Diseases associated with subsequent peritonsillar abscess: a case-control-study from ENT practices in Germany

Area of Science:

• Otolaryngology
• Infectious Diseases
• Epidemiology

Background:

• Peritonsillar abscess (PTA) is a frequent deep soft tissue infection in the head and neck, often requiring surgical intervention.
• The exact etiology of PTA remains debated, with hypotheses including tonsillar infections or inflammation of other structures like Weber's glands.

Purpose of the Study:

• To investigate the pre-diagnoses associated with the subsequent development of peritonsillar abscess (PTA).
• To identify potential causal pathways for PTA to inform therapeutic strategies, such as tonsillectomy versus incision and drainage.

Main Methods:

• Utilized a nationally representative German practice database (IQVIA™ Disease Analyzer) from 2005-2022.
• Included patients aged 18+ with a first PTA diagnosis, matched 1:5 with controls.
• Analyzed prior diagnoses (ICD-10) within 12 months pre-PTA using multivariable logistic regression and sensitivity analysis.

Main Results:

• Acute tonsillitis showed the strongest association with PTA (OR: 6.71 in MLR; OR: 5.02 in SA).
• Chronic tonsillitis (OR: 2.00 MLR; OR: 1.87 SA) and acute pharyngitis (OR: 1.74 MLR; OR: 1.27 SA) were also significantly associated with PTA.
• Results were consistent across both multivariable logistic regression and sensitivity analyses.

Conclusions:

• Acute tonsillitis is the most significant pre-diagnosis linked to peritonsillar abscess.
• The association with acute pharyngitis suggests potential non-tonsillogenic origins of PTA.
• The study highlights limitations in capturing all PTA causes (e.g., gland inflammation) within current coding systems.