Comparison of Medical Versus Surgical Management of Peritonsillar Abscess: A Retrospective Observational Study

Área: Hospitalar


Daniel Cabrera
Waqas Gilani
Matthew L. Carlson
Ronna L. Campbell
Fernanda Bellolio

Introduction: Peritonsillar abscess (PTA) is the most common deep neck space infection, accounting, in the United States, for approximately 60,000 visits annually to the emergency department (ED), from which 22% are admitted to the hospital. Our objective is to compare clinical characteristics and outcomes in patients presenting with PTA treated with either initial medical or surgical management on the ED. 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, qui squared, 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 upfront surgical treatment. Patients on the surgical group were slightly older (mean age 23.5 vs 22 years, p = 0.03); there was no difference by gender (p = 0.42). Regarding presenting symptoms and laboratory findings we found no difference in sore throat (p = 1.0), throat swelling (p = 0.78), neck pain (p = 0.55), neck swelling (p = 0.24), history of prior episodes (p = 0.84), elevated white blood count (p = 0.09) or presence of immunosuppression (8% vs 6%, p = 0.36). However, those who received initial surgical management had larger abscess size (2.6 vs. 1.3 cm, P < 0.001) and were and more likely to have muffled voice (79% vs. 47%, P < 0.001), drooling (29% vs. 17%, P = 0.03), peritonsillar bulge (91% vs. 66%, P < 0.001), trismus (65% vs. 22%, P < 0.001), uvular deviation (70% vs. 29%, P < 0.001), and dysphagia (86% vs. 73%, P = 0.008). 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 = 0.27) or complications (1% vs. 2%, P = 0.6). Patients treated medically were more likely to be admitted to the hospital (22% vs. 11%, P = 0.014) and less likely to receive steroids (78% vs. 95%, P < 0.001). There was no difference in return visits (20% medical vs. 14% surgical, P = 0.17) or failure rates (5% medical vs. 3% surgical, P = 0.30). Conclusions: Initial edical 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.