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Peritonsillar abscess or cellulitis? A clinical comparative paediatric study
1Department of Otolaryngology, McGill University, Montreal Children's Hospital, Quebec.
Insights
Peritonsillar sepsis (PTS) in children, including peritonsillar abscess (PTA) and cellulitis (PTC), is best diagnosed using clinical signs like trismus. Needle aspiration for PTA may increase recurrence compared to incision and drainage.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Head and Neck Surgery
Background:
- Peritonsillar sepsis (PTS) is the most frequent deep neck infection in children, encompassing peritonsillar abscess (PTA) and cellulitis (PTC).
- Understanding the clinical distinctions and management strategies for PTS in pediatric patients is crucial.
Purpose of the Study:
- To analyze clinical features, diagnostic methods, and treatment outcomes for peritonsillar sepsis in children.
- To differentiate between peritonsillar abscess and cellulitis based on clinical presentation and to suggest a management algorithm.
Main Methods:
- Retrospective review of 185 pediatric cases of peritonsillar sepsis treated at Montreal Children's Hospital over 10 years.
- Inclusion of data on symptoms, signs, laboratory results, radiological findings, and therapeutic interventions.
Main Results:
- Out of 185 cases, 75 were diagnosed with peritonsillar cellulitis (PTC), and the remainder with peritonsillar abscess (PTA).
- Trismus was the sole symptom statistically linked to PTA. Combined trismus and uvular deviation aided in distinguishing PTA from PTC.
- Streptococcus pyogenes group A was the predominant bacteria cultured, with a lower incidence of anaerobic bacteria observed.
Conclusions:
- Clinical presentation, particularly trismus and uvular deviation, is key for differentiating PTA from PTC in children.
- Children with a history of recurrent tonsillitis showed a higher rate of PTS recurrence.
- Needle aspiration for PTA was associated with increased recurrence rates compared to incision and drainage; a management algorithm is proposed.
Objective:
Peritonsillar sepsis (PTS) can be divided into abscess and cellulitis. It is the most common deep neck infection in the paediatric age group. In this article we discuss the clinical issues related to peritonsillar sepsis in children.
Method:
This study involves 185 cases of peritonsillar that were treated at the Montreal Children's Hospital in the last 10 years. The symptoms, signs, laboratory and radiological data as well as the medical and surgical therapies are included.
Results:
Seventy-five cases were peritonsillar cellulitis (PTC) and the rest were abscesses. The age at presentation varied between 2.5 months and 18 years. The majority of the cases diagnosed as peritonsillar abscess (PTA) occurred from age 12 to 18 years. Trismus was the only complaint that was statistically associated with PTA. Uvular deviation combined with trismus was also important in differentiating PTA from PTC. Our data revealed a lower percentage of anaerobic bacteria and the majority of cultures grew Streptococcus pyogenes group A.
Conclusions:
Clinical picture is important in differentiating PTA from PTC. Recurrence of peritonsillar sepsis was higher in children with a history of recurrent tonsillitis. Needle aspiration of PTA resulted in a higher incidence of recurrence compared to incision and drainage. A management algorithm is suggested for the child presenting with peritonsillar sepsis.