Tonsil

Follicular dendritic cell sarcoma of the tonsil: A case report and literature review

March 31, 2007     Chad McDuffie, MD; Timothy S. Lian, MD; Joel Thibodeaux, MD
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Bilateral peritonsillar abscesses: A challenging diagnosis

March 1, 2007     James T. Edinger, MD; Elias Y. Hilal, MD; Khurshed J. Dastur, MD
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Malignancy in asymmetrical but otherwise normal palatine tonsils

September 30, 2006     Adenike F. Oluwasanmi, FRCS; Stephen J. Wood, FRCS; David L. Baldwin, FRCS; Fabian Sipaul, MRCS
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Abstract
An abnormally large tonsil may be a sign of malignancy. We retrospectively analyzed the case files of 87 patients who had asymmetrically sized but otherwise normal tonsils and no risk factors for cancer to determine if asymmetry is associated with a higher incidence of malignancy. We found 2 cases (2.3%) of malignancy among these patients. One patient had high-grade non-Hodgkin's lymphoma in the larger tonsil, and the other had lymphocyte-rich Hodgkin's lymphoma. Both patients were older than 50 years, and neither had a history of recurrent tonsillitis. We believe that although the incidence of cancer in our series was small, it is significant. Therefore, we recommend routine excision of abnormally large tonsils. Moreover, when making such a recommendation to a patient, it is essential that the patient have a clear understanding of the risk and benefit of having a tonsil removed solely because of asymmetry.

An outpatient medical treatment protocol for peritonsillar abscess

September 30, 2006     Roland H. Lamkin, MD, FACS; James Portt, PAC, MMS
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Abstract
Several surgical methods are used to treat peritonsillar abscess, but no protocol for outpatient medical treatment has yet been published. Between February 2002 and February 2005, we treated 98 peritonsillar abscess patients with an outpatient medical regimen that involved hydration, antibiotics, steroids, and good pain control. All patients were Native Americans, who are known to have a particularly high incidence of peritonsillar abscess. The medical regimen was generally successful, as only 4 patients (4.1%) subsequently required post-treatment needle aspiration or incision and drainage. We conclude that the medical protocol described herein provides practitioners with a viable noninvasive alternative for treating peritonsillar abscess.

The submucosal fish bone

July 31, 2006     Patrick M. Spielmann, MBChB, MRCS (Edin); Conroy Howson, FCS (SA) ORL
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Parathyroid adenoma mimicking cervical recurrence on CT/PET fusion scan

February 1, 2006     Sofia Avitia, MD; Ryan F. Osborne, MD, FACS
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Bilateral peritonsillar abscess revisited

December 1, 2005     Adnan Safdar, FRCS; Joseph P. Hughes, FRCS; Rory McConn Walsh, FRCS; Michael Walsh, FRCS
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Abstract
Bilateral peritonsillar abscess is uncommon. When it does occur, patients usually present with sore throat; other clinical signs and symptoms may differ from those usually associated with unilateral peritonsillar abscess. We describe 2 cases of bilateral peritonsillar abscess that were successfully treated with needle aspiration of both sides with a 14-gauge intravenous cannula. Needle aspiration is an accepted form of treatment for unilateral peritonsillar abscess, but to the best of our knowledge, its use as a sole treatment modality (with observation under intravenous antibiotic coverage) for bilateral peritonsillar abscess has not been previously reported in the literature. We also believe that the incidence of acute bilateral peritonsillar abscess may be higher than the rates that have been reported in the literature. Finally, we recommend that the threshold for imaging be low for any patient who is suspected of having acute bilateral peritonsillar abscess to avoid any delay in diagnosis and treatment.

Surgical emphysema following tonsillectomy

September 30, 2005     Nitesh Patel, FRCS; Gerald Brookes, FRCS
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Abstract
Complications of tonsillectomy have been well documented. However, subcutaneous emphysema of the neck following tonsillectomy has rarely been described. We report a case of this complication in a young man who forcefully performed Valsalva's maneuver following a tonsillectomy.

Tonsillectomy without headlights: A unique solution

August 31, 2005     Narayanan Prepageran, FRCS; Rahmat Omar, MS; Rajagopalan Raman, MS, DLO
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Peritonsillar abscess: A comparison of outpatient IM clindamycin and inpatient IV ampicillin/sulbactam following needle aspiration

May 31, 2005     Cem Ozbek, MD; Erdinc Aygenc, MD; Evrim Unsal, MD; Cafer Ozdem, MD
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Abstract
In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we compared the clinical efficacy of empiric intramuscular clindamycin and intravenous ampicillin/sulbactam (following needle aspiration of the abscess) in a prospective, randomized study of 58 patients. Patients in the clindamycin group were treated on an outpatient basis, whereas those in the ampicillin/sulbactam group were hospitalized for the duration of their treatment (minimum: 7 days). Comparison of clinical outcomes with respect to the posttherapeutic duration of fever and throat pain and the time to resumption of eating revealed no statistically significant difference between the two groups. These results suggest that intramuscular clindamycin is an excellent choice and can be safely prescribed on an outpatient basis following needle aspiration, thereby reducing both antibiotic and hospital costs.

Prevalence of penicillin allergy in adults with peritonsillar abscess

April 1, 2005     Rakesh K. Chandra, MD; Collin E. Lee, RPh; Harold Pelzer, MD
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Abstract
We noticed a seemingly high prevalence of penicillin allergy in patients who had been diagnosed with peritonsillar abscess (PTA) at our institution. To formally investigate this observation, we reviewed the emergency room (ER) records of 118 patients who had presented between Jan. 1, 1995, and Dec. 31, 1999, with suspected PTA. A diagnosis of PTA was confirmed by the presence of pus on incision and drainage in 78 of these patients (66.1%). The remaining 40 patients (33.9%) were diagnosed with peritonsillar cellulitis (PTC). Of the 78 patients with confirmed PTA, 13 (16.7%) self-reported an allergy to an antibiotic, including 11 (14.1%) who claimed to be allergic to penicillin. In the 40 patients with PTC, the corresponding figures were only 3 (7.5%) and 1 (2.5%). The difference between the PTA and PTC groups with respect to the prevalence of self-reported penicillin allergy was statistically significant (p < 0.05). We also compared the prevalence of antibiotic allergies in our patients with that of 1,893 consecutively presenting patients whose records had been entered into a pharmacy database at our institution. We found that the overall prevalence of patient-reported penicillin allergy in our PTA group was similar to that of the database population, although penicillin allergy did account for a greater percentage of all antibiotic allergies (84.6%) in our PTA group than in the larger population (62.8%). In our series, patients with PTA were more likely to have reported an allergy to penicillin than were patients without an abscess. Additionally, the prevalence of patient-reported antibiotic allergy is high at our institution. Although self-reported penicillin allergy may not represent a true hypersensitivity reaction, it can influence antibiotic selection and/or compliance. Prospective studies are needed to determine what influence allergic status and antibiotic choice has on abscess development.

Harmonic scalpel tonsillectomy versus hot electrocautery and cold dissection: An objective comparison

September 30, 2004     Shai Shinhar, MD; Brett M. Scotch, DO; Walter Belenky, MD; David Madgy, DO; Michael Haupert, DO
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Abstract
We conducted a large-scale retrospective study to compare the surgical efficacy, practical utility, safety, and cost-effectiveness of ultrasonic harmonic scalpel tonsillectomy, hot electrocautery, and cold surgical dissection. We based our findings on the length of operating time, complication rates, the length of hospital stay for patients with complications, and relative costs. We then compared our findings with those published in earlier reports, none of which were based on a three-way comparison. Our study population was made up of 316 patients''175 males and 141 females aged 1 to 23 years (mean: 7.3)''who had undergone adenotonsillectomy or tonsillectomy alone at our tertiary care children's hospital between Sept. 1, 2000, and Aug. 31, 2001. The harmonic scalpel was used on 75 patients (23.7%), electrocautery on 109 patients (34.5%), and cold surgical dissection on 132 (41.8%). The mean length of operating time for adenotonsillectomy was 42.4 (n = 70), 43.0 (n = 103), and 49.2 (n = 95) minutes, respectively; the corresponding times for tonsillectomy alone were 23.6 (n = 5), 30.2 (n = 6), and 35.3 (n = 37) minutes. Overall complication rates were 2.7, 5.5, and 6.1%, respectively. Hospital stays for immediate (<24 hr) postoperative bleeding averaged 2.0, 1.0, and 0.7 days, respectively, and stays for dehydration averaged 1.0, 1.3, and 1.5 days. Mean per-patient institutional costs were $460.00, $310.75, and $300.00, respectively. We conclude that harmonic scalpel tonsillectomy is efficacious, practical, safe, and cost-effective, and we recommend that any institution involved with a significant number of pediatric tonsillectomies consider using it.
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