Sonografische Diagnostik tonsillärer Abszesse: Eigene Erfahrungen und eine systematische Übersicht

Zusammenfassung

Hintergrund Die transkutane Sonografie ist seit einigen Jahrzehnten ein fester Bestandteil der bildgebenden Diagnostik im Kopf-Hals-Bereich. Insbesondere in der Darstellung von Abszessen der Fossa tonsillaris ist die Sonografie eine schnelle, sichere und kostengünstige diagnostische Methode. Diese Arbeit soll einen Überblick über die derzeit publizierten Studien in Bezug auf die diagnostische Wertigkeit geben.

Material und Methoden Systematische Literaturrecherche in folgenden Online-Datenbanken: PubMed und MEDLINE nach den Suchbegriffen transcutaneous ultrasound, tonsillar abscess, peritonsillar abscess, intratonsillar abscess, peritonsillar cellulitis und parapharyngeal abscess. Bewertung der wissenschaftlichen Relevanz der Arbeiten nach festgelegten Kriterien.

Ergebnisse Die Publikationen wurden in Bezug auf die klinische Anwendung, die klinische Befunderhebung und die diagnostische Genauigkeit analysiert. Die Sensitivität und Spezifität werden je nach Studie und Patientenkollektiv zwischen 67 % und 100 % bzw. 50 % und 93 % angegeben.

Schlussfolgerungen In Zusammenschau der aktuell publizierten Ergebnisse verspricht die transkutane Sonografie ein großes Potenzial, die Diagnostik des Peritonsillarabszesses zu verbessern, und ermöglicht eine gute Abgrenzbarkeit zur peritonsillären Zellulitis. Dies ist für das klinische Management von Patienten mit Abszessverdacht von entscheidender Bedeutung.

Abstract

Background Transcutaneous sonography has been an integral part of imaging diagnostics in the head and neck region for several decades. Especially in the imaging of abscesses of the tonsillar fossa, sonography is a fast, safe, and cost-effective diagnostic method. This paper aims to provide an overview of the currently published studies in terms of diagnostic value.

Material and methods systematic literature search in the following online databases: PubMed und MEDLINE according to the search terms: transcutaneous ultrasound, tonsillar abscess, peritonsillar abscess, intratonsillar abscess, peritonsillar cellulitis, parapharyngeal abscess. Evaluation of the scientific relevance of the papers according to established criteria.

Results The publications were analyzed in terms of clinical application, clinical diagnosis, and diagnostic accuracy. Sensitivity and specificity are reported between 67 % – 100 %, and 50 % – 93 %, respectively, depending on the study and patient cohort.

Conclusions In the synopsis of the currently published results, transcutaneous sonography promises a high potential to improve the diagnosis of peritonsillar abscess and allows a reliable differentiation to peritonsillar cellulitis. This fact seems crucial for the clinical management of patients with suspected abscesses.

Schlüsselwörter

Peritonsillarabszess - Intratonsillarabszess - Peritonsillitis - Peritonsilläre Cellulitis - Ultraschall - Sonografie

Keywords

peritonsillar abscess - intratonsillar abscess - peritonsillitis - peritonsillar cellulitis - ultrasound - sonography

Publication History

Received: 24 June 2021

Accepted after revision: 17 January 2022

Article published online:
02 February 2022

• Literatur

• 1 Mitchelmore IJ, Prior AJ, Montgomery PQ. et al. Microbiological features and pathogenesis of peritonsillar abscesses. Eur J Clin Microbiol Infect Dis 1995; 14: 870-877 DOI: 10.1007/BF01691493. (PMID: 8605900)
• 2 Ali SA, Kovatch KJ, Smith J. et al. Predictors of intratonsillar versus peritonsillar abscess: A case-control series. Laryngoscope 2019; 129 (06) 1354-1359 DOI: 10.1002/lary.27615. (PMID: 30569506)
• 3 Froehlich MH, Huang Z, Reilly BK. Utilization of ultrasound for diagnostic evaluation and management of peritonsillar abscesses. Curr Opin Otolaryngol Head Neck Surg 2017; 25 (02) 163-168 DOI: 10.1097/MOO.0000000000000338. (PMID: 28169864)
• 4 Fordham MT, Rock AN, Bandarkar A. et al. Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. Laryngoscope 2015; 125 (12) 2799-2804 DOI: 10.1002/lary.25354. (PMID: 25945805)
• 5 Zhao X, Delaney M, Breslin K. et al. Impact of Transcervical Ultrasound for the Diagnosis of Pediatric Peritonsillar Abscesses on Emergency Department Performance Measures. J Ultrasound Med 2020; 39 (04) 715-720 DOI: 10.1002/jum.15150. (PMID: 31713253)
• 6 Scott PM, Loftus WK, Kew J. et al. Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis. J Laryngol Otol 1999; 113 (03) 229-232 DOI: 10.1017/s0022215100143634. (PMID: 10435129)
• 7 Pearce MS, Salotti JA, Little MP. et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; 380: 499-505 DOI: 10.1016/S0140-6736(12)60815-0. (PMID: 22681860)
• 8 Boesen T, Jensen F. Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis. Eur Arch Otorhinolaryngol 1992; 249 (03) 131-133 DOI: 10.1007/BF00183486. (PMID: 1642863)
• 9 Sievert M, Miksch M, Mantsopoulos K. et al. The value of transcutaneous ultrasound in the diagnosis of tonsillar abscess: A retrospective analysis. Auris Nasus Larynx 2021; DOI: 10.1016/j.anl.2021.04.006. (PMID: 33906745)
• 10 Bandarkar AN, Adeyiga AO, Fordham MT. et al. Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. Pediatr Radiol 2016; 46 (07) 1059-1067 DOI: 10.1007/s00247-015-3505-7. (PMID: 26637999)
• 11 Huang Z, Vintzileos W, Gordish-Dressman H. et al. Pediatric peritonsillar abscess: Outcomes and cost savings from using transcervical ultrasound. Laryngoscope 2017; 127 (08) 1924-1929 DOI: 10.1002/lary.26470. (PMID: 28092120)
• 12 Mösges R, Kuth G, Klimek L. et al. Der Peritonsillarabszess im Ultraschallbild. Laryngorhinootologie 1990; 69 (12) 657-659
• 13 Miziara ID, Koishi HU, Zonato AI. et al. The use of ultrasound evaluation in the diagnosis of peritonsillar abscess. Rev Laryngol Otol Rhinol (Bord) 2001; 122 (03) 201-203 (PMID: 11799864)
• 14 Küppers P, Siegert R, Blessing R. Die Ultraschalldiagnostik der Tonsillenregion. Laryngorhinootologie 1991; 70 (09) 497-500 DOI: 10.1055/s-2007-998084. (PMID: 1930493)
• 15 Hallak B, Graber S, Bouayed S. et al. Advantages of otorhinolaryngologist performed transcervical ultrasonography in the management of peritonsillar abscess. Am J Otolaryngol 2020; 41 (06) 102659 DOI: 10.1016/j.amjoto.2020.102659. (PMID: 32799041)
• 16 Araujo Filho BC, Sakae FA, Sennes LU. et al. Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses. Braz J Otorhinolaryngol 2006; 72 (03) 377-381 DOI: 10.1016/s1808-8694(15)30972-1. (PMID: 17119775)
• 17 Halm BM, Ng C, Larrabee YC. Diagnosis of a Peritonsillar Abscess by Transcutaneous Point-of-Care Ultrasound in the Pediatric Emergency Department. Pediatr Emerg Care 2016; 32 (07) 489-492 DOI: 10.1097/PEC.0000000000000843. (PMID: 27380609)
• 18 Rehrer M, Mantuani D, Nagdev A. Identification of peritonsillar abscess by transcutaneous cervical ultrasound. Am J Emerg Med 2013; 31 (01) 267.e1–e3 DOI: 10.1016/j.ajem.2012.04.021. (PMID: 22795424)
• 19 Hori H, Fukuchi T, Sugawara H. The effectiveness of transcutaneous cervical ultrasonography for diagnosing peritonsillar abscess in a patient complaining of sore throat. J Gen Fam Med 2020; 22 (01) 47-48 DOI: 10.1002/jgf2.364. (PMID: 33457156)
• 20 Ressing M, Blettner M, Klug SJ. Systematic literature reviews and meta-analyses: part 6 of a series on evaluation of scientific publications. Dtsch Arztebl Int 2009; 106 (27) 456-463 DOI: 10.3238/arztebl.2009.0456. (PMID: 19652768)
• 21 Gibbons RC, Costantino TG. Evidence-Based Medicine Improves the Emergent Management of Peritonsillar Abscesses Using Point-of-Care Ultrasound. J Emerg Med 2020; 59 (05) 693-698 DOI: 10.1016/j.jemermed.2020.06.030. (PMID: 32826122)
• 22 Ahmed K, Jones AS, Shah K. et al. The role of ultrasound in the management of peritonsillar abscess. J Laryngol Otol 1994; 108 (07) 610-612 DOI: 10.1017/s0022215100127598. (PMID: 7930906)
• 23 Biron VL, Kurien G, Dziegielewski P. et al. Surgical vs ultrasound-guided drainage of deep neck space abscesses: a randomized controlled trial: surgical vs ultrasound drainage. J Otolaryngol Head Neck Surg 2013; 42 (01) 18 DOI: 10.1186/1916-0216-42-18. (PMID: 23672735)
• 24 Page C, Biet A, Zaatar R. et al. Parapharyngeal abscess: diagnosis and treatment. Eur Arch Otorhinolaryngol 2008; 265 (06) 681-686 DOI: 10.1007/s00405-007-0524-5. (PMID: 18004583)