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Clinical aspects of inferior pole peritonsillar abscess
International Congress Series 1257 (2003) 127 – 130
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Clinical aspects of inferior pole peritonsillar abscess Yoshiko Hayamizu, Ikuyo Miyanohara, Satoshi Fukuyama, Koji Deguchi, Yuichi Kurono * Department of Otolaryngology, Faculty of Medicine, Kagoshima University, 8-35-5 Sakuragaoka, Kagoshima, Kagoshima 890-8520, Japan Received 11 August 2003; received in revised form 15 September 2003; accepted 16 September 2003
Abstract. In most peritonsillar abscess, the lesion is usually found in the superior pole of the palatine tonsil and typical symptoms such as trismus and resting of uvula are observed. On the other hand, inferior pole peritonsillar abscesses (IPPA) are rare and the symptoms are different from that of superior pole peritonsillar abscesses (SPPA). In the present study, the clinical aspects of patients with IPPA were compared with that of SPPA in order to clarify the characteristics of this disease. One hundred and six patients with peritonsillar abscess who were treated in our clinic between 1990 and 2002 were retrospectively investigated. The diagnosis of SPPA and IPPA was obtained by the findings of CT and during surgery. Among all patients, SPPA was found in 87% and IPPA, 13%. IPPA was more frequently observed in senior patients when compared with SPPA. Tonsil displacement and trismus were observed only in 25% and 17% of IPPA, respectively. The incidence of those symptoms was remarkably lower than that in SPPA. There was no significant difference in laboratory examinations between SPPA and IPPA. Bacteriological findings were quite different between IPPA and SPPA. Those results suggest that the pathogenesis of IPPA might be different from that of SPPA. D 2003 Elsevier B.V. All rights reserved. Keywords: Inferior pole peritonsillar abscess (IPPA); Superior pole peritonsillar abscess (SPPA); Elder patient; Trismus; Tonsil displacement
1. Background Peritonsillar abscess is one of the common upper respiratory infections and the abscess is usually found in the superior pole of the tonsil [1,2]. However, in some cases, the abscess occurs in the inferior pole of the tonsil and is called inferior pole peritonsillar abscess (IPPA). Previously, some investigators have reported that the diagnosis of IPPA is difficult due to less clinical signs compared with superior pole peritonsillar abscess (SPPA) [3,4]. In the present study, the patients diagnosed as SPPA and IPPA were investigated retrospectively and the clinical findings were compared in order to clarify the clinical characteristics of IPPA. * Corresponding author. Tel.: +81-99-275-5410; fax: +81-99-264-8296. E-mail address: [email protected] (Y. Kurono). 0531-5131/ D 2003 Elsevier B.V. All rights reserved. doi:10.1016/S0531-5131(03)01614-5
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2. Methods One hundred six patients diagnosed as peritonsillar abscess in our clinic between January 1990 and November 2002 were involved in the study. Among the patients, IPPA was found in 14 cases (8 males and 6 females) and SPPA in 92 cases (65 males and 27
Fig. 1. Age distribution (SPPA and IPPA).
Y. Hayamizu et al. / International Congress Series 1257 (2003) 127–130
129
females) (Fig. 1). The presence and location of abscess were determined by enhanced CT and the findings during surgery. 3. Results Peritonsillar abscess occurred in males more frequently than in females and the incidence was highest between 21 and 30 years of age [1]. The age distribution was classified into five groups, each 20 years, and was compared between IPPA and SPPA. The largest number of patients with SPPA was observed in the group aged from 20 to 39 years and there was no significant difference between males and females. On the other hand, the incidence of IPPA was highest in male patients more than 60 years old. Trismus and tonsil displacement were the typical symptoms of peritonsillar abscess and were frequently observed in SPPA [1]. Each symptom was observed in 74% and 80% of SPPA, respectively. In contrast, those symptoms were rarely found in patients with IPPA compared with SPPA. Trismus was observed in 17% of IPPA and tonsil displacement was in 25%. When those clinical signs were compared between patients aged less than 40 years old and those more than 40 years old, there was no significant difference in the incidence of trismus and tonsil displacement between those two groups in patients with SPPA. On the other hand, the incidence of those clinical signs was less frequent in elder patients with IPPA.
Fig. 2. Bacteriological findings.
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Laboratory findings such as the number of white blood cells and the levels of Creactive protein (CRP) were compared between IPPA and SPPA. There was no significant difference in the findings of those examinations between IPPA and SPPA. However, when those laboratory findings were compared with the age distribution, the levels of CRP were different between patients less than 40 years old and those more than 40 years old. In patients aged more than 40 years old, the levels of CRP were significantly lower in IPPA than in SPPA. In microbiological examination for peritonsillar abscess effusion, Streptococcus pyogenes and Streptococcus pneumonia were cultured only from SPPA. On the other hand, Haemophilus influenzae were more frequently cultured from IPPA than SPPA (Fig. 2). 4. Conclusions The present study showed that IPPA occurs more frequently in elder patients than in younger patients and clinical symptoms are less remarkable in patients with IPPA [3]. Those findings suggest the importance of considering the presence of IPPA in the diagnosis of peritonsillar abscess even if common clinical symptoms are absent, especially in elder patients. References [1] A. Matsuda, H. Tanaka, T. Kanaya, K. Kamata, M. Hasegawa, Peritonsillar abscess: a study of 724 cases in Japan, Ear Nose Throat J. 81 (6) (2002) 384 – 389. [2] G. Holt, P. Tinsley, Peritonsillar abscesses in children, Laryngoscope 91 (8) (1981) 1226 – 1230. [3] J. Stage, P. Bonding, Peritonsillar abscess with parapharyngeal involvement: incidence and treatment, Clin. Otolaryngol. 12 (1) (1987) 1 – 5. [4] R. Greg, A. Gregory, Inferior pole peritonsillar abscess, Otolaryngol. Head Neck Surg. 1 (1998) 95 – 99.
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Clinical aspects of inferior pole peritonsillar abscess Yoshiko Hayamizu, Ikuyo Miyanohara, Satoshi Fukuyama, Koji Deguchi, Yuichi Kurono * Department of Otolaryngology, Faculty of Medicine, Kagoshima University, 8-35-5 Sakuragaoka, Kagoshima, Kagoshima 890-8520, Japan Received 11 August 2003; received in revised form 15 September 2003; accepted 16 September 2003
Abstract. In most peritonsillar abscess, the lesion is usually found in the superior pole of the palatine tonsil and typical symptoms such as trismus and resting of uvula are observed. On the other hand, inferior pole peritonsillar abscesses (IPPA) are rare and the symptoms are different from that of superior pole peritonsillar abscesses (SPPA). In the present study, the clinical aspects of patients with IPPA were compared with that of SPPA in order to clarify the characteristics of this disease. One hundred and six patients with peritonsillar abscess who were treated in our clinic between 1990 and 2002 were retrospectively investigated. The diagnosis of SPPA and IPPA was obtained by the findings of CT and during surgery. Among all patients, SPPA was found in 87% and IPPA, 13%. IPPA was more frequently observed in senior patients when compared with SPPA. Tonsil displacement and trismus were observed only in 25% and 17% of IPPA, respectively. The incidence of those symptoms was remarkably lower than that in SPPA. There was no significant difference in laboratory examinations between SPPA and IPPA. Bacteriological findings were quite different between IPPA and SPPA. Those results suggest that the pathogenesis of IPPA might be different from that of SPPA. D 2003 Elsevier B.V. All rights reserved. Keywords: Inferior pole peritonsillar abscess (IPPA); Superior pole peritonsillar abscess (SPPA); Elder patient; Trismus; Tonsil displacement
1. Background Peritonsillar abscess is one of the common upper respiratory infections and the abscess is usually found in the superior pole of the tonsil [1,2]. However, in some cases, the abscess occurs in the inferior pole of the tonsil and is called inferior pole peritonsillar abscess (IPPA). Previously, some investigators have reported that the diagnosis of IPPA is difficult due to less clinical signs compared with superior pole peritonsillar abscess (SPPA) [3,4]. In the present study, the patients diagnosed as SPPA and IPPA were investigated retrospectively and the clinical findings were compared in order to clarify the clinical characteristics of IPPA. * Corresponding author. Tel.: +81-99-275-5410; fax: +81-99-264-8296. E-mail address: [email protected] (Y. Kurono). 0531-5131/ D 2003 Elsevier B.V. All rights reserved. doi:10.1016/S0531-5131(03)01614-5
128
Y. Hayamizu et al. / International Congress Series 1257 (2003) 127–130
2. Methods One hundred six patients diagnosed as peritonsillar abscess in our clinic between January 1990 and November 2002 were involved in the study. Among the patients, IPPA was found in 14 cases (8 males and 6 females) and SPPA in 92 cases (65 males and 27
Fig. 1. Age distribution (SPPA and IPPA).
Y. Hayamizu et al. / International Congress Series 1257 (2003) 127–130
129
females) (Fig. 1). The presence and location of abscess were determined by enhanced CT and the findings during surgery. 3. Results Peritonsillar abscess occurred in males more frequently than in females and the incidence was highest between 21 and 30 years of age [1]. The age distribution was classified into five groups, each 20 years, and was compared between IPPA and SPPA. The largest number of patients with SPPA was observed in the group aged from 20 to 39 years and there was no significant difference between males and females. On the other hand, the incidence of IPPA was highest in male patients more than 60 years old. Trismus and tonsil displacement were the typical symptoms of peritonsillar abscess and were frequently observed in SPPA [1]. Each symptom was observed in 74% and 80% of SPPA, respectively. In contrast, those symptoms were rarely found in patients with IPPA compared with SPPA. Trismus was observed in 17% of IPPA and tonsil displacement was in 25%. When those clinical signs were compared between patients aged less than 40 years old and those more than 40 years old, there was no significant difference in the incidence of trismus and tonsil displacement between those two groups in patients with SPPA. On the other hand, the incidence of those clinical signs was less frequent in elder patients with IPPA.
Fig. 2. Bacteriological findings.
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Y. Hayamizu et al. / International Congress Series 1257 (2003) 127–130
Laboratory findings such as the number of white blood cells and the levels of Creactive protein (CRP) were compared between IPPA and SPPA. There was no significant difference in the findings of those examinations between IPPA and SPPA. However, when those laboratory findings were compared with the age distribution, the levels of CRP were different between patients less than 40 years old and those more than 40 years old. In patients aged more than 40 years old, the levels of CRP were significantly lower in IPPA than in SPPA. In microbiological examination for peritonsillar abscess effusion, Streptococcus pyogenes and Streptococcus pneumonia were cultured only from SPPA. On the other hand, Haemophilus influenzae were more frequently cultured from IPPA than SPPA (Fig. 2). 4. Conclusions The present study showed that IPPA occurs more frequently in elder patients than in younger patients and clinical symptoms are less remarkable in patients with IPPA [3]. Those findings suggest the importance of considering the presence of IPPA in the diagnosis of peritonsillar abscess even if common clinical symptoms are absent, especially in elder patients. References [1] A. Matsuda, H. Tanaka, T. Kanaya, K. Kamata, M. Hasegawa, Peritonsillar abscess: a study of 724 cases in Japan, Ear Nose Throat J. 81 (6) (2002) 384 – 389. [2] G. Holt, P. Tinsley, Peritonsillar abscesses in children, Laryngoscope 91 (8) (1981) 1226 – 1230. [3] J. Stage, P. Bonding, Peritonsillar abscess with parapharyngeal involvement: incidence and treatment, Clin. Otolaryngol. 12 (1) (1987) 1 – 5. [4] R. Greg, A. Gregory, Inferior pole peritonsillar abscess, Otolaryngol. Head Neck Surg. 1 (1998) 95 – 99.