Comments on Peritonsillar Infections: A Prospective Study of 100 Consecutive Cases

García-Callejo, Francisco Javier; Escorihuela-García, Vicente; Pla-Gil, Ignacio; Calvo-Martínez, Jordi

doi:10.1016/j.otoeng.2012.08.001

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Our centre offers tertiary healthcare coverage for a population of 350000 and we can corroborate the epidemiological aspects reported by the authors regarding the distribution by age and gender, relationship with acute pharyngotonsillitis, second episodes and time between onset of symptoms and consultation.We conducted a prospective monitoring from January 2005 until June 2012, which allowed us to collect 812 cases and observe an increase in incidence (from 75 in 2005 to 129 in 2011), the appearance of bilaterality in 1.4%, and a similar amount of phlegmonous and abscessified forms (49.1% vs 50.9%). Adequate and direct training of colleagues in primary care has failed to reverse this trend. This implies that the symptoms are unpredictable, even in a context of immunosuppression as discussed by other authors.Therefore, we observed that our percentage of peritonsillar abscesses was greater than that presented by Costales-Marcos et al.,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> without reaching that reported by other communications.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The diagnosis of peritonsillar abscess in our environment has been established according to puncture-aspiration of suppurative collections or to the presence thereof through incision and drainage of the suspicious region under pulverised topical anaesthesia, despite obtaining a negative puncture.Out of 398 cases diagnosed with abscesses, puncture was negative in 87 cases. Whilst also assuming a significant anaerobic component in the aetiopathogenesis of the disorder,<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> the opening of the suppurative collection ensures focal detoxification.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Peritonsillar abscesses point to the prestyloid space and, although this muscular diaphragm tends to protect the large vessels, it lacks a defined anatomical limit which prevents caudal progression. Our series included 8 cases with parapharyngeal collection (1.3%) and 2 with mediastinal involvement (0.2%).These small percentages, the detection of 21.8% of abscesses through incision-drainage and the clinical verification of immediate improvement following drainage, strongly recommended this manoeuvre,<a class="elsevierStyleCrossRefs" href="#bib0010">2,5</a> which is adequately tested in the training period of resident physicians, equally simple and with a low cost.Recommending admission for 1 night, hospital stay in 772 patients with peritonsillar infection was not more than 24h, with a mean period of 40h, still higher than that reported by other authors.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Patients were treated with amoxicillin-clavulanate and clindamycin, along with intravenous steroid support from the time of admission. The empiricism of antibiotic therapy is due to the frequent absence of any isolates caused by prior antimicrobial therapy, as well as easy contamination with oxygen of anaerobic suppurations. In general, coverage against Streptococcus spp. and anaerobes should not be delayed by days.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a> Corticosteroid therapy rapidly relieves trismus by pterygoid irritation.Upon discharge it is only necessary to extend this antibiotic treatment for 1 week orally, in a similar way as reported by the authors. The incidence of a second abscess or peritonsillar phlegmon remains at 4.5% of cases, but hospital stay and cost are optimised accordingly." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: García-Callejo FJ, et al. Comentario sobre las infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos. Acta Otorrinolaringol Esp. 2013;64:85–6." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Costales-Marcos" 1 => "F. López-Álvarez" 2 => "F. Núñez-Batalla" 3 => "C. Moreno-Galindo" 4 => "C. Álvarez-Marcos" 5 => "J.L. 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ISSN: 2173-5735

Acta Otorrinolaringológica Española, the official publication of the Spanish Society of Otolaryngology and Head and Neck Surgery and the Ibero-American Society of Otorhinolaryngology, is the most important journal in Spanish dedicated to Otorhinolaryngology, which reflects the continuous scientific and technical progress of the specialty. It has become an important tool to be kept up to date. The Journal publishes Original Articles (articles on basic research and clinical investigation), reviews, brief communications, case studies and images, which are subjected to a rigorous peer review process.

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Acta Otorrinolaringológica Española has received its first journal Impact Factor (JCR) in 2023. Instructions for authors - Submit an article

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

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Impact factor 2023

0.9

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

1.4

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.326

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.54

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Journal Information

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Vol. 64. Issue 1.