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PERITONSILER ABSES
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An evidence-based review of the treatment of peritonsillar
abscess
• Peritonsillar abscess (PTA) is a collection of pus within the space between the tonsil and the superior constrictor muscle, near the tonsil’s superior pole.
• It is associated with tonsillitis & comprises approximately 30% of soft tissue head and necka bscesses.
• PTA is most common in adolescents and young adults.
• The bacteriology Streptococcus sp.most common organism cultured.
Does the Use of Steroids as Adjuvant Treatment Improve Treatment
Outcome in PTA?
• a rct for severe, acute pharyngitis,8 in which the use of adjuvant steroids demonstrated benefit.
• The authors 1 dose of intramuscular dexamethasome (10 mg) faster improvement in throat pain than controls.
• PTA Needle aspiration, incision & drainage (I&D), and simultaneous tonsillectomy with open abscess drainage (or, “quinsy tonsillectomy”).
• Others I&D to be followed by tonsillectomy a few weeks latercalled “interval tonsillectomy.
Which Technique of Surgical Drainage
Has the Highest Success Rate?
Which Technique of Surgical Drainage
Has the Highest Success Rate?
• I&D is slightly more effective in initial success rate than needle aspiration (93.7% versus 91.6%), so the NNT was 47.6 patients, in favor of I&D.
What Is the Recurrence Rate of PTA and What Are the Indications for Elective Tonsillectomy to Prevent
Recurrence?
• The recurrence rate of PTA and the relative indications for tonsillectomy.
• The Kronenberg et al patients with a history of recurrent tonsillitis had a significantly greater risk of recurrent PTA than did patients with no history of recurrent tonsillitis (40% versus 10.5%, P 0.0001).
• Clinical research evidence not support or refute the use of steroids in PTA.
• The success rates with initial I&D or needle
• aspiration are both very high initial treatment.
• The overall recurrence rate of PTA is low, but in selected subgroups of patients, elective tonsillectomy may provide benefit by decreasing the risk of recurrent PTA.