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Peritonsillar Abscess Size a Predictor of Therapy Success

Peritonsillar Abscess Size as a Predictor of Medical Therapy Success

On-Demand Content—Best of Scientific Oral Presentation


Matthew Urban, MD

Despite a recent uptick in literature supporting medical management alone for peritonsillar abscess, whether or not the size of the abscess correlates with the safety and efficacy of medical therapy had not been studied—until now.

Matthew Urban, MD, Thomas Nielsen, MD, Jamie Masliah, MD, and Tirth R. Patel, MD all of Rush University Medical Center in Chicago, Illinois, along with Cameron Heyd, of Lake Erie College of Medicine in Pennsylvania, completed a retrospective review of 250 patients who underwent a computed tomography (CT) scan of the neck with contrast for peritonsillar abscess and subsequently were treated with surgical drainage or sole medical therapy (intravenous antibiotics and steroids).

“This study was designed to assess uncomplicated peritonsillar abscess in immunocompetent adults and children,” said Dr. Urban. “Abscesses which progressed to nearby neck spaces were excluded, and individuals with any immunocompromise were excluded. Patients with these conditions should be considered separately. Also, each patient should be individually evaluated and counseled on both types of therapy.”

The results of the study found that:

  • Treatment failure occurred in 7.9% of patients treated with surgical drainage and 8.0% treated with medical therapy.
  • Failure rate was exactly equal for medical and surgical treatment of abscesses smaller than 2 cm (5%).
  • For abscesses larger than 2 cm, failure rate of those treated surgically was 9%, and failure rate of those treated medically was 13%. This difference was not statistically significant.
  • Complications were very rare: <1% of patients in both groups experienced worsening infection requiring transcervical drainage in the operating room, and no patients experienced any other complications.

The conclusion, then, according to the study, was that drainage of peritonsillar abscess may not decrease the risk of treatment failure compared with intravenous antibiotics and steroids alone, even for abscesses larger than 2 cm on CT scan. Patients should be appropriately counseled in order to potentially avoid unnecessary procedures.