Search Results (25)

Objectives: A diagnostic indicator for differentiating peritonsillar abscess (PTA) from peritonsillar cellulitis (PTC) has not been established. Our aim was to define radiological criteria for differentiating PTA from PTC. Methods: We retrospectively extracted low-density areas around the tonsils of PTA and PTC cases from contrast-enhanced CT images between 2021 and 2024. PTA cases were identified as those in which drainage by puncture or incision was observed, while PTC cases were those in which drainage was not observed. A total of 138 cases were finally analyzed (PTA, 111 cases; PTC, 27 cases). The CT attenuation value of a low-density area relative to that of the area surrounding the low-density area was used as the relative CT number, and relative CT numbers were compared between PTA and PTC cases. Using univariate and multivariate analyses, we identified factors that had diagnostic value for differentiating between PTA and PTC. Results: Relative CT numbers for PTA were significantly lower than those for PTC (p < 0.001). The univariate logistic regression analysis showed relative CT number, low-density ROI (region of interest), and surrounding ROI as having predictive value for differentiating PTA from PTC. In multivariate logistic regression analysis, only the relative CT number had predictive value for distinguishing PTA from PTC (odds ratio, 2.28), with a relative CT number of <0.46 being significantly associated with PTA. Conclusions: Low relative CT numbers could potentially be used to identify PTA, and their measurement could provide a diagnostic marker for the accurate diagnosis of abscess formation. Full article

Background/Objectives: Deep neck space infections (DNSIs) in children, particularly parapharyngeal and retropharyngeal abscesses, pose a significant risk due to their ability to cause airway obstruction. The management of these infections in children differs from that in adults, requiring a multidisciplinary approach. This study aimed to evaluate the clinical presentation, diagnostic imaging, and surgical management of pediatric DNSIs. Methods: A retrospective review was conducted on pediatric patients (≤16 years) diagnosed with deep neck space infections between 2002 and 2022. A total of 266 cases were identified using ICD-10 codes, of which eight patients (3%) had para- or retropharyngeal abscesses. The clinical presentation, imaging modalities, airway management, and surgical approaches were analyzed. Results: Children with parapharyngeal or retropharyngeal abscesses had a mean age of 5.2 years, being significantly younger than those with peritonsillar abscesses (mean age: 13.5 years). The most common symptoms were a high fever (100%) and torticollis (63%). All patients underwent initial ultrasound (US), but a definitive diagnosis required contrast-enhanced CT or MRI. Seven patients (87.5%) underwent surgical drainage, with the decision to perform an incision dictated by the location of the abscess relative to vascular structures. Image-guided navigation facilitated minimally invasive transpharyngeal drainage in four cases. Postoperatively, six patients required prolonged intubation due to airway edema or surgical site management. One patient was successfully managed conservatively with antibiotics. Conclusions: DNSIs in children require prompt diagnosis and a tailored surgical approach. Imaging plays a crucial role in the localization of the abscess, with MRI preferred for detailed soft tissue assessment. Airway management is critical, and minimally invasive, image-guided techniques improve the precision of surgery. Multidisciplinary care optimizes patient outcomes. Full article

Background: Vitamin D plays a crucial role in immune system function, and its deficiency has been associated with an increased risk of infections. This study investigates the relationship between vitamin D deficiency and the severity of purulent oropharyngeal infections, considering the need for surgical interventions and the duration of hospitalization. Materials and Methods: This retrospective study included patients diagnosed with peritonsillar phlegmons, laterocervical abscesses, and peritonsillar abscesses. Patients were categorized based on their vitamin D levels: deficiency (<30 ng/mL) and optimal levels (≥30 ng/mL). The clinical parameters, length of hospitalization, and type of treatment were analyzed. Statistical analyses included Student’s t-test, the chi-square test, and ANOVA to assess differences between groups. Results: Patients with vitamin D (25(OH)D3) deficiency had a significantly longer hospital stay (8.50 days vs. 3.24 days, p = 0.001) and required more frequent surgical interventions (55.6% vs. 27.8%, p = 0.002) compared to those with optimal vitamin D levels. A trend toward more complex treatment regimens was also observed, although this relationship was not statistically significant (p > 0.05). Conclusions: These findings suggest that vitamin D (25(OH)D3) deficiency may contribute to a more severe course of oropharyngeal infections, increasing the need for invasive treatments and prolonging hospitalization. This highlights the importance of monitoring vitamin D (25(OH)D3) levels and the potential benefits of supplementation in preventing and managing severe upper respiratory tract infections. Full article

Background: Peritonsillar abscess (PTA) is relatively common but challenging to diagnose clinically. Several clinical signs may be used, with unknown performances. We evaluated and compared the diagnostic performance of individual and combined clinical signs (trismus, edema, pharynx immobility, uvula deviation, hot potato voice, and overall clinical impression) assessed by an otolaryngologist and of contrast-enhanced computed tomography (CT) to detect acute PTA. Methods: Prospective study in 133 consecutive adult patients (77 males, mean age = 33 years) with suspected clinical PTA and CT obtained in the emergency setting of a tertiary care hospital between November 2020 and October 2022. The standard of reference consisted of surgically proven pus within 24 h of CT or a favorable clinical evolution at 48 h without surgical intervention. Results: PTA was present in 117/133 (88%) patients, with no difference between mean age or sex distribution between the groups with and without PTA. None of the evaluated clinical signs were associated with PTA (OR = 1.26–5.43, p > 0.05), whereas the CT finding “abscess” was significantly associated with PTA (OR = 67.2, p < 0.0001). The sensitivity of individual clinical signs varied between 19.7% and 73.5%, and the sensitivity of CT was significantly higher for all clinical signs (95.7%, p < 0.0001) except for overall clinical impression (97.4%, p = 0.7266). The specificity of clinical signs varied between 12.5% and 93.8%, and the specificity of CT was significantly higher (75%, p < 0.05) for overall clinical impression and edema. All clinical signs together yielded an area under the curve (AUC) = 0.677. Conclusions: In adults, clinical assessment alone using independent clinical signs and overall clinical impression does not allow a reliable diagnosis of PTA, even when performed by an otolaryngologist. CT is reliable in diagnosing PTA and, whenever available, should be the examination method of choice for diagnosing PTA, especially by a non-specialist. Full article

Abscess-forming cervical bacterial infections are rare and serious infections. Methods: We retrospectively examined the trends in abscess-forming cervical bacterial infections in children who required inpatient treatment in three periods before (January 2016 to June 2020), during (July 2020 to December 2022) and after the COVID-19 pandemic (January 2023 to June 2024). Results: The study included 96 patients with superficial cervical abscesses and 111 patients with deep cervical abscesses (34 with retropharyngeal abscesses, 51 with peritonsillar abscesses, and 26 with deep neck abscesses). Both decreased during the COVID-19 pandemic and increased significantly after the COVID-19 pandemic compared to before the COVID-19 pandemic (0.94 ± 0.92 vs. 0.50 ± 0.72 vs. 1.67 ± 1.11/month, 0.93 ± 0.96 vs. 0.60 ± 0.84 vs. 2.39 ± 1.70/month), which was related with the trends of respiratory viral infections. Bacteria were identified in 79 of the 97 cases in which punctures were performed; however, there were no significant differences between the three periods. No significant changes were found in the pharyngeal streptococcal antigen positivity rate, rate of oral antibiotic use before hospitalization, length of hospital stay, or duration of antibiotic administration before and after the COVID-19 pandemic. Conclusions: The COVID-19 pandemic has affected the epidemiology of cervical abscess-forming bacterial infections in children. Although the reemergence of respiratory viral infections after the COVID-19 pandemic may be a factor, the cause of the doubling in the number of neck abscesses after the COVID-19 pandemic remains unclear and requires further investigation. Full article

Peritonsillar abscesses and deep neck infection are potentially serious infections among patients with chronic kidney disease (CKD), posing risks for severe complications and drawing significant public health concern. This nationwide, population-based longitudinal study (2002–2019) assessed the extended relationship between chronic kidney disease (CKD) and the likelihood of peritonsillar abscess and deep neck infection in a Korean cohort. Using a 1:4 propensity score overlap-weighted matching, we included 16,879 individuals with CKD and 67,516 comparable controls, accounting for demographic variables and comorbidities to ensure balanced group comparisons. Hazard ratios (HRs) and 95% confidence intervals (CIs) for deep neck infection and peritonsillar abscesses in relation to CKD history were calculated with a propensity score overlap-weighted Cox proportional hazards model. Our results revealed no significant increase in the overall incidence of deep neck infections or peritonsillar abscesses in CKD patients compared to controls. Interestingly, CKD patients demonstrated a 50% reduced likelihood of developing peritonsillar abscesses (HR 0.50; 95% CI = 0.30–0.83; p = 0.007), particularly among subgroups aged 70 years or older, females, non-smokers, rural residents, overweight individuals, and those with lower comorbidity burdens (e.g., absence of hypertension, hyperlipidemia, or hyperglycemia). In summary, the results suggest that lifestyle modifications and the effective management of comorbidities could reduce the risk of peritonsillar abscess in certain CKD subgroups. Our findings may help to alleviate public health concerns regarding peritonsillar abscesses and deep neck infections as CKD-related comorbidities. Full article

Objectives: This review aims to analyze the treatment options for peritonsillar abscess (PTA) in children. Methods: We searched PubMed and EMBASE for studies regarding the treatment of PTA in children. Relevant studies were reviewed based on systematic review (PRISMA) guidelines. Qualitative and quantitative analyses of the extracted data were performed. Results: A total of 12 articles with 2211 cases of PTA were found to be eligible. All the identified studies were retrospective cohorts. The mean age varied from 8.5 to 15.4 years without gender difference. Treatment options included broad-spectrum antibiotic therapy with incision and drainage of the abscess, needle aspiration and immediate tonsillectomy in 69%, 7.6% and 7% of cases, respectively. Antibiotics alone were administered to 16.4% of the subjects. The rate of recurrence of PTA after primary treatment ranged from 2% to 15.8% of cases. The time of recurrence is considered within one or two months. Complications in children with PTA were torticollis, prolonged fever, sepsis, dyspnea and parapharyngeal involvement. Conclusions: The mainstay of treatment of PTA in children is antibiotic therapy with incision and drainage of the abscess. Alternatives include antibiotic treatment alone or in association with needle aspiration. Immediate tonsillectomy is reserved only for a few high-risk patients. Full article

Background/Objectives: During the COVID-19 pandemic, Austria, like many European countries, implemented lockdown measures to curb viral transmission. These public health interventions, including social distancing and improved hygiene, were anticipated to affect various infectious diseases. This study aimed to assess whether the incidence of peritonsillar abscess, a severe upper respiratory inflammatory disease, decreased during the lockdown period of 2020 compared to previous years. Methods: This retrospective study analyzed all patients diagnosed with peritonsillar abscess from 2010 to 2020 at the Department of Otorhinolaryngology, Medical University of Graz. Patients were grouped based on the onset of disease into two periods: the lockdown period (16 March–29 May) and the rest of the year = Period 2 (1 January–15 March and 30 May–31 December). The incidence during the lockdown period of 2020 was compared to the incidence in the same timeframe in the previous years from 2010 to 2019 using chi-squared tests and Poisson regression models. Results: A total of 1768 patients (female: 44%, male: 56%; mean age: 34.6 ± 18.4 years) diagnosed with peritonsillar abscess were treated between 2010 and 2020 at the Department of Otolaryngology, Medical University of Graz. The analysis revealed that the proportion of peritonsillar abscesses in Period 1 in 2020 (15/127, 12%) was significantly lower than the mean proportion in Period 1 from 2010 to 2019 (36/164, 22%) (p = 0.004). The incidence rate of peritonsillar abscess cases per year in Period 1 (16 March–29 May) was significantly higher in each previous year from 2010 to 2019 compared to 2020 (p < 0.05). Conclusions: The findings suggest that the COVID-19 lockdown measures contributed to a reduction in the incidence of peritonsillar abscess, highlighting the broader impact of public health interventions on infectious diseases. Further research is needed to explore the effects on other respiratory infections and diseases. Full article

Background: The COVID-19 pandemic has notably affected the epidemiology of various infectious diseases. The imposed public health measures and disruptions in vaccination programs have potentially altered the patterns of these diseases post pandemic. Objective: To investigate the change in epidemiology of otorhinolaryngological infectious diseases in adult and pediatric patients after the COVID-19 pandemic and the relaxation of public health measures. Methods: A retrospective cohort study was conducted at a large tertiary university otolaryngology department in the south of Germany, examining admissions with specific ICD-10 diagnoses from 2019 to 2023. Data were seasonally categorized and statistically analyzed. Results: A total of 1728 inpatient cases were analyzed. There was a significant increase in otorhinolaryngological infections in the post-pandemic winter of 2022, particularly of peritonsillar abscesses, acute tonsillitis and acute mastoiditis. No significant post-pandemic spike in mononucleosis was observed. The duration of hospitalization was shorter in 2022, and the median age of patients did not change significantly pre- versus post-pandemic. Conclusions: The study indicates a significant post-pandemic rise in otorhinolaryngological infections. Remarkably, the typical “dip” in infections during the summer months was not observed in the post pandemic years, possibly reflecting the impact of the termination of non-pharmaceutical interventions. Mononucleosis was the only infection not following this pattern. Full article

Background/Introduction: Odontogenic infection is one of the main etiologies of deep neck infection (DNI). However, the relationship between chronic periodontitis (CP) and the incidence of DNI has not been examined. This study aimed to evaluate the incidence of DNI and peritonsillar abscess (PTA) after CP. Methods: The Korean National Health Insurance Service-National Sample Cohort 2002–2019 was used. In Study I, 4585 PTA patients were matched with 19,340 control I participants. A previous history of CP for 1 year was collected, and the odds ratios (ORs) of CP for PTA were analyzed using conditional logistic regression. In Study II, 46,293 DNI patients and 185,172 control II participants were matched. A previous history of CP for 1 year was collected, and conditional logistic regression was conducted for the ORs of CP for DNI. Secondary analyses were conducted in demographic, socioeconomic, and comorbidity subgroups. Results: In Study I, a history of CP was not related to the incidence of PTA (adjusted OR = 1.28, 95% confidence interval [CI] = 0.91–1.81). In Study II, the incidence of DNI was greater in participants with a history of CP (adjusted OR = 1.55, 95% CI = 1.41–1.71). The relationship between CP history and DNI was greater in groups with young, male, low-income, and rural residents. Conclusions: A prior history of CP was associated with a high incidence of DNI in the general population of Korea. Patients with CP need to be managed for the potential risk of DNI. Full article

Background: Globally, oral diseases are common, pose an economic burden, and significantly decline the quality of life of affected individuals. Recently, researchers have substantially highlighted the effect of depression on oral disease incidence and development. In this study, we elucidated the correlation between depression and oral diseases. Methods: Using two-sample Mendelian randomization (MR), the association between depression and the risk of 17 oral diseases was evaluated. Three methods were used to perform MR analysis: the inverse variance-weighted, weighted median, and MR-Egger methods. Furthermore, Cochran’s Q test, MR-Egger intercept test, MR Pleiotropy RESidual Sum and Outlier test, and leave-one-out analysis were performed to analyze sensitivity. Results: After implementing multiple test corrections, we observed that genetic susceptibility to depression was associated with an increased risk of mouth ulcers, toothache, loose teeth, bleeding gums, painful gums, chronic periodontitis, chronic tonsil and adenoid diseases, peritonsillar abscess, and excessive tooth attrition. However, a causal relationship between depression and other oral diseases was not observed. Sensitivity analysis confirmed the robustness of the results. Conclusions: We confirmed the causal relationship between depression and several oral diseases, thereby providing a novel viewpoint on the prevention and treatment of oral diseases. Our findings suggest the integration of depression control into routine clinical care to enhance the effectiveness of oral disease treatment. Full article

As there is currently no consensus on managing deep neck infections in pediatric populations, we report a case series from a large pediatric hospital. Clinical data of patients discharged from Istituto Gaslini-Children’s Hospital from January 2014 to June 2020 with peritonsillar, parapharyngeal, or retropharyngeal abscess diagnoses were collected. A total of 59 patients were identified. Patients underwent surgical drainage in 47% of cases. Streptococcus mitis/oralis was the most isolated pathogen. Surgically treated patients did have larger abscesses compared to others, but there were no differences in the duration of hospitalization. Children who received NSAIDs at home had significant delays in diagnosis (median 4 vs. 1.5 days, p = 0.008). In our experience, clinical presentation of DNIs is often evocative, but evaluation should include imaging with CT/MRI. Surgery is effective in larger abscesses, allowing for etiological diagnosis with consequent antibiotic adjusting. From an anamnestic point of view, home medications such as NSAIDs could delay diagnosis. Full article

Primary healthcare is the pillar of a well-functioning healthcare system. General practitioners (GPs) should have a broad skillset to cope with the various conditions they encounter in everyday practice. Ear, nose, and throat (ENT) cases are some of the most common reasons for seeking care. The study aimed to define the frequency and type of ENT disorders seen in the emergency department of a tertiary hospital in Greece. All patients examined by an ENT specialist in the emergency department setting, within a year, were recorded, as well as all referrals from private practice or primary care facilities. From September to December 2021, data were collected from patients who agreed to complete a two-minute survey, namely, the Generalized Anxiety Disorder Scale (GAD-2) questionnaire. During the study year, 4542 cases were documented, from which the most common conditions listed were external otitis (6.9%/314), epistaxis (6.7%/305), and impacted earwax (5.7%/261). The diagnoses that led to hospitalization were 336 and the most common were peritonsillar abscess (16.4%/55), epistaxis (8.0%/27), and facial nerve paralysis (7.4%/25). Referrals from GPs working in the public sector represented more than the half of the total. There was a significant correlation between an increased number of hospital visits and an increased GAD-2 score, in the semester before the current visit (p < 0.001). Referrals to ENT specialists represent around 5% of all cases examined, and about 8% of all visits required hospitalization. Interdisciplinary clinical and research investment into GP training is compulsory to regulate ENT referrals by GPs. Full article

This study aimed to investigate the change in the incidence and variance of otorhinolaryngologic diseases during the coronavirus disease 19 (COVID-19) pandemic. The entire Korean population (~50 million) was evaluated for the monthly incidence of 11 common otorhinolaryngologic diseases of upper respiratory infection (URI), influenza, acute tonsillitis, peritonsillar abscess, retropharyngeal and parapharyngeal abscess, acute laryngitis and bronchitis, stomatitis and related lesions, acute sinusitis, rhinitis, otitis media, and dizziness from January 2018 through March 2021 using the International Classification of Disease (ICD)-10 codes with the data of the Korea National Health Insurance Service. The differences in the mean incidence of 11 common otorhinolaryngologic diseases before and during COVID-19 were compared using the Mann—Whitney U test. The differences in the variance of incidence before and during COVID-19 were compared using Levene’s test. The incidence of all 11 otorhinolaryngologic diseases was lower during COVID-19 than before COVID-19 (all p < 0.05). The variations in disease incidence by season were lower during COVID-19 than before COVID-19 for infectious diseases, including URI, influenza, acute tonsillitis, peritonsillar abscess, retropharyngeal and parapharyngeal abscess, acute laryngitis and bronchitis, acute sinusitis, and otitis media (all p < 0.05), while it was not in noninfectious diseases, including stomatitis, rhinitis, and dizziness. As expected, the incidences of all otorhinolalryngolgic diseases were decreased. Additionally, we found that seasonal variations in infectious diseases disappeared during the COVID-19 pandemic, while noninfectious diseases did not. Full article

Background: Despite the widespread use of antibiotics to treat infected tonsils, episodes of tonsillitis tend to recur and turn into recurrent tonsillitis (RT) or are complicated by peritonsillar abscesses (PTAs). The treatment of RT and PTAs remains surgical, and tonsillectomies are still relevant. Materials and methods: In a prospective, controlled study, we analyzed the bacteria of the tonsillar crypts of 99 patients with RT and 29 patients with a PTA. We performed the biofilm formation and antibacterial susceptibility testing of strains isolated from study patients. We compared the results obtained between patient groups with the aim to identify any differences that may contribute to ongoing symptoms of RT or that may play a role in developing PTAs. Results: The greatest diversity of microorganisms was found in patients with RT. Gram-positive bacteria were predominant in both groups. Candida species were predominant in patients with a PTA (48.3% of cases). Irrespective of patient group, the most commonly isolated pathogenic bacterium was S. aureus (in 33.3% of RT cases and in 24.14% of PTA cases). The most prevalent Gram-negative bacterium was K. pneumoniae (in 10.1% of RT cases and in 13.4% of PTA cases). At least one biofilm-producing strain was found in 37.4% of RT cases and in 27.6% of PTA cases. Moderate or strong biofilm producers were detected in 16 out of 37 cases of RT and in 2 out of 8 PTA cases. There was a statistically significant association found between the presence of Gram-positive bacteria and a biofilm-formation phenotype in the RT group and PTA group (Pearson χ² test, p < 0.001). S. aureus and K. pneumoniae strains were sensitive to commonly used antibiotics. One S. aureus isolate was identified as MRSA. Conclusions: S. aureus is the most common pathogen isolated from patients with RT, and Candida spp. are the most common pathogens isolated from patients with a PTA. S. aureus isolates are susceptible to most antibiotics. Patients with RT more commonly have biofilm-producing strains, but patients with a PTA more commonly have biofilm non-producer strains. K. pneumoniae does not play a major role in biofilm production. Full article