Management of Peritonsillar Abscess in a Tertiary Hospital in Southwest Nigeria
Olusola Ayodele Sogebi ,Emmanuel Abayomi Oyewole
Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
Correspondence to: Dr Olusola A Sogebi, e-mail: firstname.lastname@example.org
Received: 16 Jun 2021; Revised: 25 Dec 2021; Accepted: 19 Jan 2022; Available online: 25 Mar 2022
Background: Peritonsillar abscess (PTA) occurs when pus accumulates in the peritonsillar space. There are controversies about the most adequate form of treatment. The objectives of this study were to describe the clinical profile of patients, PTA and bacteriological profile of aspirates, and management of PTA. Methods: This retrospective study included patients with PTA managed in a tertiary hospital. The clinico-demographic characteristics, oropharyngeal examination findings, including that of the tonsils, test aspiration of swelling, and culture results were documented. The treatment modalities, hospitalization period, and outcome were recorded. Results: Seventeen records of adults were available (mean age, 33.3±9.7 years; female, 58.8%). All patients presented with fever, odynophagia, and trismus within 3 days. Five (29.4%) had previous sore throat, 94.1% had previous medications, and 52.9% had the abscesses on the left side. Test aspirate yielded pus in 76.5% of patients, whereas 8 aspirates cultured micro-organisms; 70.6% of the patients had incision and drainage (I&D) of the abscess, and the average hospitalization period was 3 days. Most (94.1%) of the patients had favorable outcomes. Conclusion: PTA is common in adults, and they present early with classical symptoms. Purulent aspiration is usually positive, and patients are treated with I&D with antibiotic coverage, which leads to a generally good outcome.
Keywords: Bacteriology, Characteristics, Management, Peritonsillar abscess, Tonsillectomy
Ann Afr Surg. 2022; 19(2): 68-72
© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Peritonsillar abscess (PTA) occurs when pus accumulates in the peritonsillar space, which is located between the tonsillar capsule and the superior constrictor muscle. It is a common infection in pediatric, adolescent (1), and young adult population, especially among males (2). It has been attributed to be a common variety of deep neck infection (2, 3). PTA often occurs as a complication following episodes of acute tonsillitis (4), but it can also occur primarily on its own among in-patients without evidence of concurrent tonsillitis (5).
Patients with PTA present to general duty doctors and family physicians with symptoms suggestive of an oropharyngeal infection, such as high-grade fever, odynophagia, and distortions in the quality of voice, particularly muffled voice (3). Occasionally, PTA may present dramatically with partial upper airway obstruction, which will necessitate otolaryngological consultation and management. Although the bacteriology of most PTA is non-specific, culturing of pus aspirates often yields a polymicrobial mixture of pathological organisms (2), and identification of significant pathogens is challenging (2). Thus, the best combination of antibiotics to be used is debatable.
Traditionally, treatment of PTA involves drainage to evacuate the pus, along with use of systemic antibiotics, follow ed by interval tonsillectomy, which is performed after 6 weeks (3). There are, however, arguments regarding the optimal and best treatment modality.
The outcome of management differs according to geographical locations and hospital settings. The outcome may be related to the local characteristics and presentation of patients, bacteriological profile, and the modality of management.
The objectives of this study are to describe the clinical profile of patients and characterize PTA, document the bacteriological profile of the aspirate, and the management of PTA. We also noted the complications of PTA observed in our practice.
Patients and methods
This is a retrospective study of patients who were managed with PTA at the ENT department of a teaching hospital in southwest Nigeria within a period of 5 years from April 2016 to March 2021. PTA patients were identified clinically by an acute history of fever, dysphagia or odynophagia, and a unilateral bulge or swelling in the superolateral pole of an otherwise healthy tonsillar tissue.
The patients’ case notes were identified by manual search through the minor procedures records in the clinics and the wards admission record book. Information extracted from the case notes included the age, sex, presenting complaints, duration of symptoms before presentation, previous episodes of sore throat, whether medications were used prior to presentation, and presence of comorbidity. Physical examination records and findings on oropharyngeal examinations, particularly the side of the swelling (abscess) and the condition of the tonsils, findings on test aspiration of the abscess, and the culture results of the aspirates were noted. The major treatment modalities deployed, duration of hospitalization, and the outcome were also recorded.
The data of patients with lost or inadequate important information, those that had previous foreign body (especially fish bone) impaction in the oropharynx, and those with previous neck swellings and infective cervical lymphadenitis were excluded.