Letter to the Editor
Comments on Peritonsillar Infections: A Prospective Study of 100 Consecutive Cases
Comentario sobre las infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos
Francisco Javier García-Callejo
, Vicente Escorihuela-García, Ignacio Pla-Gil, Jordi Calvo-Martínez
Corresponding author
Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Our centre offers tertiary healthcare coverage for a population of 350<span class="elsevierStyleHsp" style=""></span>000 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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore, we observed that our percentage of peritonsillar abscesses was greater than that presented by Costales-Marcos et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> without reaching that reported by other communications.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3,4</span></a> the opening of the suppurative collection ensures focal detoxification.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></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%).</p><p id="par0030" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">2,5</span></a> which is adequately tested in the training period of resident physicians, equally simple and with a low cost.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Recommending admission for 1 night, hospital stay in 772 patients with peritonsillar infection was not more than 24<span class="elsevierStyleHsp" style=""></span>h, with a mean period of 40<span class="elsevierStyleHsp" style=""></span>h, still higher than that reported by other authors.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></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 <span class="elsevierStyleItalic">Streptococcus</span> spp. and anaerobes should not be delayed by days.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Corticosteroid therapy rapidly relieves trismus by pterygoid irritation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">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.</p>" ] ] "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. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2021 January | 0 | 3 | 3 |
| 2020 December | 0 | 1 | 1 |
| 2020 September | 0 | 2 | 2 |
| 2020 August | 0 | 1 | 1 |
| 2020 March | 4 | 4 | 8 |
| 2020 February | 3 | 6 | 9 |
| 2020 January | 9 | 7 | 16 |
| 2019 December | 18 | 7 | 25 |
| 2019 November | 5 | 8 | 13 |
| 2019 October | 4 | 4 | 8 |
| 2019 September | 16 | 2 | 18 |
| 2019 August | 10 | 3 | 13 |
| 2019 July | 12 | 8 | 20 |
| 2019 June | 31 | 5 | 36 |
| 2019 May | 33 | 10 | 43 |
| 2019 April | 7 | 9 | 16 |
| 2019 March | 5 | 5 | 10 |
| 2019 February | 5 | 6 | 11 |
| 2019 January | 5 | 4 | 9 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 7 | 3 | 10 |
| 2018 October | 10 | 3 | 13 |
| 2018 May | 1 | 0 | 1 |
| 2018 April | 4 | 1 | 5 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 1 | 0 | 1 |
| 2018 January | 3 | 0 | 3 |
| 2017 December | 1 | 0 | 1 |
| 2017 November | 3 | 1 | 4 |
| 2017 October | 5 | 0 | 5 |
| 2017 September | 4 | 0 | 4 |
| 2017 August | 6 | 2 | 8 |
| 2017 July | 14 | 2 | 16 |
| 2017 June | 19 | 2 | 21 |
| 2017 May | 1 | 0 | 1 |
| 2017 April | 9 | 1 | 10 |
| 2017 March | 9 | 1 | 10 |
| 2017 February | 5 | 0 | 5 |
| 2017 January | 4 | 0 | 4 |
| 2016 December | 9 | 10 | 19 |
| 2016 November | 19 | 8 | 27 |
| 2016 October | 28 | 12 | 40 |
| 2016 September | 18 | 4 | 22 |
| 2016 August | 20 | 7 | 27 |
| 2016 July | 15 | 2 | 17 |
| 2016 June | 18 | 22 | 40 |
| 2016 May | 23 | 15 | 38 |
| 2016 April | 24 | 11 | 35 |
| 2016 March | 21 | 20 | 41 |
| 2016 February | 18 | 18 | 36 |
| 2016 January | 25 | 17 | 42 |
| 2015 December | 19 | 15 | 34 |
| 2015 November | 15 | 14 | 29 |
| 2015 October | 24 | 21 | 45 |
| 2015 September | 8 | 5 | 13 |
| 2015 August | 10 | 11 | 21 |
| 2015 July | 11 | 4 | 15 |
| 2015 June | 5 | 6 | 11 |
| 2015 May | 15 | 7 | 22 |
| 2015 April | 11 | 8 | 19 |
| 2015 March | 20 | 8 | 28 |
| 2015 February | 10 | 1 | 11 |
| 2015 January | 31 | 5 | 36 |
| 2014 December | 25 | 4 | 29 |
| 2014 November | 18 | 3 | 21 |
| 2014 October | 21 | 5 | 26 |
| 2014 September | 22 | 3 | 25 |
| 2014 August | 13 | 3 | 16 |
| 2014 July | 27 | 4 | 31 |
| 2014 June | 11 | 2 | 13 |
| 2014 May | 19 | 3 | 22 |
| 2014 April | 13 | 2 | 15 |
| 2014 March | 6 | 6 | 12 |
| 2014 February | 7 | 2 | 9 |
| 2014 January | 7 | 2 | 9 |
| 2013 December | 14 | 1 | 15 |
| 2013 November | 11 | 2 | 13 |
| 2013 October | 19 | 7 | 26 |
| 2013 September | 22 | 3 | 25 |
| 2013 August | 9 | 1 | 10 |
| 2013 July | 5 | 2 | 7 |
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