COMPUTERIZED-TOMOGRAPHY OF ACUTE, TENDER PERITONSILLAR SWELLINGS

A randomized trial involving 40 consecutive patients with an acute pai nful peritonsillar swelling was set up to determine if an enhanced com puterized neck tomogram was cost-effective or improved patient managem ent. Each patient was placed into one of two groups. The first group h ad enhanced computerized tomography (CT) which allowed precise identif ication of a quinsy and this was aspirated with an 18G needle aspirati on at the site directed by the scan. The second group of patients had 3-point permucosal 18G needle aspirations. A proportion of patients fr om each group, but primarily from the second, required immediate or de layed admission to hospital after aspiration, for persistent or recurr ent symptoms. Costing each groups treatment, including the scan and ho spitalization on intravenous antibiotics, we conclude that CT scanning prevents the morbidity associated with unsuccessful attempts at drain age in the patient with cellulitis and ensures complete drainage of pu s, thereby optimizing patient treatment and it is cost-effective.