Management of peritonsillitis/peritonsillar

Abstract

Peritonsillitis and peritonsillar abscess (quinsy) are commonly encountered emergencies in day to day ENT practice. However the value of a tonsillectomy as well as its timing in these cases is debatable amongst Otolaryngologists. A postal survey performed amongst practising ENT surgeons in the U.K. revealed that 475 out of 571 ENT surgeons (83%) prefer to "wait and observe" for a single isolated attack of peritonsillitis/peritonsillar abscess while 86 surgeons (15%) would routinely advocate interval tonsillectomy after an attack of peritonsillitis/quinsy. In patients without a background history of tonsillitis, 432 of the 475 ENT surgeons (90.9%) would advise a tonsillectomy after the second attack of peritonsillitis/quinsy whereas 30 surgeons (6.3%) would do so only after a third attack. A retrospective study of 207 patients was performed to evaluate the safety of a "wait and observe" policy. One hundred and four of the 129 adults (88.3%) and 5 out of the 6 children (83.2%) who did not undergo a tonsillectomy remained asymptomatic after the single isolated attack of peritonsillitis/quinsy. Four adults (3.1%) and 1 child (16.6%) required a tonsillectomy eventually for recurring attacks of tonsillitis. Recurrence of peritonsillitis/peritonsillar abscess was observed in 11 patients (8.5%). These results suggest that a "wait and observe" policy is safe for most patients presenting with a single attack of peritonsillitis/peritonsillar abscess without a background history of tonsillitis.