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Peritonsillar and parapharyngeal space abscess in the older adult
Christine B Franzese1, Jon E Isaacson
1Division of Otolaryngology, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
Insights
Peritonsillar (PTA) and parapharyngeal space abscesses (PPSA) are rare in older adults. New sore throat and dysphagia in patients over 50 warrant investigation, as PTA may require hospitalization and surgery.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Geriatric Medicine
Background:
- Peritonsillar abscess (PTA) and parapharyngeal space abscess (PPSA) are deep neck space infections.
- These infections are typically seen in younger individuals, with less data on presentation and management in older adults.
Purpose of the Study:
- To review the clinical presentation and management of PTA and PPSA in patients aged 50 and older.
- To compare the findings in older adults with the typical presentation and management in younger patients.
Main Methods:
- Retrospective review of an 18-year period (1983-2001) at a tertiary care hospital.
- Database search using diagnosis codes for PTA and PPSA, including inpatient and outpatient visits.
- Chart review to record data on presentation, management, and outcomes, with comparison to existing literature.
Main Results:
- Fourteen patients (8 PTA, 6 PPSA) aged 50+ were identified.
- Sore throat and dysphagia were the most common symptoms; fever, trismus, and drooling were infrequent.
- Five PTA patients required inpatient care, and two underwent surgical intervention.
Conclusions:
- PTA and PPSA are uncommon in older adults.
- New-onset sore throat and dysphagia in patients over 50 should raise suspicion for PTA/PPSA, even without fever or toxicity.
- PTA in this demographic may have a higher likelihood of requiring inpatient admission and surgical management.
Objective:
To review the presentation and management of peritonsillar (PTA) and parapharyngeal space (PPSA) abscesses in older adults and compare this with the usual presentation and management in the younger patient.
Study Design:
An 18-year retrospective review at a tertiary care hospital.
Methods:
The patient database was searched by using the diagnosis codes for PTA and PPSA. The search included inpatient and outpatient visits of patients 50 years of age and older from 1983 to 2001. The charts were reviewed, and data regarding presentation, management, and outcome were recorded. Comparisons to the current literature were made.
Results:
Fourteen patients were identified, 8 with PTA and 6 with PPSA. The most common symptoms in both groups were sore throat and dysphagia. Only 1 patient in either group was febrile. All vital signs were within normal limits in all other patients. Only 1 patient in each group experienced trismus, and no patients showed drooling. Five of the PTA patients required inpatient care, and 2 were taken to the operating room.
Conclusions:
PTA and PPSA are uncommon infections in the older adult, with only 14 patients identified at a tertiary care hospital over an 18-year period. Complaints of new onset sore throat and dysphagia of several days duration in patients over 50 years old should alert the evaluating physician to these 2 clinical entities, even in afebrile, nontoxic patients. PTA in this group may be more likely to require inpatient care along with surgical treatment in the operating room.