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CC BY-NC-ND 4.0 · International Journal of Practical Otolaryngology 2024; 07(01): e8-e15
DOI: 10.1055/s-0044-1782146
Original Article

Clinical Study of 162 Cases of Peritonsillar Abscess Diagnosed by Contrast-Enhanced Computed Tomography

Tadahiko Saiki
1   Department of Otorhinolaryngology, Himeji St. Mary's Hospital, Hyogo, Japan
,
Teruhiro Ogawa
1   Department of Otorhinolaryngology, Himeji St. Mary's Hospital, Hyogo, Japan
,
Takenori Haruna
1   Department of Otorhinolaryngology, Himeji St. Mary's Hospital, Hyogo, Japan
,
Kazuaki Kuroda
2   Kuroda ENT Aki Clinic, Japan
› Author Affiliations Funding None.
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Abstract

In this retrospective clinical study of peritonsillar abscesses, we reviewed the data of 162 patients (116 males and 46 females) with peritonsillar abscess aged 8 to 86 years (mean age, 37.0 years) who had been diagnosed by contrast-enhanced computed tomography (CT), hospitalized, and treated for the abscess between January 2017 and December 2022. The abscess occurred on the left side in 72 (44.4%) patients, on the right side in 80 (49.4%) patients, and bilaterally in 10 (6.2%) patients. The abscess was of the superior oval type on 85 (49.4%) sides, the superior cap type on 41 (23.8%) sides, the inferior oval type on 25 (14.5%) sides, and the inferior cap type on 21 (12.2%) sides. Among 111 patients, bacteriological examination of the abscess fluid for the causative bacteria yielded 78 causative strains, including 24 strains of aerobic bacteria, predominantly Streptococcus pyogenes (51.6%), and 47 strains of anaerobic bacteria; the remainder were mixed bacterial strains. Bacterial resistance rates to antibiotics were as follows: 5.8% for piperacillin, 3.4% for ceftriaxone, 2.6% for meropenem, 11.5% for clindamycin, 28.6% for levofloxacin, and 15.4% for minocycline. Of the 162 patients, 83 (48.3%) were treated by incision, 25 (14.5%) by puncture, 62 (36.0%) with antibiotics, and 2 (1.2%) via abscess tonsillectomy. The most frequently used antibiotics (87.2% cases) were ampicillin/sulbactam combined with clindamycin and/or dexamethasone. The peritonsillar abscess recurred in 14 (8.6%) patients, and the recurrence occurred within 3 months of the initial onset in 8 (57.1%) of these patients. In conclusion, contrast-enhanced CT should be performed to accurately diagnose the location, size, and shape of a peritonsillar abscess and select the optimal treatment.

Keywords

peritonsillar abscess - contrast-enhanced CT - bacteriological examination - ampicillin/sulbactam


Publication History

Received: 17 August 2023

Accepted: 02 November 2023

Article published online:
04 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ohori J, Umakoshi M, Miyashita K, Hayamizu Y, Harada M, Kurono Y. Computed tomography image analysis of peritonsillar abscess [in Japanese]. Nihon Jibiinkoka Gakkai Kaiho 2013; 116 (08) 947-952
    CrossrefPubMedGoogle Scholar
  • 2 Saiki T, Sakaki M, Watanabe F. Clinical study of 215 cases of peritonsillar abscess. Oto-Rhino-Laryngologica 2010; 103: 1021-1027
    CrossrefPubMedGoogle Scholar
  • 3 Bando N, Goto T. A retrospective study of peritonsillar abscess. The J Jpn Soc Infect Aerosol Orl 2017; 5: 5-10
    PubMedGoogle Scholar
  • 4 Adachi M, Tobita T, Akizuki H. A study on 140 hospitalized patients with peritonsillar abscess. Oto-Rhino-Laryngologica 2019; 112: 47-53
    CrossrefPubMedGoogle Scholar
  • 5 Koizumi S, Watanabe K, Ishigaki K, Unuma M, Oda K, Oyama K. Peritonsillar abscess: a retrospective analysis of 210 cases. Nihon Jibiinkoka Gakkai Kaiho 2021; 124: 1013-1020
    CrossrefPubMedGoogle Scholar
  • 6 Miyagi M, Miyamoto Y, Kai T. et al. Clinical study of hospitalized patients with peritonsillar abscess. Otologia Fukuoku 2022; 68: 258-265
    PubMedGoogle Scholar
  • 7 Matsuoka A, Shitara T, Yao K. et al. A clinical study of peritonsillar abscess. The J Jpn Soc Tonsil Problem 1989; 28: 162-168
    PubMedGoogle Scholar
  • 8 Kato H, Wada I, Nakada H. et al. A clinical and statistical study of admitted peritonsillar abscess cases. Stomato-Pharyngol 2006; 18: 421-428
    PubMedGoogle Scholar
  • 9 Oka A, Makihara S. Study of CT findings and clinical course of peritonsillar abscesses. J Jpn Bronchoesophagol Soc 2017; 68: 217-221
    CrossrefPubMedGoogle Scholar
  • 10 Umibe A, Anazawa U, Kessoku H. et al. Clinical analyses of 115 patients with peritonsillar abscess. Nihon Jibiinkoka Gakkai Kaiho 2015; 118 (10) 1220-1225
    CrossrefPubMedGoogle Scholar
  • 11 Wakisaka R, Kumai T, Kishibe K. et al. Clinical study of 107 hospitalized patients with peritonsillar abscess. Int J Pract Otolaryngol 2021; 4: e11-e16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Kanebayashi H, Ogawa Y, Yamanishi T. et al. Clinical investigation of the peritonsillar abscess. O.R.L. Tokyo 2003; 46: 284-288
    PubMedGoogle Scholar
  • 13 Kraitrakul S, Sirithunyaporn S, Yimtae K. Distribution of minor salivary glands in the peritonsillar space. J Med Assoc Thai 2001; 84 (03) 371-378
    PubMedGoogle Scholar
  • 14 Passy V. Pathogenesis of peritonsillar abscess. Laryngoscope 1994; 104 (02) 185-190
    CrossrefPubMedGoogle Scholar
  • 15 Kawabata M, Umakoshi M, Matsumoto H. et al. The clinical characteristics of inferior pole peritonsillar abscesses. Stomato-Pharyngol 2018; 31: 187-192
    PubMedGoogle Scholar
  • 16 Suzuki K, Kurono Y, Ikeda K. et al. The sixth nationwide surveillance of clinical isolates from patients with six otolaryngological field infections and antimicrobial susceptibility pattern in the isolated pathogens in Japan. The J Jpn Soc Infect Aerosol Orl 2020; 8: 193-211
    PubMedGoogle Scholar
  • 17 Maruyama Y, Tsukada Y, Kitagawa Y, Yoshikawa T, Kojima S, Yoshizaki T. Usefulness of abscess tonsillectomy for the treatment of severe peritonsillar abscess. Nihon Jibinkoka Tokeibugeka Gakkai Kaiho 2021; 124: 1398-1405
    CrossrefPubMedGoogle Scholar
  • 18 Kobayashi K, Imai R. Study of both the axial length of the peritonsillar abscess and the clinical course by the method of treatment. Stomato-Pharyngol 2014; 27: 81-86
    PubMedGoogle Scholar
  • 19 Aoi N. The indication for and the limit of needle aspiration or incision and drainage for the treatment of peritonsillar abscess. Stomato-Pharyngol 2013; 26: 1-6
    PubMedGoogle Scholar
  • 20 Hagiwara Y, Kikuchi T, Akasu Y. et al. Transoral pharyngeal ultrasonography guiding puncture for peritonsillar abscess: the application of transoral carotid ultrasonography. Neurosonology 2020; 33: 45-49
    CrossrefPubMedGoogle Scholar
  • 21 Kobayashi K, Imai R. Clinical investigation of peritonsillar abscess and CT findings (3rd Report). Stomato-Pharyngol 2013; 26: 131-136
    PubMedGoogle Scholar
  • 22 Takahashi T, Arai K, Lee DH. et al. Epidemiological study of erythromycin-resistant Streptococcus pyogenes from Korea and Japan by emm genotyping and multilocus sequence typing. Ann Lab Med 2016; 36 (01) 9-14
    CrossrefPubMedGoogle Scholar
  • 23 Yano H. Peritonsillar abscess-causing bacteria and selection of antimicrobials. Johns 2022; 38: 1435-1437
    PubMedGoogle Scholar
  • 24 Suzuki K. Countermeasures against AMR in the treatment of neck infections. Johns 2021; 37: 823-825
    PubMedGoogle Scholar
  • 25 Bando N, Harabuchi Y. Abscess management and pitfalls. Abscess in the oral floor and Ludwig's angina (cellulitis of the floor of the mouth). J Jpn Soc H&N Surg 2015; 87: 134-140
    PubMedGoogle Scholar