findings are supported by a rapid normalization of white blood cell count and C-reactive protein. IDTT eliminates the necessity of painful re-draining of the wound cavity and is free of bleeding complications. In contrast to ID and NA, histological examination of tonsillar tissue is feasible to disclose a previously undetected malign disease. Further analysis is warranted to verify the success rate in the long-term.
Literatur
1.
Zurück zum Zitat Galioto NJ (2008) Peritonsillar abscess. Am Fam Phys 77(2):199–202 Galioto NJ (2008) Peritonsillar abscess. Am Fam Phys 77(2):199–202
2.
Zurück zum Zitat Herzon FS (1995) Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope 105(8 Pt 3 Suppl 74):1–17 Herzon FS (1995) Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope 105(8 Pt 3 Suppl 74):1–17
3.
Zurück zum Zitat Virtanen S, Laukkanen-Ninios R, Ortiz Martinez P, Siitonen A, Fredriksson-Ahomaa M, Korkeala H (2013) Multiple-locus variable-number tandem-repeat analysis in genotyping Yersinia enterocolitica strains from human and porcine origins. J Clin Microbiol 51(7):2154–2159. doi:10.1128/JCM.00710-13 CrossRefPubMedPubMedCentral Virtanen S, Laukkanen-Ninios R, Ortiz Martinez P, Siitonen A, Fredriksson-Ahomaa M, Korkeala H (2013) Multiple-locus variable-number tandem-repeat analysis in genotyping Yersinia enterocolitica strains from human and porcine origins. J Clin Microbiol 51(7):2154–2159. doi:10.​1128/​JCM.​00710-13 CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Spires JR, Owens JJ, Woodson GE, Miller RH (1987) Treatment of peritonsillar abscess. A prospective study of aspiration vs incision and drainage. Arch Otolaryngol Head Neck Surg 113(9):984–986 Spires JR, Owens JJ, Woodson GE, Miller RH (1987) Treatment of peritonsillar abscess. A prospective study of aspiration vs incision and drainage. Arch Otolaryngol Head Neck Surg 113(9):984–986
5.
Zurück zum Zitat Stringer SP, Schaefer SD, Close LG (1988) A randomized trial for outpatient management of peritonsillar abscess. Arch Otolaryngol Head Neck Surg 114(3):296–298CrossRefPubMed Stringer SP, Schaefer SD, Close LG (1988) A randomized trial for outpatient management of peritonsillar abscess. Arch Otolaryngol Head Neck Surg 114(3):296–298CrossRefPubMed
6.
Zurück zum Zitat Herzon FS, Martin AD (2006) Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep 8(3):196–202CrossRefPubMed Herzon FS, Martin AD (2006) Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep 8(3):196–202CrossRefPubMed
7.
Zurück zum Zitat Johnson RF, Stewart MG (2005) The contemporary approach to diagnosis and management of peritonsillar abscess. Curr Opin Otolaryngol Head Neck Surg 13(3):157–160CrossRefPubMed Johnson RF, Stewart MG (2005) The contemporary approach to diagnosis and management of peritonsillar abscess. Curr Opin Otolaryngol Head Neck Surg 13(3):157–160CrossRefPubMed
8.
Zurück zum Zitat Johnson RF, Stewart MG, Wright CC (2003) An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg 128(3):332–343CrossRefPubMed Johnson RF, Stewart MG, Wright CC (2003) An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg 128(3):332–343CrossRefPubMed
14.
Zurück zum Zitat Shaul C, Koslowsky B, Rodriguez M, Schwarz Y, Muahnna N, Peleg U, Sichel JY (2015) Is needle aspiration for peritonsillar abscess still as good as we think? A long-term follow-up. Ann Otol Rhinol Laryngol 124(4):299–304. doi:10.1177/0003489414556083 CrossRefPubMed Shaul C, Koslowsky B, Rodriguez M, Schwarz Y, Muahnna N, Peleg U, Sichel JY (2015) Is needle aspiration for peritonsillar abscess still as good as we think? A long-term follow-up. Ann Otol Rhinol Laryngol 124(4):299–304. doi:10.​1177/​0003489414556083​ CrossRefPubMed
15.
Zurück zum Zitat Rokkjaer MS, Klug TE (2015) Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature. Eur Arch Otorhinolaryngol 272(9):2439–2444. doi:10.1007/s00405-014-3186-0 CrossRefPubMed Rokkjaer MS, Klug TE (2015) Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature. Eur Arch Otorhinolaryngol 272(9):2439–2444. doi:10.​1007/​s00405-014-3186-0 CrossRefPubMed
16.
Zurück zum Zitat Alvi A, Vartanian AJ (1998) Microscopic examination of routine tonsillectomy specimens: is it necessary? Otolaryngol Head Neck Surg 119(4):361–363CrossRefPubMed Alvi A, Vartanian AJ (1998) Microscopic examination of routine tonsillectomy specimens: is it necessary? Otolaryngol Head Neck Surg 119(4):361–363CrossRefPubMed
17.
Zurück zum Zitat Windfuhr J (2002) Malignant neoplasia at different ages presenting as peritonsillar abscess. Otolaryngol Head Neck Surg 126(2):197–198CrossRefPubMed Windfuhr J (2002) Malignant neoplasia at different ages presenting as peritonsillar abscess. Otolaryngol Head Neck Surg 126(2):197–198CrossRefPubMed
19.
Zurück zum Zitat Glazer DV, Romeling F (2014) Pleomorphic adenoma causing a peritonsillar abscess. Ugeskr Laeger 176(52):2–3 Glazer DV, Romeling F (2014) Pleomorphic adenoma causing a peritonsillar abscess. Ugeskr Laeger 176(52):2–3
20.
Zurück zum Zitat Lee KD, Lee HS, Hong JC, Yu TH, Lee HH, Chun BG, Gil YG, Kim KH (2008) Diameter of vessels across the tonsillar capsule as an anatomical consideration for tonsillectomy. Clin Anat 21(1):33–37CrossRefPubMed Lee KD, Lee HS, Hong JC, Yu TH, Lee HH, Chun BG, Gil YG, Kim KH (2008) Diameter of vessels across the tonsillar capsule as an anatomical consideration for tonsillectomy. Clin Anat 21(1):33–37CrossRefPubMed
23.
Zurück zum Zitat Licameli GR, Grillone GA (1998) Inferior pole peritonsillar abscess. Otolaryngol Head Neck Surg 118(1):95–99CrossRefPubMed Licameli GR, Grillone GA (1998) Inferior pole peritonsillar abscess. Otolaryngol Head Neck Surg 118(1):95–99CrossRefPubMed
24.
Zurück zum Zitat Stankiewicz JA, Talland C (1988) Peritonsillarlike lateral oropharyngeal abscess after tonsillectomy. Arch Otolaryngol Head Neck Surg 114(10):1181–1183CrossRefPubMed Stankiewicz JA, Talland C (1988) Peritonsillarlike lateral oropharyngeal abscess after tonsillectomy. Arch Otolaryngol Head Neck Surg 114(10):1181–1183CrossRefPubMed
25.
Zurück zum Zitat Al-Kindy S (2002) Post tonsillectomy quinsy. Saudi Med J 23(2):240–241PubMed Al-Kindy S (2002) Post tonsillectomy quinsy. Saudi Med J 23(2):240–241PubMed
26.
Zurück zum Zitat Passy V (1994) Pathogenesis of peritonsillar abscess. Laryngoscope 104(2):185–190PubMed Passy V (1994) Pathogenesis of peritonsillar abscess. Laryngoscope 104(2):185–190PubMed
27.
Zurück zum Zitat Ong YK, Goh YH, Lee YL (2004) Peritonsillar infections: local experience. Singap Med J 45(3):105–109 Ong YK, Goh YH, Lee YL (2004) Peritonsillar infections: local experience. Singap Med J 45(3):105–109
28.
Zurück zum Zitat Powell E, Powell J, Samuel J, Wilson J (2013) A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother 68:1941–1950CrossRefPubMed Powell E, Powell J, Samuel J, Wilson J (2013) A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother 68:1941–1950CrossRefPubMed
29.
Zurück zum Zitat Love RL, Allison R, Chambers ST (2011) Peritonsillar infection in Christchurch 2006–2008: epidemiology and microbiology. N Z Med J 124(1337):16–23PubMed Love RL, Allison R, Chambers ST (2011) Peritonsillar infection in Christchurch 2006–2008: epidemiology and microbiology. N Z Med J 124(1337):16–23PubMed
32.
Zurück zum Zitat Mazur E, Czerwinska E, Korona-Glowniak I, Grochowalska A, Koziol-Montewka M (2014) Epidemiology, clinical history and microbiology of peritonsillar abscess. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. doi:10.1007/s10096-014-2260-2 Mazur E, Czerwinska E, Korona-Glowniak I, Grochowalska A, Koziol-Montewka M (2014) Epidemiology, clinical history and microbiology of peritonsillar abscess. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. doi:10.​1007/​s10096-014-2260-2
33.
Zurück zum Zitat 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. doi:10.1016/j.jiac.2014.07.018 CrossRefPubMed 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. doi:10.​1016/​j.​jiac.​2014.​07.​018 CrossRefPubMed
35.
Zurück zum Zitat Brook I (2004) Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 62(12):1545–1550CrossRefPubMed Brook I (2004) Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 62(12):1545–1550CrossRefPubMed
36.
Zurück zum Zitat Hidaka H, Kuriyama S, Yano H, Tsuji I, Kobayashi T (2011) Precipitating factors in the pathogenesis of peritonsillar abscess and bacteriological significance of the Streptococcus milleri group. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol 30(4):527–532. doi:10.1007/s10096-010-1114-9 CrossRef Hidaka H, Kuriyama S, Yano H, Tsuji I, Kobayashi T (2011) Precipitating factors in the pathogenesis of peritonsillar abscess and bacteriological significance of the Streptococcus milleri group. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol 30(4):527–532. doi:10.​1007/​s10096-010-1114-9 CrossRef
37.
Zurück zum Zitat Rusan M, Klug TE, Henriksen JJ, Ellermann-Eriksen S, Fuursted K, Ovesen T (2012) The role of viruses in the pathogenesis of peritonsillar abscess. Eur J Clin Microbiol Infect Dis. doi:10.1007/s10096-012-1573-2 PubMed Rusan M, Klug TE, Henriksen JJ, Ellermann-Eriksen S, Fuursted K, Ovesen T (2012) The role of viruses in the pathogenesis of peritonsillar abscess. Eur J Clin Microbiol Infect Dis. doi:10.​1007/​s10096-012-1573-2 PubMed
38.
Zurück zum Zitat Dunn N, Lane D, Everitt H, Little P (2007) Use of antibiotics for sore throat and incidence of quinsy. Br J Gener Pract J R Coll Gener Pract 57(534):45–49 Dunn N, Lane D, Everitt H, Little P (2007) Use of antibiotics for sore throat and incidence of quinsy. Br J Gener Pract J R Coll Gener Pract 57(534):45–49
39.
Zurück zum Zitat Kilty SJ, Gaboury I (2008) Clinical predictors of peritonsillar abscess in adults. J Otolaryngol Head Neck Surg 37(2):165–168PubMed Kilty SJ, Gaboury I (2008) Clinical predictors of peritonsillar abscess in adults. J Otolaryngol Head Neck Surg 37(2):165–168PubMed
40.
Zurück zum Zitat Lehnerdt G, Senska K, Fischer M, Jahnke K (2005) Rauchen prädisponiert zum Peritonsillarabszess. Laryngorhinootologie 84(9):676–679CrossRefPubMed Lehnerdt G, Senska K, Fischer M, Jahnke K (2005) Rauchen prädisponiert zum Peritonsillarabszess. Laryngorhinootologie 84(9):676–679CrossRefPubMed
41.
Zurück zum Zitat Torre V, Bucolo S, Giordano C, Cicciarello R, Cavallari V, Garofalo L, Beatrice F (2005) Palatine tonsils in smoker and non-smoker patients: a pilot clinicopathological and ultrastructural study. J Oral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol 34(7):390–396. doi:10.1111/j.1600-0714.2005.00319.x Torre V, Bucolo S, Giordano C, Cicciarello R, Cavallari V, Garofalo L, Beatrice F (2005) Palatine tonsils in smoker and non-smoker patients: a pilot clinicopathological and ultrastructural study. J Oral Pathol Med Off Publ Int Assoc Oral Pathol Am Acad Oral Pathol 34(7):390–396. doi:10.​1111/​j.​1600-0714.​2005.​00319.​x
43.
Zurück zum Zitat 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(9):1941–1950. doi:10.1093/jac/dkt128 CrossRefPubMed 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(9):1941–1950. doi:10.​1093/​jac/​dkt128 CrossRefPubMed
46.
Zurück zum Zitat Arkkila E, Sipila J, Laurikainen E, Suonpaa J (1998) Peritonsillar abscess associated with infectious mononucleosis. ORL J Oto-Rhino-Laryngol Relat Spec 60(3):159–163CrossRef Arkkila E, Sipila J, Laurikainen E, Suonpaa J (1998) Peritonsillar abscess associated with infectious mononucleosis. ORL J Oto-Rhino-Laryngol Relat Spec 60(3):159–163CrossRef
48.
Zurück zum Zitat Burstin PP, Marshall CL (1998) Infectious mononucleosis and bilateral peritonsillar abscesses resulting in airway obstruction. J Laryngol Otol 112(12):1186–1188PubMed Burstin PP, Marshall CL (1998) Infectious mononucleosis and bilateral peritonsillar abscesses resulting in airway obstruction. J Laryngol Otol 112(12):1186–1188PubMed
49.
Zurück zum Zitat Koch KU, Lindhardt C, Andersen OO, Kristensen S (2005) Bilateral peritonsillar abscess in mononucleosis. Ugeskr Laeger 167(17):1862–1863PubMed Koch KU, Lindhardt C, Andersen OO, Kristensen S (2005) Bilateral peritonsillar abscess in mononucleosis. Ugeskr Laeger 167(17):1862–1863PubMed
50.
Zurück zum Zitat Monem SA, O’Connor PF, O’Leary TG (1999) Peritonsillar abscess and infectious mononucleosis: an association or a different presentation of the same condition. Ir Med J 92(2):278–280PubMed Monem SA, O’Connor PF, O’Leary TG (1999) Peritonsillar abscess and infectious mononucleosis: an association or a different presentation of the same condition. Ir Med J 92(2):278–280PubMed
51.
Zurück zum Zitat Johnsen T (1981) Infectious mononucleosis and peritonsillar abscess. J Laryngol Otol 95(8):873–876CrossRefPubMed Johnsen T (1981) Infectious mononucleosis and peritonsillar abscess. J Laryngol Otol 95(8):873–876CrossRefPubMed
52.
Zurück zum Zitat Portman M, Ingall D, Westenfelder G, Yogev R (1984) Peritonsillar abscess complicating infectious mononucleosis. J Pediatr 104(5):742–744CrossRefPubMed Portman M, Ingall D, Westenfelder G, Yogev R (1984) Peritonsillar abscess complicating infectious mononucleosis. J Pediatr 104(5):742–744CrossRefPubMed
Metadaten
Titel
Cranial tonsillotomy for peritonsillar abscess: what a relief!
verfasst von
Jochen P. Windfuhr
M. Nematian
S. Ziogou
Publikationsdatum
20.06.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Oto-Rhino-Laryngology / Ausgabe 12/2016
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-016-4158-3

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