Introduction:
In addition to abscess-tonsillectomy and abscess-incision or drainage, patients with
milder symptoms of peritonsillar abscess (PTA) benefit from antibiotic therapy. To
date, however, there exists no objective instrument that allows an adequate division
of patients into the therapeutic regimes.
Methods:
Serum and saliva of patients with peritonsillar inflammation were analyzed concerning
the concentration of a broad range of cytokines, chemokines and soluble proteins,
such as IL-1ß, IL-8 TNF-α and S100A8/A9, using an enzyme-linked immunosorbent assay
(ELISA) and cytometric bead arrays. A PTA score was developed by combining the biomarker
S100A8/A9 with determined clinical characteristics (halitosis, trismus, uvula edema
and palatine asymmetry). A retrospective analysis of the new developed PTA score and
the applied therapy approach was performed.
Results:
Solely S100A8/A9 showed the potential as a biomarker for the PTA among the determined
cytokines, chemokines and soluble proteins. With a range of minimum 0 and maximum
6 points, the PTA score has the potential to identify a PTA with a sensitivity of
92% and a specificity of 93%. In addition, patients with a PTA score of ≤2 benefit
from medical therapy whereas a PTA score > 2 indicates the need for abscess relief.
The early selection of the correct therapy strategy leads to a reduced duration of
hospitalization from 7 to 4 days in median.
Conclusion:
The application of the novel PTA score allows to determine an individualized therapy
approach in patients with PTA and thus prevents unnecessary stressful interventions.
Furthermore, a significant cost reduction can be achieved by consecutive reduction
of hospital bed-days and therapy costs.