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An evidence-based review of peritonsillar abscess

Lookup NU author(s): Professor Janet Wilson

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Abstract

Objective of review: We present the current literature surrounding peritonsillar abscess management highlighting areas of controversy. Type of review and search strategy: Literature review using Medline and Embase databases (search terms ‘peritonsillar abscess’, ‘peritonsillar infection’ and ‘quinsy’) limited to articles published from 1991 to 2011 (English language). Results: (i) Investigations: Intraoral ultrasound has a sensitivity and specificity of between 89–95% and 79–100%, respectively, for correctly diagnosing peritonsillar abscess and is underutilised currently. (ii) Medical management: Steroids can effectively aid recovery, reducing hospitalisation time and improving symptom relief; however, further study is needed, especially related to risk and cost benefit. Penicillin and metronidazole are an effective combination in 98–99% of cases of peritonsillar abscess. (iii) Surgical management: Overall, there is no convincing evidence in favour of either aspiration or incision & drainage. Quinsy tonsillectomy is subject to great geographical variation, however, is a safe procedure and reduces overall recovery time when compared with interval tonsillectomy. (iv) Admission: peritonsillar abscess can be effectively managed as an outpatient in many cases. (v) Further management: Overall, the recurrence rate of peritonsillar abscess is poorly defined but estimated as 9-22% based on current evidence. Interval tonsillectomy may be indicated in selected groups of patients at high risk of recurrence. Conclusions: Peritonsillar abscess is a common condition with increasing incidence. We demonstrate the potential for evidence-based modifications in clinical management. However, lack of national consensus may mean that this evidence base is not being adequately exploited in current practice. A national audit of peritonsillar abscess management, in particular looking at recurrence rates and patient experience with different management strategies, appears indicated.


Publication metadata

Author(s): Powell J, Wilson JA

Publication type: Review

Journal: Clinical Otolaryngology

Year: 2012

Volume: 37

Issue: 2

Pages: 136-145

Print publication date: 09/02/2012

ISSN (print): 1749-4478

ISSN (electronic): 1749-4486

URL: http://dx.doi.org/10.1111/j.1749-4486.2012.02452.x

DOI: 10.1111/j.1749-4486.2012.02452.x


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