Predictors of Treatment Failure in the Surgical Management of Peritonsillar Abscesses
- 1Unit of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
- 2Otorhinolaryngology Section, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C), University of Palermo, 90133 Palermo, Italy
Abstract
Objectives: Peritonsillar abscess (PTA) is the most common deep neck infection and is usually managed with antibiotic therapy and surgical drainage. However, drainage may fail, leading to persistent disease, repeat intervention, tonsillectomy, or early recurrence. This study aimed to identify factors associated with drainage failure. Methods: We conducted a retrospective single-centre study of patients admitted for PTA between 2019 and 2024. All patients underwent antibiotic therapy and surgical drainage by needle aspiration or incision and drainage. Drainage failure was defined as absence of pus evacuation, lack of clinical improvement within 72 h, need for quinsy tonsillectomy (QT), or recurrence within 30 days. Clinical and radiological variables and drainage techniques were analysed using univariate and multivariable analyses. Results: Eighty-four patients were included; drainage was successful in 68 (81%) and failed in 16 (19%). Previous ipsilateral PTA, smaller abscess diameter, multiloculation, and peritonsillar abscess with a concurrent intratonsillar abscess were significantly associated with failure. Needle aspiration showed a higher failure rate than incision and drainage (33.3% vs. 12.3%; OR 3.57; 95% CI 1.16–11.00; p = 0.035), but was not significant after adjustment (OR 2.87; 95% CI 0.63–14.04; p = 0.170). Peritonsillar abscess with a concurrent intratonsillar abscess (OR 57.30; 95% CI 2.37–9371.97; p = 0.011) and previous ipsilateral PTA (OR 20.68; 95% CI 4.77–108.22; p < 0.001) were independent predictors of failure. Conclusions: Peritonsillar abscess with a concurrent intratonsillar abscess and previous ipsilateral PTA were independently associated with drainage failure. These findings may help identify patients at increased risk of unsuccessful drainage and support individualized management.
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BibTeX
@article{micciche2026predictors,
title = {{Predictors of Treatment Failure in the Surgical Management of Peritonsillar Abscesses}},
author = {Selene Miccichè and Maddalena Fontana and Simona Rusignuolo and Francesco Dispenza and Francesco Lorusso and Salvatore Gallina and Angelo Immordino and Federico Sireci},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218207},
url = {https://www.mdpi.com/2077-0383/15/21/8207},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Predictors of Treatment Failure in the Surgical Management of Peritonsillar Abscesses
AU - Selene Miccichè
AU - Maddalena Fontana
AU - Simona Rusignuolo
AU - Francesco Dispenza
AU - Francesco Lorusso
AU - Salvatore Gallina
AU - Angelo Immordino
AU - Federico Sireci
PY - 2026
DA - 2026/10/22
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218207
UR - https://www.mdpi.com/2077-0383/15/21/8207
AB - Objectives: Peritonsillar abscess (PTA) is the most common deep neck infection and is usually managed with antibiotic therapy and surgical drainage. However, drainage may fail, leading to persistent disease, repeat intervention, tonsillectomy, or early recurrence. This study aimed to identify factors associated with drainage failure. Methods: We conducted a retrospective single-centre study of patients admitted for PTA between 2019 and 2024. All patients underwent antibiotic therapy and surgical drainage by needle aspiration or incision and drainage. Drainage failure was defined as absence of pus evacuation, lack of clinical improvement within 72 h, need for quinsy tonsillectomy (QT), or recurrence within 30 days. Clinical and radiological variables and drainage techniques were analysed using univariate and multivariable analyses. Results: Eighty-four patients were included; drainage was successful in 68 (81%) and failed in 16 (19%). Previous ipsilateral PTA, smaller abscess diameter, multiloculation, and peritonsillar abscess with a concurrent intratonsillar abscess were significantly associated with failure. Needle aspiration showed a higher failure rate than incision and drainage (33.3% vs. 12.3%; OR 3.57; 95% CI 1.16–11.00; p = 0.035), but was not significant after adjustment (OR 2.87; 95% CI 0.63–14.04; p = 0.170). Peritonsillar abscess with a concurrent intratonsillar abscess (OR 57.30; 95% CI 2.37–9371.97; p = 0.011) and previous ipsilateral PTA (OR 20.68; 95% CI 4.77–108.22; p < 0.001) were independent predictors of failure. Conclusions: Peritonsillar abscess with a concurrent intratonsillar abscess and previous ipsilateral PTA were independently associated with drainage failure. These findings may help identify patients at increased risk of unsuccessful drainage and support individualized management.
SN - 2077-0383
ER -