Otolaryngology consultation for peritonsillar abscess in the pediatric population

Objective: To assess clinical outcomes of children seen in consultation for peritonsillar abscess treated without the routine use of computed tomograp hy or needle aspiration. Study Design: Retrospective review of patients eva luated in the emergency department for possible peritonsillar abscess. Pati ent outcomes are reviewed with a statistical analysis of children grouped a ccording to age. Methods: A series of 102 patients, ages 8 months to 19 yea rs, who were evaluated by the emergency department with otolaryngology cons ultation 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 pat ients who did not respond underwent elective tonsillectomy, Main Outcome Me asure: Outcome of patients evaluated for peritonsillar abscess treated with out immediate surgery, needle aspiration, or computed tomography. Outcomes are correlated with age and clinical findings. Results: Fifty-two patients were discharged after initial medical therapy. Fifty patients underwent ele ctive 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 a ge of children requiring surgery (11.0 y) compared with those who responded to medical treatment (7.9 y) were observed (P = .003), Younger children wh o underwent tonsillectomy had a lower incidence of surgically confirmed abs cess. Conclusions: A significant number of children presenting with odynoph agia, malaise, pharyngotonsillar bulge, and decreased oral intake respond t o medical therapy without radiological evaluation or surgical intervention. Additionally, younger children (1-6 y) are more likely to respond to medic al treatment than older children. Pertinent clinical data, as well as advan tages and disadvantages of this approach, are discussed.