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Peritonsillarabszess

Trends und Komplikationen bei der Behandlung, insbesondere bei Kindern

Trends and complications in the management of peritonsillar abscess with emphasis on children

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Zusammenfassung

Hintergrund: Auf Grund der anatomischen Enge, fehlenden Mitteilungsmöglichkeit und besonderen Belastung durch die Untersuchung stellt der Peritonsillarabszess (PTA) insbesondere bei sehr jungen Kindern eine Herausforderung dar. Ziel dieser Untersuchung war es, die Blutungskomplikationen der Tonsillekomie à chaud (TAC) bei Kindern <16 Jahre zu ermitteln und die Resultate mit Empfehlungen der aktuellen Literatur zu vergleichen. Methoden: In einer retrospektiven Studie wurden die Daten von 218 Patienten (<16 Jahre) ausgewertet, bei denen zwischen dem 1.1.1988 und 1.1.2003 ein PTA durch sofortige Tonsillektomie behandelt worden war. Der jüngste Patient war 18 Monate, der älteste 15,9 Jahre alt (Altersdurchschnitt: 14,53; Median: 14; STD: 12,11 Jahre). 95 Patienten waren männlich (43,6%) und 123 weiblich (56,4%). Ergebnisse: Auf der Abszessseite kam es bei keinem Patienten zu einer Nachblutung. Auf der kontralateralen Seite bluteten insgesamt 4 Patienten, bei denen die Nachblutung unter Vollnarkose versorgt wurde (1,8%). Bluttransfusionen waren nicht erforderlich, Todesfälle ereigneten sich nicht. Die Literaturrecherche ergab keine eindeutige langfristige Überlegenheit einer Therapiemodalität. Wegen der hohen initialen Erfolgsrate scheint die Nadelaspiration (NP) oder Inzisionsdrainage (ID) in den meisten Fällen ausreichend zu sein. Die Analgosedierung ermöglicht vielfach, diese Verfahren auch bei Kindern vorzunehmen. Schlussfolgerungen: Für die Mehrheit der Patienten erscheint die NP oder ID ein ausreichendes Verfahren darzustellen, da die Rezidivrate nach dieser Behandlung—insbesondere bei Kindern—niedrig ist. Deswegen sollte nur noch in ausgesuchten Fällen eine TAC erfolgen, die nach unseren Ergebnissen gerade bei jungen Kindern nicht mit einer erhöhten Nachblutungsrate belastet ist.

Abstract

Background: Peritonsillar abscess (PTA) is the most common deep neck space infection treated by otolaryngologists affecting predominantly young adults. Children present a challenge owing to the difficulty in obtaining an exact history and adequate physical examination. Particularly for the pediatric age group controversy surrounds the question of optimal treatment. This study was undertaken to evaluate bleeding complications following immediate tonsillectomy (TAC) in a pediatric population (<16 years) of age and to compare our management protocol with the current status in the literature. Material and methods: The data of 218 children who had undergone TAC between January 1988 and January 2003 in our clinic were enrolled in a retrospective study. The youngest patient was 18 months, the oldest 15.9 years of age (mean: 14.53; median: 14; STD: 12.11 years). 95 patients were male (43.6%), 123 female (56.4%). Various treatment protocols of the current literature are addressed. Results: Postoperative hemorrhage (all from the opposite side) requiring surgical treatment under general anesthesia occurred in 4 children (1.8%). Repeated hemorrhage did not occur, blood transfusions were not required, there was no case with lethal outcome. Several reports indicate that needle aspiration (NP) or incision and drainage (ID) may suffice for the majority of cases but do not distinguish between different treatments for children and adults. More recently, conscious sedation has become a great support for pediatric treatment protocols. Conclusions: The initial success rates of NP or ID are both very high (>90%) and the overall recurrence rate is low, particularly in children. Only for selected subgroups, patients may profit from TAC, which was clearly not associated with an increased risk of bleeding in our pediatric population.

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Windfuhr, J.P., Remmert, S. Peritonsillarabszess. HNO 53, 46–57 (2005). https://doi.org/10.1007/s00106-003-1036-2

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