The management of peritonsillar abscess.
Over a four month period from 1 st November 1998 to 28th February 1999 a randomised prospective study was undertaken in 75 patients with peritonsiller abscess (PTA) to determine the treatment modality that is most effective in alleviating the excruiating pain and discomfort associated with the condition. The patients were divided into three treatment groups. There were 25 patients in each group. Group A patients were treated with intravenous antibiotics and intra muscular opiates, Group B aspiration and oral antibiotics and Group C incision and drainage and oral antibiotics. Pain relief was objectively assessed with each treatment modality by measuring the upper to lower incisor distance, 15 mins, 24 hours and 48 hours and oral intake at 2 hours, 24 hours and 48 hours after the initial treatment. The improvement of the mean upper to lower incisor distance 15 minutes after the initial treatment was 5% in Group A, 38% in Group B and 100% in Group C. Twenty four hours later the improvement was 30% in Group A, 111 % in Group B and 125% in Group C. None of the patients in Group A were able to take fluid orally at 2 hours. Only 2 patients (8%) could in Group B and 23 patients (92%) in Group C. 24 hours later, 15 patients (60%) could take fluid orally in group A, 19 (76%) in group B and 25 (100%) in group C. Treatment failures were those patients in whom the trismus, odynophagia and pyrexia failed to subside after 48 hours. There were 8 patients (30 per cent) in group A, 6 (24%) in group B and none in Group C. The 14 failures were successfully treated with incision and drainage. The conclusion derived from this study is that incision and drainage is superior to intravenous antibiotic and aspiration in alleviating the pain and discomfort associated with peritonsillar abscess.