Comparison of medical versus surgical management of peritonsillar abscess: A retrospective observational study

Abstract

Objectives/hypothesis: To compare clinical characteristics and outcomes in patients presenting with peritonsillar abscess (PTA) treated with either initial medical or surgical management.

Study design: Retrospective observational cohort.

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, χ(2) , 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 surgical treatment. Patients who received initial surgical management had larger abscess size (2.6 vs. 1.3 cm, P < .001) and were and more likely to have muffled voice (79% vs. 47%, P < .001), drooling (29% vs. 17%, P = .03), peritonsillar bulge (91% vs. 66%, P < .001), trismus (65% vs. 22%, P < .001), and dysphagia (86% vs. 73%, P = .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 = .27) or complications (1% vs. 2%, P = .6). Patients treated medically were more likely to be admitted to the hospital (22% vs. 11%, P = .014) and less likely to receive steroids (78% vs. 95%, P < .001). There was no difference in return visits (20% medical vs. 14% surgical, P = .17) or failure rates (5% medical vs. 3% surgical, P = .30).

Conclusions: Initial medical 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.

Level of evidence: 4. Laryngoscope, 126:1529-1534, 2016.

Keywords: Peritonsillar abscess; neck space infection; pharyngitis; tonsillitis.