BACKGROUND AND OBJECTIVES: Diagnostic features of peritonsillar abscess are an asymmetrically enlarged palatine tonsil with peripheral rim enhancement and central low density in the post-contrast computed tomography (CT). Although it is necessary to differentiate tumorous conditions of tonsils to compare pre- and post-contrast CT, pre-contrast CT may be less useful in the diagnosis of peritonsillar abscess. This study aims to evaluate of the efficacy of single post-contrast CT for diagnosis and treatment of peritonsillar abscess. SUBJECTS AND METHOD: We retrospectively compared 29 patients with peritonsillar abscess, who were diagnosed by single post-contrast CT, with 36 patients diagnosed by pre- and post-contrast CT to determine the success rates of pus drainage and hospital days. Additionally, two otorhinolaryngologists made a judgment of abscess presence for sixty randomly mixed CT images of peritonsillar abscess or tonsillitis with pre- and post-contrast CT or single post-contrast CT. RESULTS: There were no significant differences in the success rate of drainage (p=0.622) and hospital days (p=0.504) between groups with/without pre-contrast CT. Abscess presence was judged by raters with/without pre-contrast CT. Inter-rater agreement value (Cohen's kappa) was 0.825 (p<0.01). CONCLUSION: Single post-contrast CT of peritonsillar abscess may be a good alternative for diagnosis and treatment and may reduce unnecessary exposure to radiation.
Abscess ; Contrast Media ; Diagnosis ; Drainage ; Humans ; Judgment ; Methods ; Palatine Tonsil ; Peritonsillar Abscess ; Retrospective Studies ; Sensitivity and Specificity ; Suppuration ; Tonsillitis

Gossypiboma is the term used to describe mass lesion caused by retained surgical sponges with reactive tissue after a surgical intervention. This condition has been mostly reported after abdominal or thoracic surgery. We recently experienced a case of gossypiboma of the peritonsillar space in a 31-year old male patient, who previously undergone incision and drainage for treatment of peritonsillar abscess but had persistent symptom of sore throat, myalgia and febrile sensation for 6 months. The gauze was accidently left in the peritonsillar space after a surgical intervention and resulted in mass like lesion in the ipsilateral peritonsillar space. To our knowledge, this is the first case of oropharyngeal gossypiboma in the literature. Although it is rare in adults, foreign body of peritonsillar space should be considered in the differential diagnosis of unilateral recurrent tonsillitis.
Adult ; Diagnosis, Differential ; Drainage ; Foreign Bodies ; Humans ; Male ; Palatine Tonsil ; Peritonsillar Abscess ; Pharyngitis ; Sensation ; Surgical Sponges ; Thoracic Surgery ; Tonsillectomy ; Tonsillitis

OBJECTIVETo explore the application of enhanced CT in the differential diagnosis and treatment of peritonsillar abscess (PTA) and intratonsillar abscess (ITA).

METHODSThirty-eight in-patients with clinically suspected PTA from June 2011 to June 2013 were included in this study. All these patients underwent enhanced CT scan for the throat region. According to CT results, the location of abscess was determined, and the thickness of the posterior wall of abscess as well as its distance with the internal carotid artery was calculated.Incision and drainage were then guided with this information.

RESULTSTwenty-six of the 38 patients (68.4%) met the diagnosis of PTA, demonstrating a hypodense collection with rim enhancement in the peritonsillar space, including 4 cases with multilocular abscess. Ten cases (26.3%) should actually be diagnosed as ITA, with a abscess collection located in the palatine tonsil tissue. Two cases(5.3%) were diagnosed as peritonsillar cellulitis (PTC), showing diffuse isodense lesion around the peritonsillar space. The 26 cases of PTA and 10 cases of ITA patients were all cured using incision and drainage under the precise guidance of CT, while the 2 cases of PTC only treated with medicine. The mean distance between the posterior wall of abscess and the carotid artery (X(-) ± s) were (0.76 ± 0.34) cm and (0.90 ± 0.37) cm for the two entities respectively, with no significant difference (P > 0.05).

CONCLUSIONSEnhanced CT scan can clearly demonstrate the characters of PTA and ITA, and make identification. Moreover, it is helpful for the determination of therapy, improving the success rate of drainage and reducing the potential risk of large artery injury.

Abscess ; diagnostic imaging ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Peritonsillar Abscess ; diagnostic imaging ; Tomography, X-Ray Computed ; methods ; Tonsillitis ; diagnostic imaging

BACKGROUND: Due to the antibiotic therapy and the appropriate treatment, the incidence of the infections of the neck decreased. But during last 5 years in the Red Cross hospital, there were the hundred cases. And a few significant complications were still experienced. OBJECTIVES: For the early treatment and the prevention of the infection of the neck, it is necessary to study the characteristics, the diagnosis, and the treatment. MATERIALS AND METHODS: The hundred cases of the infections of the neck in the Red Cross hospital from January in 1992 to December in 1996 were analyzed about the age and sex distribution related to spaces involved, the location of cellulitis and abscess, the side of lesion, the symptoms and signs, the etiologic events, the associated conditions, the results of culture, the special diagnostic methods, the treatments, and the complications. RESULTS: In the infections of the neck, the following contents were more frequent: male(sex), the third decade(age), pain and fever(symptoms and signs), acute tonsillitis and odontogenic origin(etiologic events), Diabetes Mellitus(associated condition), hemolytic Streptococcus and Bacteroides(the results of culture), and Computerized Tomography(the special diagnostic methods). There was no significant difference in the side of lesion. The useful treatment in the peritonsillar space infection was the incision and drainage and then tonsillectomy two or three weeks after the recovery of the infection, and in the deep neck space infection, only antibiotic therapy or the incision and drainage with the antibiotic therapy were useful. The complications were four cases with two cases of sepsis, one cases of mediastinitis, and one cases of internal jugular vein thrombosis. CONCLUSION: In spite of the antibiotic therapy and the appropriate treatment, there were some complications experieced. So, we must know the characteristics of the infection of the neck well, and the systemic and active attitude is necessary.
Abscess ; Cellulitis ; Diagnosis ; Drainage ; Incidence ; Jugular Veins ; Mediastinitis ; Neck* ; Palatine Tonsil ; Peritonsillar Abscess ; Red Cross ; Sepsis ; Sex Distribution ; Streptococcus ; Thrombosis ; Tonsillectomy ; Tonsillitis

BACKGROUND AND OBJECTIVES: Peritonsillar abscess (PTA) is a collection of pus lateral to tonsil and is located between the fibrous capsule of the palatine tonsil, usually at its upper pole, and the superior to the pharyngeal constrictor muscle. It frequently occurs as a complication of acute tonsillitis. Bacteriology including clinical characteristics in PTA were evaluated. SUBJECTS AND METHOD: Sixty-one patients with peritonsillar abscess, who visited National Medical Center from January 1997 through August 2001 were entered into the study. Each patient was asked to answer a questionnaire for clinical aspects of PTA. Needle aspirations were performed and pus was drained in all cases. Bacterial susceptibility to ampicillin, cephazoline, ciprofloxacin, erythromycin, tetracyclin, and vancomycin was tested on the ioslated bacteria. RESULTS: Among 61 cases, aerobes were isolated in 15 cases (24.6%) and anaerobes in 16 cases (26.2%). There was no significant difference in the culture positive rate of aerobes (p=0.767) and anaerobes (p=1.0) between antibiotics-medicated patients and nonmedicated patients. Among the cultured organisms, peptostreptococcus was the most common and the second most common was beta-hemolytic streptococcus. However, alpha-hemolytic streptococcus, an important pathogen considered in the previous study, was detected at 1.6%. CONCLUSION: Antibiotics medication was not a significant factor in culture positive rate in our study. Peptostreptococcus as an anaerobe and beta-hemolytic streptococcus as an aerobe were the major causes that contributed to the decreased state of peritonsillar abscess and culture positive rate of alpha-hemolytic streptococcus.
Ampicillin ; Anti-Bacterial Agents ; Aspirations (Psychology) ; Bacteria ; Bacteriology ; Cefazolin ; Ciprofloxacin ; Erythromycin ; Humans ; Needles ; Palatine Tonsil ; Peptostreptococcus ; Peritonsillar Abscess* ; Surveys and Questionnaires ; Streptococcus ; Suppuration ; Tonsillitis ; Vancomycin

The study carried out on 2305 adults (from 16 to 70 years old) in three areas: in town, countryside and the U Minh indigo forest of Ca Mau province. The result showed that: the common chronic tonsilitis prevalence in the community was 8.4%, the town area 7.2%, the countryside 7.7% and the U Minh indigo forest 11.3%. Ratio of catching disease was highest in people working in forest (12%), and lowest in staffs (5.6%). People who smoking over one pack per day had highest morbidity (13.7%) and nonsmokers had lowest rate of catching disease (7.5%). People with chronic tonsilitis seek for periodical health check up reached 4.4%, lower than people do not (8.6%). People with chronic tonsilitis in poor families acquired 11.4%, higher than that in moderate income families (8% ). So, the dangerous factors leading to the risk for the chronic tonsilitis included: the career nature, smoking habit, periodical health check-ups, the family income and non-risking factors included the sex and living with smokers
Tonsillitis ; Adult ; Epidemiology

Humans ; Palatine Tonsil ; Tonsillitis

No abstract available.
Palatine Tonsil* ; Tonsillitis*

Spontaneous tonsillar hemorrhage from infectious causes is extremely rare and post-tonsillectomy hemorrhage, although also relatively rare, is an unavoidable complication of the procedure. Hemorrhage in association with tonsillitis or tonsillectomy is potentially dangerous and can be life threatening. We report here the presentation and management of a 42-yr-old man with severe spontaneous hemorrhage from infected tonsils and post-tonsillectomy hemorrhage. We suggest that if attempts to control the bleeding are not successful or if severe spontaneous tonsillar hemorrhage occurs repeatedly or a malignancy is suspected, tonsillectomy and close postoperative follow up is recommended.
Hemorrhage ; Palatine Tonsil ; Tonsillectomy ; Tonsillitis

OBJECTIVES: To report a case of acute tonsillitis that subsequently developed descending necrotizing mediastinitis, and to discuss the signs and symptoms, differential diagnosis, pathophysiology, diagnostic criteria, ancillary procedures and management.

METHODS:
Design: Case Report

Setting: Tertiary Private and Government Hospital

Patient: One

RESULTS:  A 36-year-old woman was admitted with a 2-day history of sore throat and a diagnosis of acute exudative tonsillitis. She complained of sore throat accompanied by dyspnea, neck and chest pain which rapidly progressed to mediastinitis. She was transferred to a tertiary government hospital where video assisted thoracoscopic surgery with bilateral deloculation,  mediastinoscopy and bronchoscopy revealed purulent discharge from the right main stem bronchus with multiloculated effusion in the left lung and posterolateral loculated effusion in the right lung. Her condition improved and she was discharged after a month of antibiotic therapy.

CONCLUSION: Acute tonsillitis seldom leads to a life-threatening complication such as mediastinitis. Descending necrotizing mediastinitis develops when acute tonsillar infection progresses and descends to the mediastinum. It is a surgical emergency which requires mediastinal drainage, thoracotomy and long-term antimicrobials. Clinicians who manage oropharyngeal infections should be aware of this rare but lethal complication which may occur even in non-immunocompromised individuals.

Human ; Female ; Adult ; Tonsillitis ; Mediastinitis