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Changing Trends of Peritonsillar Abscess
protein or gene form to minimise keloid formation. Nevertheless, wound healing is the result of many interacting cytokines and therefore neutralising or targeting one protein could result in no significant effect.
General Adult Tonsillectomy: Current Indications and Outcomes Elizabeth Kathryn Hoddeson (presenter); Christine G. Gourin, MD OBJECTIVE: With increased antibiotic usage, the indications for pediatric tonsillectomy have shifted from infection to treatment of airway obstruction. Limited data exists regarding the current prevalence of indications for tonsillectomy in adults. We sought to determine the indications for tonsillectomy in an adult population and identify factors associated with postoperative complications. METHODS: The medical records of all adult patients (18 or more years of age) who underwent tonsillectomy from 20012007 were reviewed. Patients who underwent concurrent procedures were excluded. RESULTS: A total of 361 patients met study criteria. Indications for surgery were chronic infection in 207 patients (57%), upper airway obstruction secondary to tonsillar hypertrophy in 98 patients (27%), and suspected neoplasm in 56 patients (16%). Postoperative complications occurred in 54 cases (15%) with hemorrhage in 19 patients (5%), followed by pain and dehydration in 16 patients (4%) and admission for postoperative oxygen desaturations in 11 patients (3%). Hospitalization beyond 24 hours occurred in 18 cases (5%), with emergency room visits for pain and dehydration in 16 patients (4%), and readmission for pain control in 17 cases (5%). Patients who underwent tonsillectomy for upper airway obstruction had an increased incidence of prolonged hospitalization or readmission (19% vs. 6%; P⫽0.01), while patients who underwent tonsillectomy for infection had an increased incidence of post-operative bleeding (6% vs. 4%; p⫽0.02). CONCLUSIONS: Chronic infection remains the most common indication for adult tonsillectomy, in contrast to the pediatric population. Complication rates vary according to the indication for surgery. These data may provide useful information for preoperative counseling. Changing Trends of Peritonsillar Abscess Tal Marom, MD (presenter); Yehudah Roth, MD; David Itskoviz MD; Udi Cinamon OBJECTIVE: To assess changes in the characteristics of peritonsillar abscess (PTA). METHODS: A retrospective cohort study. Data obtained from medical records of patients diagnosed as having a peritonsillar
P33 abscess that were treated in a secondary urban medical center over a ten-year period (1998-2007). RESULTS: 427 patients, within ages of 3 to 91 years (average 31.6, SD 15.2, median 30) were enrolled. 47 patients (11%) were admitted more than once for PTA. There was no gender, seasonal, or localization predominance. 13 patients (3%) developed PTA complications. 104 patients (24.4%) were 40 years old or older, having a longer hospitalization period, and were more prone to complications. 102 patients (23.9%) did not have acute tonsillitis before PTA evolvement. Smoking was more common among patients than in the general population rate (33% vs 25%), associated with a higher complication. Culture results and antibiotic therapy influence were analyzed for all PTA cases (n⫽486). In 283 patients (58.2%) developed PTA in spite of a prior antibiotic therapy. Smoking was associated with a higher infection rate by Streptococcus viridans. CONCLUSIONS: Comparison of current data to earlier reports suggests that PTA has gradually changed its characteristics: affecting older patients, having a more vigorous presentation and a longer course, abscess evolvement without an anteceding tonsillitis, and patients developing PTA in spite of a prior adequate antibiotic therapy. In addition, smoking may be a predisposing factor. Electrocautery Adenoidectomy Outcomes: A Metaanalysis Jeremy T. Reed, MD (presenter); Shankar K. Sridhara, MD; Scott E Brietzke, MD, MPH OBJECTIVE: Review and assess the current published literature regarding clinical outcomes of suction electrocautery adenoidectomy (ECA) in pediatric patients. METHODS: The MEDLINE database was systematically reviewed for articles reporting on the use of ECA. Inclusion criteria included English language, sample size greater than 5, and presentation of extractable data regarding pediatric outcomes with ECA. Random effects modeling was used to estimate summary outcomes. RESULTS: 9 studies met the inclusion criteria. There were 2 level 1b studies, 2 level 3b studies, and 5 level 4 studies. The mean sample size was 276 patients with a grand mean age of 6.0 years. Random effects modeling of summary estimates of intra-operative hemorrhage (4.1 cc vs. 24.0 cc 95% CI of difference⫽16.5-23.1, p⬍0.001) and operative time (10.0 minutes vs. 11.9 minutes 95% CI of difference⫽0.82-2.90, p⬍0.001) favored ECA vs. traditional curette adenoidectomy. Subjective success was reported in 95.0% (95% CI⫽92.797.3%, p⬍0.001) of ECA patients with a grand mean of 5.8 months of postoperative follow-up and a grand mean lost to follow-up rate of 23.2%. Adenoid regrowth was evaluated objectively (endoscopy or X-ray) in only 116 of 2,132 (5.4%) total
SCI. ORALS
Scientific Oral Presentations
General Adult Tonsillectomy: Current Indications and Outcomes Elizabeth Kathryn Hoddeson (presenter); Christine G. Gourin, MD OBJECTIVE: With increased antibiotic usage, the indications for pediatric tonsillectomy have shifted from infection to treatment of airway obstruction. Limited data exists regarding the current prevalence of indications for tonsillectomy in adults. We sought to determine the indications for tonsillectomy in an adult population and identify factors associated with postoperative complications. METHODS: The medical records of all adult patients (18 or more years of age) who underwent tonsillectomy from 20012007 were reviewed. Patients who underwent concurrent procedures were excluded. RESULTS: A total of 361 patients met study criteria. Indications for surgery were chronic infection in 207 patients (57%), upper airway obstruction secondary to tonsillar hypertrophy in 98 patients (27%), and suspected neoplasm in 56 patients (16%). Postoperative complications occurred in 54 cases (15%) with hemorrhage in 19 patients (5%), followed by pain and dehydration in 16 patients (4%) and admission for postoperative oxygen desaturations in 11 patients (3%). Hospitalization beyond 24 hours occurred in 18 cases (5%), with emergency room visits for pain and dehydration in 16 patients (4%), and readmission for pain control in 17 cases (5%). Patients who underwent tonsillectomy for upper airway obstruction had an increased incidence of prolonged hospitalization or readmission (19% vs. 6%; P⫽0.01), while patients who underwent tonsillectomy for infection had an increased incidence of post-operative bleeding (6% vs. 4%; p⫽0.02). CONCLUSIONS: Chronic infection remains the most common indication for adult tonsillectomy, in contrast to the pediatric population. Complication rates vary according to the indication for surgery. These data may provide useful information for preoperative counseling. Changing Trends of Peritonsillar Abscess Tal Marom, MD (presenter); Yehudah Roth, MD; David Itskoviz MD; Udi Cinamon OBJECTIVE: To assess changes in the characteristics of peritonsillar abscess (PTA). METHODS: A retrospective cohort study. Data obtained from medical records of patients diagnosed as having a peritonsillar
P33 abscess that were treated in a secondary urban medical center over a ten-year period (1998-2007). RESULTS: 427 patients, within ages of 3 to 91 years (average 31.6, SD 15.2, median 30) were enrolled. 47 patients (11%) were admitted more than once for PTA. There was no gender, seasonal, or localization predominance. 13 patients (3%) developed PTA complications. 104 patients (24.4%) were 40 years old or older, having a longer hospitalization period, and were more prone to complications. 102 patients (23.9%) did not have acute tonsillitis before PTA evolvement. Smoking was more common among patients than in the general population rate (33% vs 25%), associated with a higher complication. Culture results and antibiotic therapy influence were analyzed for all PTA cases (n⫽486). In 283 patients (58.2%) developed PTA in spite of a prior antibiotic therapy. Smoking was associated with a higher infection rate by Streptococcus viridans. CONCLUSIONS: Comparison of current data to earlier reports suggests that PTA has gradually changed its characteristics: affecting older patients, having a more vigorous presentation and a longer course, abscess evolvement without an anteceding tonsillitis, and patients developing PTA in spite of a prior adequate antibiotic therapy. In addition, smoking may be a predisposing factor. Electrocautery Adenoidectomy Outcomes: A Metaanalysis Jeremy T. Reed, MD (presenter); Shankar K. Sridhara, MD; Scott E Brietzke, MD, MPH OBJECTIVE: Review and assess the current published literature regarding clinical outcomes of suction electrocautery adenoidectomy (ECA) in pediatric patients. METHODS: The MEDLINE database was systematically reviewed for articles reporting on the use of ECA. Inclusion criteria included English language, sample size greater than 5, and presentation of extractable data regarding pediatric outcomes with ECA. Random effects modeling was used to estimate summary outcomes. RESULTS: 9 studies met the inclusion criteria. There were 2 level 1b studies, 2 level 3b studies, and 5 level 4 studies. The mean sample size was 276 patients with a grand mean age of 6.0 years. Random effects modeling of summary estimates of intra-operative hemorrhage (4.1 cc vs. 24.0 cc 95% CI of difference⫽16.5-23.1, p⬍0.001) and operative time (10.0 minutes vs. 11.9 minutes 95% CI of difference⫽0.82-2.90, p⬍0.001) favored ECA vs. traditional curette adenoidectomy. Subjective success was reported in 95.0% (95% CI⫽92.797.3%, p⬍0.001) of ECA patients with a grand mean of 5.8 months of postoperative follow-up and a grand mean lost to follow-up rate of 23.2%. Adenoid regrowth was evaluated objectively (endoscopy or X-ray) in only 116 of 2,132 (5.4%) total
SCI. ORALS
Scientific Oral Presentations