Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-24T21:14:13.142Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving the management of suspected tonsillitis and peritonsillar abscess referred to ENT – a coronavirus disease 2019 service improvement

Part of: JLO Coronavirus Collection

Published online by Cambridge University Press:  29 April 2021

N Cereceda-Monteoliva ,
Y Devabalan ,
H Lorenz ,
J C Magill ,
S Unadkat  and
C Rennie
N Cereceda-Monteoliva*
Affiliation:
Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
Y Devabalan
Affiliation:
Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
H Lorenz
Affiliation:
Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
J C Magill
Affiliation:
Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
S Unadkat
Affiliation:
Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
C Rennie
Affiliation:
Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
*
Author for correspondence: Mr Nicholas Cereceda-Monteoliva, Department of Otolaryngology, Head and Neck Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, Hammersmith, LondonW6 8RF, UK E-mail: nicholas.cm@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The impact of coronavirus disease 2019 on healthcare has led to rapid changes in otolaryngology service provisions. As such, new standard operating procedures for the management of suspected tonsillitis or quinsy were implemented in our centre.

Methods

A retrospective audit was performed of acute referrals to ENT of patients with suspected tonsillitis, peritonsillar cellulitis or quinsy, during the 10 weeks before (group 1) and 10 weeks after (group 2) implementation of the new standard operating procedures.

Results

Group 2 received fewer referrals. Fewer nasendoscopies were performed and corticosteroid use was reduced. The frequency of quinsy drainage performed under local anaesthetic increased, although the difference was not statistically significant. Hospital admission rates decreased from 56.1 to 20.4 per cent, and mean length of stay increased from 1.13 to 1.5 days. Face-to-face follow up decreased from 15.0 to 8.2 per cent, whilst virtual follow up increased from 4.7 to 16.3 per cent. There were no significant differences in re-presentation or re-admission rates.

Conclusion

Management of suspected tonsillitis or quinsy using the new standard operating procedures appears to be safe and effective. This management should now be applied to an out-patient setting in otherwise systemically well patients.

Keywords

TonsillitisPeritonsillar AbscessCoronavirusPandemicsOtolaryngologyQuality Improvement
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 7 , July 2021 , pp. 584 - 588
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr N Cereceda-Monteoliva takes responsibility for the integrity of the content of the paper

References

Moghadas, SM, Shoukat, A, Fitzpatrick, MC, Wells, CR, Sah, P, Pandey, A et al. Projecting hospital utilization during the COVID-19 outbreaks in the United States. Proc Natl Acad Sci U S A 2020;117:9122–6CrossRefGoogle ScholarPubMed
Givi, B, Schiff, BA, Chinn, SB, Clayburgh, D, Iyer, NG, Jalisi, S et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngol Head Neck Surg 2020;146:579–84CrossRefGoogle ScholarPubMed
Stephenson, K, Sowerby, LJ, Hopkins, C, Kumar, N. The UK national registry of ENT surgeons with coronavirus disease 2019. J Laryngol Otol 2020;134:665–910.1017/S0022215120001747CrossRefGoogle Scholar
Bann, DV, Patel, VA, Saadi, R, Gniady, JP, Goyal, N, McGinn, JD et al. Impact of coronavirus (COVID-19) on otolaryngologic surgery: brief commentary. Head Neck 2020;42:1227–3410.1002/hed.26162CrossRefGoogle ScholarPubMed
Unadkat, SN, Andrews, PJ, Bertossi, D, D'Souza, A, Joshi, A, Shandilya, M et al. Recovery of elective facial plastic surgery in the post-coronavirus disease 2019 era: recommendations from the European Academy of Facial Plastic Surgery Task Force. Facial Plast Surg Aesthet Med 2020;22:233–7CrossRefGoogle ScholarPubMed
Mehanna, HM, Al-Bahnasawi, L, White, A. National audit of the management of peritonsillar abscess. Postgrad Med J 2002;78:545–710.1136/pmj.78.923.545CrossRefGoogle Scholar
ENT Trainee Research Collaborative – West Midlands. National prospective cohort study of peritonsillar abscess management and outcomes: the Multicentre Audit of Quinsies study. J Laryngol Otol 2016;130:768–76CrossRefGoogle Scholar
Al Yaghchi, C, Cruise, A, Kapoor, K, Singh, A, Harcourt, J. Out-patient management of patients with a peritonsillar abscess. Clin Otolaryngol 2008;33:52–5CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Sore throat (acute): antimicrobial prescribing: NICE guideline [NG84] In: https://www.nice.org.uk/guidance/ng84/chapter/Recommendations [13 April 2021]Google Scholar
Ozbek, C, Aygenc, E, Tuna, EU, Selcuk, A, Ozdem, C. Use of steroids in the treatment of peritonsillar abscess. J Laryngol Otol 2004;118:439–42CrossRefGoogle ScholarPubMed
Chau, JKM, Seikaly, HR, Harris, JR, Villa-Roel, C, Brick, C, Rowe, BH. Corticosteroids in peritonsillar abscess treatment: a blinded placebo-controlled clinical trial. Laryngoscope 2014;124:97–10310.1002/lary.24283CrossRefGoogle ScholarPubMed
Hur, K, Zhou, S, Kysh, L. Adjunct steroids in the treatment of peritonsillar abscess: a systematic review. Laryngoscope 2018;128:72–710.1002/lary.26672CrossRefGoogle ScholarPubMed
Sadeghirad, B, Siemieniuk, RAC, Brignardello-Petersen, R, Papola, D, Lytvyn, L, Vandvik, PO et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ 2017;358:j3887CrossRefGoogle ScholarPubMed
Li, X, Xu, S, Yu, M, Wang, K, Tao, Y, Zhou, Y et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146:110–1810.1016/j.jaci.2020.04.006CrossRefGoogle ScholarPubMed
McCabe, R, Schmit, N, Christen, P, D'Aeth, JC, Løchen, A, Rizmie, D et al. Adapting hospital capacity to meet changing demands during the COVID-19 pandemic. BMC Med 2020;18:32910.1186/s12916-020-01781-wCrossRefGoogle ScholarPubMed
Public Health England. COVID-19: Guidance for maintaining services within health and care settings. Infection prevention and control recommendations. [Archived Guidance version 3.2 18 June 2020]. In: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/954690/Infection_Prevention_and_Control_Guidance_January_2021.pdf [13 April 2021]Google Scholar
ENT UK. COVID-19 Adult Tonsillitis & Quinsy Guidelines. In: https://www.entuk.org/covid-19-adult-tonsillitis-quinsy-guidelines [13 April 2021]Google Scholar
Bird, JH, Biggs, TC, King, EV. Controversies in the management of acute tonsillitis: an evidence-based review. Clin Otolaryngol 2014;39:368–7410.1111/coa.12299CrossRefGoogle Scholar
Forner, D, Curry, DE, Hancock, K, MacKay, C, Taylor, SM, Corsten, M et al. Medical intervention alone vs surgical drainage for treatment of peritonsillar abscess: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2020;163:915–22CrossRefGoogle ScholarPubMed
Sideris, AW, Ghosh, N, Lam, ME, Mackay, SG. Peritonsillar abscess and concomitant COVID-19 in a 21-year-old male. BMJ Case Rep 2020;13:e23810410.1136/bcr-2020-238104CrossRefGoogle Scholar
Centor, RM, Witherspoon, JM, Dalton, HP, Brody, CE, Link, K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1:239–4610.1177/0272989X8100100304CrossRefGoogle Scholar
McIsaac, WJ, Kellner, JD, Aufricht, P, Vanjaka, A, Low, DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004;291:1587–95CrossRefGoogle ScholarPubMed
Harris, AM, Hicks, LA, Qaseem, A; High, Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2016;164:425–34CrossRefGoogle ScholarPubMed
Hardman, JC, McCulloch, NA, Nankivell, P. Do corticosteroids improve outcomes in peritonsillar abscess? Laryngoscope 2015;125:537–8CrossRefGoogle ScholarPubMed
Johnson, RM, Vinetz, JM. Dexamethasone in the management of covid-19. BMJ 2020;370:m264810.1136/bmj.m2648CrossRefGoogle ScholarPubMed
British Society of Skeletal Radiologists. Recommendations of the British Society of Skeletal Radiologists: The safety of corticosteroid injections during the COVID-19 global pandemic. In: https://acpomit.csp.org.uk/system/files/documents/2021-01/musculoskeletal_radiology_during_the_covid-19_global_pandemic-rhw001180-lap.pdf [13 April 2021]Google Scholar
Smith, ME. Admission avoidance in tonsillitis and peritonsillar abscess: a prospective national audit during the initial peak of the COVID-19 pandemic. Clin Otolaryngol 2020;46:363–72Google Scholar
Mahase, E. Covid-19: low dose steroid cuts death in ventilated patients by one third, trial finds. BMJ 2020;369:m2422CrossRefGoogle ScholarPubMed
RECOVERY Collaborative Group, Horby, P, Lim, WS, Emberson, JR, Mafham, M, Bell, JL et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384:693–704Google ScholarPubMed
Patel, B, Hardman, JC, Yang, W, Robson, A, Putnam, G, George, A et al. Reusable respirators as personal protective equipment during ENT surgery. J Laryngol Otol 2020;134:732–4CrossRefGoogle ScholarPubMed
OMFS and ENT surgeons issue new COVID-19 PPE guidance. Br Dent J 2020;228:57110.1038/s41415-020-1552-4CrossRefGoogle Scholar
Selwyn, D, Yang, D, Heward, E, Kerai, A, Thompson, E, Shommakhi, A et al. A prospective multicentre external validation study of the Liverpool Peritonsillar abscess Score (LPS) with a no-examination COVID-19 modification. Clin Otolaryngol 2021;46:229–33CrossRefGoogle ScholarPubMed
Stringer, SP, Schaefer, SD, Close, LG. A randomized trial for outpatient management of peritonsillar abscess. Arch Otolaryngol Head Neck Surg 1988;114:296–8CrossRefGoogle ScholarPubMed
Powell, J, Wilson, JA. An evidence-based review of peritonsillar abscess. Clin Otolaryngol 2012;37:136–45CrossRefGoogle ScholarPubMed
Ophir, D, Bawnik, J, Poria, Y, Porat, M, Marshak, G. Peritonsillar abscess. A prospective evaluation of outpatient management by needle aspiration. Arch Otolaryngol Head Neck Surg 1988;114:661–3CrossRefGoogle ScholarPubMed
Lamkin, RH, Portt, J. An outpatient medical treatment protocol for peritonsillar abscess. Ear Nose Throat J 2006;85:658–6010.1177/014556130608501013CrossRefGoogle ScholarPubMed
Cherukuri, S, Benninger, MS. Use of bacteriologic studies in the outpatient management of peritonsillar abscess. Laryngoscope 2002;112:18–20CrossRefGoogle ScholarPubMed