Saturday, September 22, 2012

Treating Tonsil Abscesses with Immediate Tonsillectomy

In the current issue of Acta Oto-Laryngologica, Drs. Nicolas Albertz and Gonzalo Nazar summarized 10 years of experience in treating patients with abscesses around the tonsil region (known as peritonsillar abscesses). An abscess is a well-defined collection of pus that has escaped from blood vessels and has been deposited on tissues or in tissue surfaces.

One or both tonsils can become infected and develop an abscess. These types of abscesses are actually the most common infections in the deep part of the neck. A common form of treatment is to cut into the abscess and drain the pus. However, Drs, Albertz and Nazar provide evidence that immediate surgical removal of the tonsils (tonsillectomy) is a safe and effective alternative treatment based on reviewing 10 years worth of patients (total =112 people, average age = 24 years) with this condition who had one tonsil (28 patients) or both tonsils removed.

Of the patients who received the surgery, none developed sepsis, which is a potentially deadly whole-body inflammatory response to infection. Only four (3.6%) of the patients developed bleeding after the operation and of these, two resolved spontaneously. Only 29% of the patients had enough pain that they needed to use a pump to self-administer morphine after surgery for pain relief. The average hospital length was 3.4 days. Of the 28 patients who had one tonsil removed, four (14.2%) developed a strept infection of the tonsils. Two of the 28 patients (7.1%) were admitted to the hospital again with inflammation around the tonsil area on the side that was not operated on. Only one of these patients required drainage and removal of the other tonsil. The authors concluded that the complication rate of the immediate tonsillectomy in these patients was similar to that of scheduled tonsillectomies in adults and that this should be considered a first-line treatment for peritonsillar abscesses.

Reference: Albertz, A. & Nazar, G. (2012). Peritonsillar abscess: Treatment with immediate tonsillectomy –10 years of experience. Acta Oto-Laryngologica, 132, 1102-1107.

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