Results
PMA diagnosis involved 106 adults (female/male ratio:21/85, mean age: 51±14.1 years). Associated comorbidities included hypertension (n=22), dyslipidemia (n=20), heart disease (n=8), thyroid disease (n=8), diabetes mellitus (n=7), asthma (n=5), anemia (n=3), renal insufficiency (n=1) and rheumatoid arthritis (n=1); 8 had a history of tonsillectomy. CT-scan with contrast confirmed diagnosis.
PMAs patients’ symptoms are summarized on Table 1. The most commonly reported symptoms were dysphagia, odynophagia and fever. The mean onset of symptoms was 3.2±1.7 days prior to admission. Trismus and neck swelling were significantly lower in PMAs compared to non-PMA DNIs (p<0.01); while dysphagia was significantly higher (p<0.01). No association with teeth was noted in PMAs.
Table 2 tabulates the summary of PMA patients’ physical examination findings. One-sided lateral pharyngeal wall edema was invariable; pyriform sinus, vallecula, uvula, peritonsillar swelling and unilaterally enlarged tonsil were noticed in 40.57%, 27,36%, 27,36%, 26,42% and 17,92% of patients respectively; while nasopharyngeal edema and adenoiditis was found in 3 patients. Tenderness was noted in all patients during palpation of larynx. The most common laryngeal endoscopy finding was arytenoid oedema (19.81%); glottic and subglottic areas were spared. Neck swelling was present in 24,53% of patients.
Mean WBC count and CRP values upon admission were 14,5±5,11K/μL (reference range, 4-10,8K/μL) and 13,4±10,1 (reference range, 0-0,5mg/dL) respectively. Samples for microbiological analysis were obtained in 61 patients; the rest 45 samples were not processed due to insufficient purulent material. Cultures yielded 23 positive results (Table 3). All isolated bacteria species were aerobic; the commonest were Streptococcus pyogenes (52,2%) and Staphylococcus aureus (30,4%). Before admission, 37 patients were under antibiotics and 6 under steroids by their GPs.
In-hospital empirical therapy included IV ampicillin-sulbactam combined with metronidazole or clindamycin. Spontaneous drainage was noted in 52(49,1%) patients, transoral drainage under local anesthetic in 47(44,3%), and aspiration in 7(6,6%). The mean time ±SD until spontaneous drainage was 1.8±0.8 days from admission. No further surgical intervention was necessary and no major adverse event was noted in any patient, while the mean hospital stay was 4.2±1.8 days.