Incidental [18F]FDG-avid focuses in parotid glands on PET/CT.

BACKGROUND: The number of unexpected focal [18F]FDG-avid findings (incidentalomas) within the parotid gland (PGI) continues to increase with the expanding use of PET/CT scanning. The prevalence of malignancy in PGIs is uncertain and appropriate management is unsettled. AIMS: We aimed to explore the underlying pathologies associated with PGI. MATERIALS AND METHODS: A retrospective review of all patients with parotid gland incidentaloma(s) treated at the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark in the period 2012-2021, was performed. RESULTS: In total, 94 patients with one (n = 86) or two (n = 8) PGI(s) were included. In patients with one PGI, 72 (84%) focuses were benign, two (2%) focuses were malignant (both malignant melanoma metastases), and 12 (14%) focuses were undiagnosed. In patients with two PGIs, all 12 lesions with pathological examinations were benign (4 PGIs were undiagnosed). The median SUVmax found in benign lesions was higher (12.0) compared to malignant lesions (5.5) (p = .043). CONCLUSIONS AND SIGNIFICANCE: The prevalence of malignancy was low (2/94, 2.4%) in PGIs. Based on our findings, PGI in patients without a history of parotid malignancy, who undergo PET/CT scanning for reasons other than head and neck cancer (including malignant melanoma), may be managed similarly to patients with asymptomatic parotid gland tumors.

The impact of social restrictions on the incidence and microbiology of peritonsillar abscess: a retrospective cohort study.

OBJECTIVES: We aimed to explore the impact of social distancing on the incidence and microbiology of peritonsillar abscess (PTA). METHODS: We performed a cross-sectional analysis of all patients with PTA and their microbiological findings in the 2 years preceding versus the 2 years following the COVID-19 lockdown in Denmark (11 March 2020), who were admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Age-stratified population data for the catchment area were obtained from Statistics Denmark. RESULTS: The annual incidence rate was significantly higher in the 2-year period before (21.8 cases/100 000 inhabitants) compared with after (14.9 cases/100 000) the lockdown (p < 0.001). The number of cases with growth of Streptococcus pyogenes was significantly higher in the period before (n = 67) compared with after (n = 28) the lockdown (p < 0.001), whereas the number of cases positive for Fusobacterium necrophorum (n = 60 vs. n = 64) and streptococcus anginosus group (SAG) (n = 37 vs. n = 43) were stabile (p 0.79 and p 0.58, respectively). The relative prevalence of S. pyogenes was significantly higher in the period before (67/246 cultures, 27%) compared with after (28/179, 16%) the lockdown (p 0.007). On the contrary, the relative prevalence of F. necrophorum and SAG is significantly lower before (60/246, 24% and 37/246, 15%) compared with after (64/179, 36% and 43/179, 24%) the lockdown (p 0.013 and p 0.023). DISCUSSION: Social distancing had a significant impact on the incidence and microbiology of PTA. Our findings suggest that S. pyogenes-positive PTA is highly related to direct social interaction, and represents a contagious pathogen. By contrast, PTA development caused by F. necrophorum and SAG is unrelated to direct social interaction and may be derived from flora imbalance.

Bacterial findings in patients referred to hospital for the treatment of acute tonsillitis with or without peritonsillar phlegmon.

BACKGROUND: The vast majority of patients with acute tonsillitis (AT) are managed in general practice. However, occasionally patients are referred to hospital for specialized management because of aggravated symptoms and/or findings suggestive of peritonsillar involvement. No prospective studies have been conducted aiming to investigate the prevalent and significant microorganisms in this highly selected group of patients. We aimed to describe the microbiological findings of acute tonsillitis with or without peritonsillar phlegmon (PP) in patients referred for hospital treatment and to point out potential pathogens using the following principles to suggest pathogenic significance: (1) higher prevalence in patients compared to healthy controls, (2) higher abundance in patients compared to controls, and (3) higher prevalence at time of infection compared to time of follow up. METHODS: Meticulous and comprehensive cultures were performed on tonsillar swabs from 64 patients with AT with (n = 25) or without (n = 39) PP and 55 healthy controls, who were prospectively enrolled at two Danish Ear-Nose-Throat Departments between June 2016 and December 2019. RESULTS: Streptococcus pyogenes was significantly more prevalent in patients (27%) compared to controls (4%) (p < 0.001). Higher abundance was found in patients compared to controls for Fusobacterium necrophorum (mean 2.4 vs. 1.4, p = 0.017) and S. pyogenes (mean 3.1 vs. 2.0, p = 0.045) in semi-quantitative cultures. S. pyogenes, Streptococcus dysgalactiae, and Prevotella species were significantly more prevalent at time of infection compared to follow up (p = 0.016, p = 0.016, and p = 0.039, respectively). A number of species were detected significantly less frequently in patients compared to controls and the mean number of species was significantly lower in patients compared to controls (6.5 vs. 8.3, p < 0.001). CONCLUSIONS: Disregarding Prevotella spp. because of the prevalence in healthy controls (100%), our findings suggest that S. pyogenes, F. necrophorum, and S. dysgalactiae are significant pathogens in severe AT with or without PP. In addition, infections were associated with reduced diversity (dysbacteriosis). TRIAL REGISTRATION: The study is registered in the ClinicalTrials.gov protocol database (# 52,683). The study was approved by the Ethical Committee at Aarhus County (# 1-10-72-71-16) and by the Danish Data Protection Agency (# 1-16-02-65-16).

Evaluation of Guidelines For Tonsillectomy in Adults With Recurrent Acute Tonsillitis.

OBJECTIVES: The criteria for selecting patients with recurrent acute tonsillitis (RT) for tonsillectomy remain unsettled and different guidelines are used internationally. We aimed to evaluate currently used guidelines for tonsillectomy in adults with RT and identify the best predictive parameters for improved throat-related quality of life (TR-QOL) after surgery. METHODS: About 66 RT patients undergoing tonsillectomy was prospectively included and categorized into 3 groups based on which guideline(s) they met: Group 1: patients not meeting any of the Danish/Paradise/Scottish Intercollegiate Guideline Network (SIGN) guidelines. Group 2: patients meeting the Danish guidelines. Group 3: patients meeting the Paradise and/or the SIGN guidelines. TR-QOL was assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) before and 6 months after tonsillectomy as well as the Glasgow Benefit Inventory (GBI). Predictive parameters for improved TR-QOL were investigated using multiple linear regression. RESULTS: About 61 (92%) patients completed the questionnaires. Patients in all groups had significant TR-QOL improvements (Group 1 (n = 20): ΔTOI-14 31.1; GBI 29.4; Group 2 (n = 31): ΔTOI-14 32.0; GBI 36.4; Group 3 (n = 10): ΔTOI-14 45.6; GBI 39.7) and satisfaction rates were high (94%-100%). Preoperative TOI-14 score was the best predictor for improved TR-QOL (P < .001, R2 = .80), followed by the number of tonsillitis episodes with physician verification within the previous 12 months (P = .002, R2 = .25). CONCLUSIONS: Patients in all groups experienced massive TR-QOL improvements suggesting that currently used guidelines may be too restrictive. Preoperative TOI-14 score was the best parameter for predicting TR-QOL improvement, and this tool may be useful in the selection of adults with RT for tonsillectomy.

Translation and validation of the Tonsillectomy Outcome Inventory 14 into Danish.

INTRODUCTION: No Danish validated patient-reported outcome measure (PROM) exises for assessing throat-related quality of life in patients with recurrent acute tonsillitis (RT) and chronic tonsillitis (CT). We aimed to translate and linguistically validate the Tonsillectomy Outcome Inventory 14 (TOI-14) into Danish and describe scores in RT and CT patients before and after tonsillectomy as well as in healthy controls. METHODS: We followed the guideline for PROM translation and cultural adaption set out by the Quality of Life Special Interest Group - Translation and Cultural Adaptation group formed by ISPOR. We included RT and CT patients undergoing elective tonsillectomy, who answered the questionnaire pre- and post-operatively (six-month follow-up) as well as healthy controls who answered the questionnaire once. RESULTS: A Danish version of the TOI-14 was developed according to the guideline. A total of 49 RT patients, 34 CT patients and 67 controls were included in the final analysis. Preoperatively, RT and CT patients had markedly higher TOI-14 scores than controls (mean total scores: RT: 45.6; CT: 21.7; controls: 8.9, both p less-than 0.001). Post-operatively, scores fell to levels similar to those of controls (RT: 10.2, p = 0.51; CT: 4.7, p = 0.05). CONCLUSION: We translated, culturally adapted and linguistically validated the Danish version of the TOI-14, finding scores in RT patients, CT patients and controls similar to those recorded by previous studies in German, English and Finnish. FUNDING: The Lundbeck Foundation, grant #R185-2014-2482. TRIAL REGISTRATION: Central Denmark Region #1-16-02-723-20.

Epidemiology, outcomes, and prognostic factors in submandibular gland carcinomas: a national DAHANCA study.

PURPOSE: The aim of this study is to present incidence, histological subtypes, survival rates, and prognostic factors based on a national cohort of patients with salivary gland carcinoma. METHODS: All Danish patients with submandibular gland carcinoma diagnosed from 1990 to 2015 (n = 206) were included and analyzed following histological re-evaluation. Data were collected by the Danish Head and Neck Cancer Group (DAHANCA). Overall, disease-specific and recurrence-free survival were evaluated. Prognostic factors were analyzed with multivariate Cox Hazard Regression. RESULTS: The study population consisted of 109 (53%) men and 97 (47%) women, median age 62 years (range 11-102). Adenoid cystic carcinoma was the most frequent subtype (50%). Tumour classification T1/T2 (75%) and N0 (78%) was most frequent. The mean crude incidence was 0.17/100,000/year. Most patients (n = 194, 94%) were treated with primary surgery, and 130 (67%) received postoperative radiotherapy. The 5- and 10-year survival rates were for overall survival 64% and 41%, disease-specific survival 74% and 61%, and recurrence-free survival 70% and 56%, respectively. Survival rates were higher for adenoid cystic carcinoma compared to other subtypes, but the difference was not significant in multivariate analysis. Recurrence occurred in 69 patients, and 37 (53.6%) of them had recurrence in a distant site. Advanced T-classification and regional lymph-node metastases had significant negative impact on survival rates. CONCLUSION: The incidence of submandibular gland carcinoma in Denmark was 0.17/100,000/year and stable during the time period. The most frequent subtype was adenoid cystic carcinoma. Half of the recurrences presented in a distant site, and multivariate analysis confirmed that advanced stage was independent negative prognostic factor for recurrence and survival.

Incidental FDG-Avid Focuses in Palatine Tonsils on PET/CT.

OBJECTIVES: The management of incidental findings of FDG-avid tonsils on PET/CT (IFT) is unclear. We aimed to explore the prevalence of malignancy in IFT, identify risk factors for malignancy, and calculate optimal cutoffs of maximum standardized uptake values (SUVmax ) to discriminate between benign and malignant lesions. METHODS: All patients who were tonsillectomized at our institution because of IFT from October 2011 to December 2020 were included. Patients undergoing PET/CT due to suspected tonsillar disease or cancer of unknown primary were excluded. RESULTS: In total, 77 patients were included, of which 11 (14%) of them had IFT malignancy. Dysphagia (p = 0.019) and alcohol abuse (p = 0.035) were associated with malignancy. Absolute SUVmax cutoff (≥9: sensitivity 100%; specificity 53%) was superior to SUVmax side-to-side ratio (≥1.5: sensitivity 64%; specificity 70%) to discriminate between benign and malignant lesions. CONCLUSION: We recommend tonsillectomy for patients with IFT displaying SUVmax ≥ 9.0, ratio ≥ 1.5, or symptoms or findings suggesting malignancy. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2370-2378, 2022.

Quality of life after tonsillectomy in adult patients with recurrent acute tonsillitis: a systematic review.

PURPOSE: The aims of this systematic review were to (1) explore the evidence for improved quality of life (QOL) in adult patients undergoing tonsillectomy because of recurrent acute tonsillitis (RT) and (2) evaluate which set of guidelines for tonsillectomy in adult RT patients is preferable, using QOL as outcome measure. METHODS: A systematic search was conducted in the PubMed, Embase, and Scopus databases. RCT/cohort studies exploring the effect of elective tonsillectomy in adult RT patients using any QOL assessment tool no less than 6 months after surgery were included. Studies were divided into two guideline groups based on the number of tonsillitis episodes required for tonsillectomy (Group 1: ≥ 5; Group 2: ≤ 4). RESULTS: A total of 364 unique records were identified. Seven studies (n = 409 patients) were included in a qualitative analysis and four studies were included in a meta-analysis. Patients' QOL rose significantly, primarily because of improvements in the general and physical domains. In the meta-analysis, 96% (293/304) of patients benefitted from tonsillectomy. Patients included in guideline Group 1 studies had significantly higher QOL scores (Glasgow Benefit Inventory (GBI) 39.6) compared to patients in Group 2 studies (GBI 24.9) (p < 0.001). CONCLUSION: Adult patients undergoing tonsillectomy because of RT reported improved QOL 6-84 months after surgery. The benefit of tonsillectomy was higher among patients in studies with a higher minimum number of tonsillitis episodes compared to those included in studies with less strict criteria. Whether the improved QOL outweigh the morbidity associated with surgery in both guideline groups remains unclear.

Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment.

PURPOSE: The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens. METHODS: All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated. RESULTS: Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were identified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69). CONCLUSION: S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes.

Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess: a prospective observational study.

PURPOSE: We aimed to evaluate the effectiveness of different antibiotic regimens for the treatment of parapharyngeal abscess (PPA) and characterize patients, who suffered potentially preventable complications (defined as death, abscess recurrence, spread of infection, or altered antibiotic treatment because of insufficient progress). METHODS: Sixty adult patients with surgically verified PPA were prospectively enrolled at five Danish Ear-nose-throat departments. RESULTS: Surgical treatment included internal incision (100%), external incision (13%), and tonsillectomy (88%). Patients were treated with penicillin G ± metronidazole (n = 39), cefuroxime ± metronidazole (n = 16), or other antibiotics (n = 5). Compared to penicillin-treated patients, cefuroxime-treated patients were hospitalized for longer (4.5 vs 3.0 days, p = 0.007), were more frequently admitted to intensive care (56 vs 15%, p = 0.006), underwent external incision more frequently (31 vs 5%, p = 0.018), and suffered more complications (50 vs 18%, p = 0.022), including re-operation because of abscess recurrence (44 vs 3%, p < 0.001). Nine patients suffered potentially preventable complications. These patients displayed significantly higher C-reactive protein levels, received antibiotics prior to admission more frequently, underwent external incision more commonly, and were admitted to intensive care more frequently compared to other patients. CONCLUSION: The majority of patients with PPA were effectively managed by abscess incision, tonsillectomy, and penicillin G ± metronidazole. Cefuroxime-treated patients were more severely ill at time of admission and had worse outcome compared to penicillin-treated patients. We recommend penicillin G + metronidazole as standard treatment for patients with PPA, but in cases with more risk factors for potentially preventable complications, we recommend aggressive surgical and broadened antibiotic therapy, e.g. piperacillin-tazobactam.

Microbiology of parapharyngeal abscesses in adults: in search of the significant pathogens.

We aimed to describe the microbiology of parapharyngeal abscess (PPA) and point out the likely pathogens using the following principles to suggest pathogenic significance: (1) frequent recovery, (2) abundant growth, (3) growth in relative abundance to other microorganisms, (4) percentage of the isolates recovered in both absolute and relative abundance, (5) more frequent recovery in PPA pus compared with tonsillar surface and tissue. Comprehensive bacterial cultures were performed on specimens obtained from adult patients (n = 60) with surgically verified PPA, who were prospectively enrolled at five Danish ear-nose-throat departments. The prevalent isolates (in PPA pus) were unspecified anaerobes (73%), non-hemolytic streptococci (67%), Streptococcus anginosus group (SAG) (40%), Corynebacterium spp. (25%), Neisseria spp. (23%), Fusobacterium spp. (22%), Fusobacterium necrophorum (17%), Prevotella spp. (12%), and Streptococcus pyogenes (10%). The bacteria most frequently isolated in heavy (maximum) growth were unspecified anaerobes (60%), SAG (40%), F. necrophorum (23%), and Prevotella spp. (17%). The predominant microorganisms (those found in highest relative abundance) were unspecified anaerobes (53%), SAG (28%), non-hemolytic streptococci (25%), F. necrophorum (15%), S. pyogenes (10%), and Prevotella spp. (10%). Four potential pathogens were found in both heavy growth and highest relative abundance in at least 50% of cases: F. necrophorum, Prevotella spp., SAG, and S. pyogenes. SAG, Prevotella spp., F. necrophorum, S. pyogenes, and Bacteroides spp. were recovered with the same or higher frequency from PPA pus compared with tonsillar tissue and surface. Our findings suggest that SAG, F. necrophorum, Prevotella, and S. pyogenes are significant pathogens in PPA development.

Salivary gland carcinoma in Denmark: a national update and follow-up on incidence, histology, and outcome.

PURPOSE: Salivary gland carcinoma is a rare disease and studies on epidemiology and outcome require data collection over many years. The aim of this study is to present an update of incidence rates, anatomical sites, histological subtypes, and survival rates based on the Danish national cohort of salivary gland carcinoma patients. METHODS: Data from all Danish patients with salivary gland carcinoma diagnosed from 1990 to 2015 (n = 1601) were included and analyzed following histological reevaluation and reclassification. Overall, disease-specific, and recurrence-free survival were evaluated. Prognostic factors were analyzed with multivariate Cox Hazard Regression. RESULTS: The study population consisted of 769 men and 832 women, median age 62 years (range 6-102). The most frequent anatomic site was the parotid gland (51.8%). Adenoid cystic carcinoma was the most common subtype (24.7%). The majority had tumor classification T1/T2 (65.3%). The mean crude incidence was 1.2/100.000/year with an increase of 1.5% per year. There was no increase in age-adjusted incidence. The 5-, 10-, and 20-year survival rates were for overall survival 68, 52, and 35%, for disease-specific survival, 77, 69, and 64%, and for recurrence-free survival, 75, 64, and 51%, respectively. Age, high-grade histological subtype, advanced T-classification, cervical lymph node metastases, vascular invasion, and involved surgical margins had significantly negative impact on survival rates. CONCLUSION: The age-adjusted incidence has been stable for a period of 26 years. Multivariate analysis confirmed that histological grade, advanced stage, involved surgical margins and vascular invasion are independent negative prognostic factors. Survival rates were stationary compared to earlier reports.

Clinical presentation and microbiology of acute salivary gland infections.

INTRODUCTION: Acute salivary gland infections (ASI) have been associated with poor outcome in elderly and postoperative patients. Perioperative care and treatment of co-morbidities have improved considerably, but most of our knowledge regarding ASI dates back several decades. The aim of this study was to describe the microbiology and treatment of ASI in a large post-millennial cohort. METHODS: All patients with ASI admitted to the Department of Otorhinolaryngology - Head and Neck Surgery, Aarhus University Hospital in the period from 2001 to 2017 were included. RESULTS: In total, 157 patients with ASI were included. The parotid gland (PG) was affected in 89 (57%) cases and the submandibular gland (SMG) in 68 (43%) cases. The most prevalent bacterial findings were viridans streptococci (25 isolates) and Staphylococcus aureus (19 isolates). S. aureus was almost exclusively found in PG (17/19 cases). S. aureus-positive cases showed a significantly higher inflammatory response than other bacteria (C-reactive protein, p = 0.008 and absolute neutrophil count, p = 0.0108). CONCLUSIONS: S. aureus is a significant pathogen in ASI and especially in PG cases. Other pathogens may play a role in the development of SMG infections. Based on the bacterial findings in this study, we recommend penicillinase-resistant penicillin as first-line treatment in ASI. FUNDING: none Trial registration: not relevant. The Danish Data Protection Agency approved the project.

Complications of peritonsillar abscess.

BACKGROUND: The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. METHODS: Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. RESULTS: Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). CONCLUSION: Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.

Head and neck sarcomas: the first report addressing the duration of symptoms and diagnostic work up.

Background: Head and neck sarcomas are rare and difficult to diagnose and manage.Aim: To describe a population of patients with head and neck sarcomas focusing on the effect of symptom duration and time to diagnosis on mortality and recurrence risk.Materials and methods: Fifty-one patients treated in our department between 1998-2013 were retrospectively included. Patient and tumour characteristics as well as dates of interest were obtained from sarcoma registries, charts and pathology records. The effect of symptom duration and time to diagnosis on mortality and risk of recurrence was tested by multivariate analysis.Results: There was a wide range in symptom duration (1-144 months, median 5) and time for diagnosis (0-234 days, median 14) without significant effect on overall mortality, disease-specific mortality or risk of recurrence. Chondrosarcomas in the larynx dominated among the patients with the longest diagnostic duration.Conclusion and significance: The diagnostic process is challenging and in some cases of extremely long duration without effect on mortality. The symptom duration and time to diagnosis in relation to mortality and risk of recurrence has not previously been described. Early biopsy, better imaging and advanced pathological techniques can hopefully speed up the diagnostic process and reduce morbidity and mortality.

Post-operative haemorrhage after acute bilateral tonsillectomy in patients with peritonsillar abscess: prevalence, treatment, risk factors, and side of bleeding.

Background: Bilateral quinsy tonsillectomy (QT) in patients with peritonsillar abscess (PTA) is associated with the risk of post-tonsillectomy haemorrhage (PTH) and current literature finds a significantly higher risk of PTH contralaterally to the quinsy.Aims: To determine the prevalence of PTH in a large cohort of patients undergoing QT, explore risk factors for PTH, describe our methods of treatment, and evaluate if contralateral haemorrhage is more common than ipsilateral haemorrhage.Materials & methods: All patients undergoing QT at Aarhus University Hospital in the period 2001-2017 were included in the study.Results: One hundred sixteen of 1671 (6.9%) QT patients were admitted with PTH. PTH patients were significantly more frequently males (66%) and infected with Streptococcus group A (GAS) (31%) compared to QT patients without PTH (53% and 18%, respectively) (p = .005 and p = .002, respectively). Haemostasis was obtained in general anaesthesia (n = 61) or local anaesthesia (n = 28) and stopped spontaneously in 25 patients. The side of PTH was not associated with the side of PTA (ipsilateral (n = 41), contralateral (n = 43), and bilateral PTH (n = 23), p = .93).Conclusions and significance: Our findings question if unilateral QT is preferable to bilateral QT when the PTA does not respond to conservative treatment, especially in males with GAS-positive PTA.

Sore Throat Assessment Tool-10 for patients with acute pharyngo-tonsillitis.

INTRODUCTION: The aim of this study was to develop and validate a patient-based questionnaire for the assessment of sore throat symptoms. The questionnaire can be used to quantify the effects of different treatments in patients with acute pharyngo-tonsillitis (APT). METHODS: A 13-item questionnaire was constructed using a five-point Likert scale. Adult patients with APT consulting one of the participating general practitioners answered the survey. Healthy students served as controls. RESULTS: A total of 77 sore throat patients and 103 healthy controls were included. Ten items had moderate to high (> 0.25) inter-item correlations and high mean scores (> 3.0) among patients and were included in the final tool, the Sore Throat Assessment Tool (STAT)-10. The patients' mean STAT-10 score was 36.5 (95% confidence interval (CI): 34.8-38.2) at the time of inclusion compared with 10.4 (95% CI: 10.2-10.6) for controls (p < 0.001). Cronbach´s alpha coefficient for the questionnaire was 0.87. The standard error of measurement was 2.99, the intraclass correlation 0.92 and the Spearman correlation test-retest reliability 0.87. The STAT-10 scores increased with Centor scores (p = 0.018). CONCLUSIONS: The reliability and validity of the STAT-10 were very high. The STAT-10 is the first validated tool for measuring the intensity and duration of symptoms from the perspective of sore throat patients and for quantifying and comparing different treatment modalities in APT patients. FUNDING: This study received funding from The Lundbeck Foundation (Grant #R185-2014-2482), Fonden for Lægevidenskabens Fremme, and Hans Skouby´s Fond. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (2015-57-0002).

Low rate of co-infection in complicated infectious mononucleosis.

INTRODUCTION: It remains unclarified if bacterial co-infection is common in patients with infectious mononucleosis (IM) and acute tonsillitis and/or peritonsillar abscess (PTA). Recent studies suggest that Fusobacterium necrophorum is a prevalent pathogen in acute tonsillitis and PTA. We hypothesised that this anaerobe may play a significant role for the aggravated infection and the development of PTA among teenagers and young adults with IM. METHODS: All patients with IM and clinical findings of acute tonsillitis or PTA admitted to our department in the 2001-2015 period were included in the study. RESULTS: In total, 257 patients with IM and acute tonsillitis (n = 220) or PTA (n = 37) were included. Positive bacterial cultures were obtained in 28% of patients with AT and in 50% with PTA. The most prevalent bacterial findings were Group C/G streptococci (14%) among patients with acute tonsillitis and Staphylococcus aureus (22%) in patients with PTA. F. necrophorum was recovered in 9% and 2% of patients with acute tonsillitis and PTA, respectively. CONCLUSIONS: We were unable to substantiate a prevalent role for F. necrophorum in patients with IM and acute tonsillitis/PTA. S. aureus may play a role in PTA development in patients IM. The majority of our findings did not support the use of antibiotics in patients with IM, even in this selected group of patients with severe symptoms and a high risk of PTA. FUNDING: This work was funded by the Lundbeck Foundation (Grant number R185-2014-2482). TRIAL REGISTRATION: The Danish Data protection Agency approved the project.

Management of sore throat in Danish general practices.

BACKGROUND: The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline. METHODS: A cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients. RESULTS: In total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%). CONCLUSION: Danish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.