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Michael Blaivas - One of the best experts on this subject based on the ideXlab platform.
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intraoral ultrasound in the diagnosis and treatment of suspected Peritonsillar Abscess in the emergency department
Academic Emergency Medicine, 2005Co-Authors: M Lyon, Michael BlaivasAbstract:Peritonsillar Abscess (PTA) can be a life-threatening disease and may lead to significant complications without drainage. Objectives: To describe the utility of ultrasound (US) in the evaluation of potential PTA and US-guided PTA drainage. Methods: The authors performed a retrospective US quality assurance review of all patients over 18 years of age scanned by emergency physicians for possible PTA. All patients presenting with PTA signs and symptoms including erythema and swelling of the tonsillar pillar and uvular deviation were eligible to be scanned. Patients confirmed to have an Abscess on US had US-guided drainage followed by intravenous antibiotics in the emergency department and discharge home on oral antibiotics. Scans were performed by credentialed attending emergency physicians and residents. Researchers recorded patient symptoms, US findings, results of Abscess drainage if performed, and any complications of drainage. All US examinations were performed with sheathed endocavity broadband US transducers on minimum depth and maximum resolution settings. Statistical analysis included descriptive statistics. Results: Forty-three patients received intraoral US examinations for suspected PTA. Thirty-five (81%) were diagnosed as having Abscess on US. All Abscesses were drained with an 18- or 14-gauge needle under US guidance. There were no drainage complications. There was one false positive with a focal area of edema yielding no pus on needle aspiration under direct US visualization. No patient returned unexpectedly after drainage. Conclusions: These data suggest that intraoral US of suspected PTA allows for reliable diagnosis and safe and accurate Abscess drainage. Key words: Peritonsillar Abscess; Peritonsillar Abscess drainage; Peritonsillar ultrasound; emergency ultrasound; intraoral ultrasound; ultrasound-guided procedure. ACADEMIC EMERGENCY MEDICINE 2005; 12:85‐88.
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bilateral Peritonsillar Abscess diagnosed on the basis of intraoral sonography
Journal of Ultrasound in Medicine, 2003Co-Authors: M Lyon, Paul Glisson, Michael BlaivasAbstract:Peritonsillar Abscess consists of suppuration outside the tonsillar capsule as a consequence of acute tonsillitis.1,2 Even though acute tonsillitis is a bilateral process, a Peritonsillar Abscess rarely occurs bilaterally.2 However, when it occurs bilaterally, the key clinical features of the Peritonsillar Abscess are absent. Specifically, uvular and palatal deviation away from the Abscess will not be present.3 This can make the clinical diagnosis of a bilateral Peritonsillar Abscess difficult, leading to complications that include extension to the retropharyngeal space, rupture leading to aspiration, mediastinitis, erosion into the carotid artery, and sepsis. In the following case, intraoral sonography was used to show a bilateral Peritonsillar Abscess and to aid in its drainage. To our knowledge, this is the first case report describing a bilateral Peritonsillar Abscess shown by intraoral sonography.
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ultrasound guided drainage of Peritonsillar Abscess by the emergency physician
American Journal of Emergency Medicine, 2003Co-Authors: Michael Blaivas, Daniel Theodoro, Sandeep DuggalAbstract:The diagnosis of Peritonsillar Abscess (PTA) poses a challenge to emergency physicians (EPs). The decision to perform an invasive procedure with potential complications is based on clinical judgment that is often inaccurate. Although there is some mention of intraoral ultrasound in otolaryngology practice, there is none in the emergency medicine (EM) literature. However, this bedside emergency application of ultrasonography has the potential to be of considerable use in EM practice, and could allow EPs who previously deferred blind needle aspiration of a potential Abscess to perform the procedure themselves. We report the cases of 6 patients who presented with probable PTA and were evaluated with intraoral ultrasound at the bedside by an EP. All 6 patients then underwent needle aspiration. As diagnosed on ultrasound, 3 of the patients had negative aspirations and were diagnosed with Peritonsillar cellulitis. Three others were found to have PTA, with 2 requiring real-time ultrasound needle guidance to accomplish Abscess drainage after multiple failures with the blind approach.
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ultrasound guided drainage of Peritonsillar Abscess by the emergency physician
American Journal of Emergency Medicine, 2003Co-Authors: Michael Blaivas, Daniel Theodoro, Sandeep DuggalAbstract:Abstract The diagnosis of Peritonsillar Abscess (PTA) poses a challenge to emergency physicians (EPs). The decision to perform an invasive procedure with potential complications is based on clinical judgment that is often inaccurate. Although there is some mention of intraoral ultrasound in otolaryngology practice, there is none in the emergency medicine (EM) literature. However, this bedside emergency application of ultrasonography has the potential to be of considerable use in EM practice, and could allow EPs who previously deferred blind needle aspiration of a potential Abscess to perform the procedure themselves. We report the cases of 6 patients who presented with probable PTA and were evaluated with intraoral ultrasound at the bedside by an EP. All 6 patients then underwent needle aspiration. As diagnosed on ultrasound, 3 of the patients had negative aspirations and were diagnosed with Peritonsillar cellulitis. Three others were found to have PTA, with 2 requiring real-time ultrasound needle guidance to accomplish Abscess drainage after multiple failures with the blind approach. (Am J Emerg Med 2003;21:155-158. Copyright 2003, Elsevier Science (USA). All rights reserved.)
M Lyon - One of the best experts on this subject based on the ideXlab platform.
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intraoral ultrasound in the diagnosis and treatment of suspected Peritonsillar Abscess in the emergency department
Academic Emergency Medicine, 2005Co-Authors: M Lyon, Michael BlaivasAbstract:Peritonsillar Abscess (PTA) can be a life-threatening disease and may lead to significant complications without drainage. Objectives: To describe the utility of ultrasound (US) in the evaluation of potential PTA and US-guided PTA drainage. Methods: The authors performed a retrospective US quality assurance review of all patients over 18 years of age scanned by emergency physicians for possible PTA. All patients presenting with PTA signs and symptoms including erythema and swelling of the tonsillar pillar and uvular deviation were eligible to be scanned. Patients confirmed to have an Abscess on US had US-guided drainage followed by intravenous antibiotics in the emergency department and discharge home on oral antibiotics. Scans were performed by credentialed attending emergency physicians and residents. Researchers recorded patient symptoms, US findings, results of Abscess drainage if performed, and any complications of drainage. All US examinations were performed with sheathed endocavity broadband US transducers on minimum depth and maximum resolution settings. Statistical analysis included descriptive statistics. Results: Forty-three patients received intraoral US examinations for suspected PTA. Thirty-five (81%) were diagnosed as having Abscess on US. All Abscesses were drained with an 18- or 14-gauge needle under US guidance. There were no drainage complications. There was one false positive with a focal area of edema yielding no pus on needle aspiration under direct US visualization. No patient returned unexpectedly after drainage. Conclusions: These data suggest that intraoral US of suspected PTA allows for reliable diagnosis and safe and accurate Abscess drainage. Key words: Peritonsillar Abscess; Peritonsillar Abscess drainage; Peritonsillar ultrasound; emergency ultrasound; intraoral ultrasound; ultrasound-guided procedure. ACADEMIC EMERGENCY MEDICINE 2005; 12:85‐88.
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bilateral Peritonsillar Abscess diagnosed on the basis of intraoral sonography
Journal of Ultrasound in Medicine, 2003Co-Authors: M Lyon, Paul Glisson, Michael BlaivasAbstract:Peritonsillar Abscess consists of suppuration outside the tonsillar capsule as a consequence of acute tonsillitis.1,2 Even though acute tonsillitis is a bilateral process, a Peritonsillar Abscess rarely occurs bilaterally.2 However, when it occurs bilaterally, the key clinical features of the Peritonsillar Abscess are absent. Specifically, uvular and palatal deviation away from the Abscess will not be present.3 This can make the clinical diagnosis of a bilateral Peritonsillar Abscess difficult, leading to complications that include extension to the retropharyngeal space, rupture leading to aspiration, mediastinitis, erosion into the carotid artery, and sepsis. In the following case, intraoral sonography was used to show a bilateral Peritonsillar Abscess and to aid in its drainage. To our knowledge, this is the first case report describing a bilateral Peritonsillar Abscess shown by intraoral sonography.
Romaine F Johnson - One of the best experts on this subject based on the ideXlab platform.
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emergency department visits hospitalizations and readmissions of patients with a Peritonsillar Abscess
Laryngoscope, 2017Co-Authors: Romaine F JohnsonAbstract:Objectives To determine the demographics and treatment outcomes of patients with a Peritonsillar Abscess (PTA) and to provide guidance for treatment options. Methods The 2012 National Emergency Department Database, 2012 National Inpatient Sample, and 2013 Nationwide Readmissions Database were used to analyze patients with a PTA who presented to emergency departments (ED), were admitted and/or readmitted to hospitals in the United States. Outcomes were used to create a decision model to compare initial medical versus surgical management. Results An estimated 62,787 ED visits; 15,095 inpatient admissions; and 267 readmissions for PTA were recorded. The average age was 29 years old, with a slight male predominance. The majority of patients seen in the ED (80%) were treated without surgery and discharged home. Patients admitted to hospital were more likely to undergo surgery (50%). The tonsillectomy rate was 11%. The complication and readmission rates were < 2%. Medical therapy was used more often than surgical therapy in many cases. Conclusion Peritonsillar Abscess mostly occurs in adults and leads to a significant number of ED visits, admissions, and readmissions. A trial of medical management of PTA appears to be safe, although surgery is highly successful and associated with low morbidity. Level of Evidence 2c. Laryngoscope, 127:S1–S9, 2017
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the contemporary approach to diagnosis and management of Peritonsillar Abscess
Current Opinion in Otolaryngology & Head and Neck Surgery, 2005Co-Authors: Romaine F Johnson, Michael G StewartAbstract:Purpose of review Peritonsillar Abscess is a common problem, but some aspects of diagnosis and management remain controversial. We review the recent literature on Peritonsillar Abscess. Recent findings Intraoral ultrasound can be a helpful diagnostic tool for Peritonsillar Abscess. For management, needle aspiration, incision and drainage, and quinsy tonsillectomy all yield successful results. Recent reviews have still not established that one treatment is consistently preferred. A randomized, placebo-controlled trail found that the use of intravenous steroids seems to reduce many symptoms, when used along with Abscess drainage. Summary The use of steroids may be beneficial in the treatment of Peritonsillar Abscess, and different techniques for Abscess drainage are still used around the world, with consistently good results.
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an evidence based review of the treatment of Peritonsillar Abscess
Otolaryngology-Head and Neck Surgery, 2003Co-Authors: Romaine F Johnson, Michael G Stewart, Crystal C WrightAbstract:OBJECTIVE: Peritonsillar Abscess (PTA) is commonly seen but still controversial. We performed an evidence-based review to answer 3 questions: Are steroids beneficial? Which is the best technique for acute surgical management? When is tonsillectomy indicated?STUDY DESIGN: We performed a MEDLINE search of the published literature using appropriate search terms to identify pertinent articles, which were reviewed and graded according to the evidence quality.RESULTS: Forty-two articles were analyzed. There are no published studies on steroids in PTA. There were 5 level I clinical studies on surgical technique, which indicated that needle aspiration, incision and drainage, and quinsy tonsillectomy are all effective for initial management. The overall PTA recurrence rate is 10% to 15%.CONCLUSIONS: Overall, grade C evidence indicates that several methods of initial surgical drainage are equally effective, and the recurrence rate is low. The literature does not specifically address different treatments for childre...
A Blokmanis - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of Peritonsillar Abscess value of intraoral sonography
American Journal of Roentgenology, 1994Co-Authors: A R Buckley, E H Moss, A BlokmanisAbstract:Clinical differentiation of Peritonsillar Abscess from Peritonsillar cellulitis can be difficult and often relies on blind needle aspiration of the tonsillar fossa to locate pus. The objective of this study was to establish a noninvasive and reliable sonographic technique for differentiating Peritonsillar Abscess from Peritonsillar cellulitis in equivocal cases and to thereby avoid unnecessary needle aspiration.The study population included three healthy volunteers and 18 patients with clinically suspected Peritonsillar Abscess. The tonsils were assessed by using transcutaneous and intraoral sonography.The tonsils were visualized on both transcutaneous and intraoral sonograms in all three volunteers and in 16 patients. In one patient, the tonsils were not visualized on transcutaneous imaging; intraoral imaging showed cellulitis. In another patient, the intraoral examination was unsuccessful, whereas transcutaneous sonograms showed normal tonsils. On the basis of findings on transcutaneous sonograms, tonsi...
Leland P Johnson - One of the best experts on this subject based on the ideXlab platform.
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intraoral ultrasound evaluation of Peritonsillar Abscess
Laryngoscope, 1995Co-Authors: Bradley E Strong, Paula J Woodward, Leland P JohnsonAbstract:Peritonsillar cellulitis and Peritonsillar Abscess are similar clinical entities with markedly different methods of treatment. Therefore, accurate diagnosis is paramount to appropriate treatment. This pilot study was designed to evaluate the sensitivity and specificity of intraoral ultrasound as a noninvasive method of differentiating Abscess from cellulitis. Sixteen consecutive patients suspected of having Peritonsillar Abscess were prospectively evaluated with intraoral ultrasound. The results were confirmed with imaging or surgical drainage. Correct diagnoses were made in 9(90%) of 10 Abscesses and in 5 (83%) of 6 cases of cellulitis. Our results suggest that, while there is a learning curve for intraoral ultrasound, it is an accurate, noninvasive, and inexpensive tool to differentiate Abscess from cellulitis. We believe that this will be a clinically useful technique in the future.