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Comparison of medical versus surgical management of peritonsillar abscess: A retrospective observational study
Author(s) -
Souza Dante L. S.,
Cabrera Daniel,
Gilani Waqas I.,
Campbell Ronna L.,
Carlson Matthew L.,
Lohse Christine M.,
Bellolio M. Fernanda
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25960
Subject(s) - medicine , peritonsillar abscess , trismus , retrospective cohort study , drooling , surgery , abscess
Objectives/Hypothesis To compare clinical characteristics and outcomes in patients presenting with peritonsillar abscess (PTA) treated with either initial medical or surgical management. Study Design Retrospective observational cohort. Methods A consecutive cohort of patients presenting between 2010 and 2014 with the final diagnosis of PTA ( International Classification of Diseases, Ninth Revision code 475) were included. Comparisons between groups were evaluated using two‐sample t , Wilcoxon rank sum, χ 2 , and Fisher exact tests. Results Among 297 patients who presented with PTA during the 5‐year period, 97 (33%) underwent primary medical management, and 200 (67%) received surgical treatment. Patients who received initial surgical management had larger abscess size (2.6 vs. 1.3 cm, P < .001) and were and more likely to have muffled voice (79% vs. 47%, P < .001), drooling (29% vs. 17%, P = .03), peritonsillar bulge (91% vs. 66%, P < .001), trismus (65% vs. 22%, P < .001), and dysphagia (86% vs. 73%, P = .008). There was no difference in the rates of imaging (55% vs. 59%) or antibiotic administration (100% in both groups), length of hospital stay (median 2 vs. 1 day, P = .27) or complications (1% vs. 2%, P = .6). Patients treated medically were more likely to be admitted to the hospital (22% vs. 11%, P = .014) and less likely to receive steroids (78% vs. 95%, P < .001). There was no difference in return visits (20% medical vs. 14% surgical, P = .17) or failure rates (5% medical vs. 3% surgical, P = .30). Conclusions Initial medical management can be considered in patients with less advanced symptoms or smaller abscess size without compromising outcome. Those with more advanced symptoms may benefit from surgical drainage. Level of Evidence 4. Laryngoscope , 126:1529–1534, 2016