Healthcare aspects of peritonsillar infection before and during the COVID-19 pandemic

Abstract

Introduction

This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI).

Materials and methods

In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded.

Results

From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24 h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases.

Conclusions

The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.

Resumen

Introducción

Este estudio trata de valorar la repercusión de la pandemia sobre la incidencia y la evolución clínica de la infección periamigdalina (IPA).

Material y métodos

Revisamos en un seguimiento longitudinal y descriptivo retrospectivo las circunstancias de los pacientes atendidos durante 5 años, de 2017 a 2021, en dos hospitales, uno comarcal y otro terciario. Se registraron variables relacionadas con la patología de base, antecedentes de amigdalitis, tiempo de evolución, visitas previas en Atención Primaria, hallazgos en el diagnóstico, relación absceso/flemón y días de estancia hospitalaria.

Resultados

De 2017 a 2019 la incidencia de la enfermedad osciló entre 14 y 16 casos/100.000 habitantes-año, pero en 2020 se redujo a 9,3, un 43% menos. Los pacientes con IPA que consultaron en pandemia generaron pocas visitas previas en servicios de Atención Primaria, presentaron mayor severidad de los síntomas y mayor demora en el diagnóstico. Además, hubo más abscesos que flemones y la necesidad de ingreso hospitalario superior a 24 h fue del 66%. Apenas hubo causalidad con amigdalitis agudas, aunque el 66% de los pacientes padecía amigdalitis de repetición, y el 71% patología concomitante. Todos estos hallazgos mostraron diferencias estadísticamente significativas respecto a los casos prepandemia.

Conclusiones

La protección de la transmisión aérea, el distanciamiento social y el confinamiento adoptados en nuestro país son medidas que han podido modificar la evolución de la IPA, con una incidencia muy inferior, un período de recuperación mayor y mínima relación con amigdalitis aguda.