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Empiric treatment for peritonsillar abscess: A single-center experience with medical therapy alone
Aaron L Zebolsky1, John Dewey1, Emma Jane Swayze1
1Western Michigan University, Homer Stryker M.D. School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States of America.
Purpose:
Compare the use of medical therapy alone (MTA) with surgical therapy (ST) for the empiric treatment of peritonsillar abscess (PTA).
Materials And Methods:
A consecutive cohort of patients treated for PTA at our institution from May 2013 to February 2019 was analyzed. Demographics, disease characteristics, management strategies, and treatment outcomes were compared between treatment groups. Primary outcomes included treatment failure, defined as the need for follow-up surgical intervention, and complications within 2-weeks of empiric treatment.
Results:
306 patients (72.7%) received MTA while 115 (27.3%) underwent ST. There was no significant difference in the rate of treatment failure between the MTA (7.2%) and ST (6.1%) groups (p = 0.879). Complications were rare in both groups (1.6% with MTA versus 0.9% with ST; p = 0.898). Dysphagia (p = 0.011), trismus (p = 0.045), larger abscesses (p < 0.001), and hospital admission (p < 0.001) were more common in the ST group. Corticosteroid prescriptions were a common component of MTA (53.3%) and less often used with ST (33.9%; p = 0.001). After adjusting for abscess size, there remained no significant difference in the rate of treatment failure between groups. Univariate analyses demonstrated no significant independent predictors of treatment failure including age, sex, race, tonsillitis history, smoking history, presenting signs and symptoms, abscess size, hospital admission, and corticosteroid prescriptions.
Conclusions:
MTA may be a safe and effective alternative to surgical drainage for the empiric treatment of PTA, warranting larger-scale prospective analyses. Abscess size did not appear to influence treatment failure; however, careful patient selection is likely to optimize treatment outcomes.
Insights
Medical therapy alone (MTA) is a safe and effective alternative to surgical therapy (ST) for peritonsillar abscess (PTA). Treatment failure and complications were similar between groups, suggesting MTA can be considered for empiric PTA treatment.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Infectious Diseases
Background:
- Peritonsillar abscess (PTA) is a common complication of tonsillitis.
- Treatment typically involves surgical drainage, but medical management is an alternative.
Purpose of the Study:
- To compare the efficacy and safety of medical therapy alone (MTA) versus surgical therapy (ST) for empiric treatment of PTA.
Main Methods:
- Retrospective analysis of 421 patients treated for PTA between May 2013 and February 2019.
- Comparison of treatment failure rates, complications, and clinical characteristics between MTA and ST groups.
Main Results:
- No significant difference in treatment failure (MTA 7.2% vs. ST 6.1%) or complications (MTA 1.6% vs. ST 0.9%) between groups.
- Dysphagia, trismus, larger abscess size, and hospital admission were more frequent in the ST group.
- Abscess size did not independently predict treatment failure.
Conclusions:
- Medical therapy alone (MTA) is a viable and safe alternative to surgical drainage for empiric PTA treatment.
- Patient selection is crucial for optimizing outcomes with MTA.
- Further large-scale prospective studies are warranted.
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Classification
Acute pharyngitis can be categorized based on its underlying cause:
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Three primary contributing factors have been identified.
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Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...