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[Our experience in the management of peritonsillar phlegmon and abscess in children]
F J García Callejo1, M M Velert Vila
1Servicio de Otorrinolaringología, Hospital Clínico Universitario, Valencia.
Insights
Pediatric peritonsillar abscess cases are rising, possibly linked to ineffective antibiotic treatments rather than acute tonsillar infections. Further research is needed to understand this trend in children.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
Background:
- Peritonsillar abscess (PTA) is increasingly diagnosed in children, a condition previously considered rare in this age group.
- The rising incidence necessitates an investigation into potential contributing factors.
Purpose of the Study:
- To evaluate the potential causes behind the recent increase in pediatric peritonsillar abscesses.
- To identify factors associated with the condition in children.
Main Methods:
- Retrospective study of nine pediatric cases diagnosed between 1983 and 1998.
- Data collected included clinical presentation, prior infections, antibiotic treatments, diagnostic procedures (fine needle aspiration, ultrasound), and bacteriology.
- Treatment involved abscess drainage, intravenous antibiotics, and delayed tonsillectomy.
Main Results:
- The average age of affected children was 9.8 years.
- Eight children had a history of pharyngo-tonsillar infection.
- Bacteriological analysis revealed a predominance of Haemophilus influenzae and anaerobes in abscess pus and tonsillar core, with poor correlation to tonsillar surface isolates.
- All patients recovered without complications.
Conclusions:
- The increasing incidence of pediatric peritonsillar abscess may be associated with the use of inadequate antibiotic regimens.
- A clear link to acute tonsillar infections was not established, suggesting other etiological factors may be involved.
Objective:
Our objective was to evaluate the possible causes of the increased incidence of peritonsillar abscess in children during recent years, since up until now this condition has been unusual in children.
Patients And Methods:
A retrospective study of all cases diagnosed in the Emergency Room between 1983 and 1998 detected nine children admitted to the hospital with painful swallowing, high fever and trismus. All of them underwent fine needle aspiration and transcutaneous ultrasound.
Results:
The mean age was 9.8 years. Eight children suffered previous pharyngo-tonsillar infection, although emergency assistance was only confirmed in four cases. Six children were treated with macrolides, two with amoxicillin and one with cefuroxime. Exploration always diagnosed peritonsillar infection and needle aspiration detected an abscess in six cases. Ultrasound did not provide new information. In cases with abscess, drainage was performed and in three patients under general anesthesia. Bacteriologic cultures showed a lack of correlation between the isolates from the tonsillar surface and from pus from the abscess or tonsillar core. In the latter two there was a preponderance of Haemophilus influenzae and anaerobes. All children received intravenous antibiotic therapy and delayed tonsillectomy was done. There were no complications.
Conclusions:
Infant cases of peritonsillar abscess are increasing and there is no clear relationship with acute tonsillar infections, but probably with the use of inadequate antibiotics.
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