An evidence-based review of the treatment of peritonsillar

abscess

• Peritonsillar abscess (PTA) is a collection of pus within the space between the tonsil and the superior constrictor muscle, near the tonsil’s superior pole.

• It is associated with tonsillitis & comprises approximately 30% of soft tissue head and necka bscesses.

• PTA is most common in adolescents and young adults.

• The bacteriology Streptococcus sp.most common organism cultured.

Does the Use of Steroids as Adjuvant Treatment Improve Treatment

Outcome in PTA?

• a rct for severe, acute pharyngitis,8 in which the use of adjuvant steroids demonstrated benefit.

• The authors 1 dose of intramuscular dexamethasome (10 mg) faster improvement in throat pain than controls.

• PTA Needle aspiration, incision & drainage (I&D), and simultaneous tonsillectomy with open abscess drainage (or, “quinsy tonsillectomy”).

• Others I&D to be followed by tonsillectomy a few weeks latercalled “interval tonsillectomy.

Which Technique of Surgical Drainage

Has the Highest Success Rate?

Which Technique of Surgical Drainage

Has the Highest Success Rate?

• I&D is slightly more effective in initial success rate than needle aspiration (93.7% versus 91.6%), so the NNT was 47.6 patients, in favor of I&D.

What Is the Recurrence Rate of PTA and What Are the Indications for Elective Tonsillectomy to Prevent

Recurrence?

• The recurrence rate of PTA and the relative indications for tonsillectomy.

• The Kronenberg et al patients with a history of recurrent tonsillitis had a significantly greater risk of recurrent PTA than did patients with no history of recurrent tonsillitis (40% versus 10.5%, P 0.0001).

• Clinical research evidence not support or refute the use of steroids in PTA.

• The success rates with initial I&D or needle

• aspiration are both very high initial treatment.

• The overall recurrence rate of PTA is low, but in selected subgroups of patients, elective tonsillectomy may provide benefit by decreasing the risk of recurrent PTA.