Peritonsillar abscess: remember to always think twice

Peritonsillar abscess (PTA) is the most common complication of acute tonsillitis resulting in fever, unilateral sore throat, odynophagia and trismus. This retrospective study was undertaken to analyze the clinical courses of 775 patients with two different methods of the first-line treatment. Abscess tonsillectomy (TAC) including contralateral tonsillectomy was preferably performed between 2007 und 2010 (group A; n = 443). After that, incisional drainage (ID) was chosen as first-line treatment between 2010 and 2013 (group B; n = 332). The data of the patients were pooled from the individual charts to evaluate the prevalence of smoking habits, the incidence of the recurrence/complication rates and the number/types of surgical procedures associated with each therapy modality. Replacing TAC by ID as first-line treatment of PTA resulted in a significant decrease of days of inpatient treatment (4 vs. 7 days) and hemorrhage rate (0.3 vs. 5.1 %). A second, third and fourth surgical revision procedure was performed with comparable rates in group A (21.6; 2.4; 0.5 %) and B (21; 4.9; 0.3 %). Smoking habits were reported by almost every second patient. ID as first-line treatment of PTA is capable to reduce the hemorrhage rate and length of inpatient observation significantly. To suggest ID as first-line PTA treatment mandates a close follow-up to indicate repeated drainage of residual pus at an early stage. Further analysis is warranted to verify whether a better surveillance in an academic teaching hospital or surgical modification of the ID is followed by a higher success rate. Smoking habits are overrepresented in PTA patients.