Blotter J W, Yin L, Glynn M, Wiet G J
Department of Otolaryngology--Head and Neck Surgery, The Ohio State University, Columbus, USA.
Laryngoscope. 2000 Oct;110(10 Pt 1):1698-701. doi: 10.1097/00005537-200010000-00024.
To assess clinical outcomes of children seen in consultation for peritonsillar abscess treated without the routine use of computed tomography or needle aspiration.
Retrospective review of patients evaluated in the emergency department for possible peritonsillar abscess. Patient outcomes are reviewed with a statistical analysis of children grouped according to age.
A series of 102 patients, ages 8 months to 19 years, who were evaluated by the emergency department with otolaryngology consultation for possible peritonsillar abscess. All patients were admitted and given intravenous fluid replacement, antibiotics, and analgesia. Patients who responded to 24 hours of medical treatment were discharged, whereas patients who did not respond underwent elective tonsillectomy.
Outcome of patients evaluated for peritonsillar abscess treated without immediate surgery, needle aspiration, or computed tomography. Outcomes are correlated with age and clinical findings.
Fifty-two patients were discharged after initial medical therapy. Fifty patients underwent elective tonsillectomy; 40 of these patients were found to have abscesses at the time of surgery. When analyzed according to age, patients ages 8 months to 6 years were more likely to respond to medical treatment than children ages 7 to 12 and 12 to 19 (P = .023). Significant differences in the mean age of children requiring surgery (11.0 y) compared with those who responded to medical treatment (7.9 y) were observed (P = .003). Younger children who underwent tonsillectomy had a lower incidence of surgically confirmed abscess.
A significant number of children presenting with odynophagia, malaise, pharyngotonsillar bulge, and decreased oral intake respond to medical therapy without radiological evaluation or surgical intervention. Additionally, younger children (1-6 y) are more likely to respond to medical treatment than older children. Pertinent clinical data, as well as advantages and disadvantages of this approach, are discussed.
评估在不常规使用计算机断层扫描或针吸术的情况下接受会诊治疗的扁桃体周围脓肿患儿的临床结局。
对在急诊科评估是否可能患有扁桃体周围脓肿的患者进行回顾性研究。根据年龄对儿童进行分组，并对患者结局进行统计分析。
一系列102例年龄在8个月至19岁之间的患者，在急诊科接受了耳鼻喉科会诊，以评估是否可能患有扁桃体周围脓肿。所有患者均入院，并接受静脉补液、抗生素和镇痛治疗。对接受24小时药物治疗有反应的患者予以出院，而无反应的患者则接受择期扁桃体切除术。
在未立即进行手术、针吸术或计算机断层扫描的情况下，对评估为扁桃体周围脓肿的患者的结局。结局与年龄和临床发现相关。
52例患者在初始药物治疗后出院。50例患者接受了择期扁桃体切除术；其中40例患者在手术时被发现有脓肿。按年龄分析，8个月至6岁的患者比7至12岁和12至19岁的儿童更有可能对药物治疗有反应（P = 0.023）。观察到需要手术的儿童的平均年龄（11.0岁）与对药物治疗有反应的儿童（7.9岁）之间存在显著差异（P = 0.003）。接受扁桃体切除术的年幼儿童手术确诊脓肿的发生率较低。
大量出现吞咽痛、不适、咽扁桃体隆起和口腔摄入量减少的儿童在未进行放射学评估或手术干预的情况下对药物治疗有反应。此外，年幼儿童（1 - 6岁）比年长儿童更有可能对药物治疗有反应。讨论了相关的临床数据以及这种方法的优缺点。
