ORIGINAL RESEARCH Hemorrhage Risk After Quinsy Tonsillectomy Roland Giger, MD, Basile Nicolas Landis, MD, and Pavel Dulguerov, MD, Geneva, Switzerland BACKGROUND: The goal of the study was to evaluate the incidence and possible predictive factors of post-tonsillectomy hemorrhage (PTH) in patients with peritonsillar abscess, treated by acute abscess tonsillectomy. METHODS: A retrospective cohort study was performed on 205 patients who underwent bilateral abscess tonsillectomy under general anesthesia. Age, sex, smoking habits, history of recurrent tonsillitis or prior peritonsillar abscess, current medical treatment, side of the peritonsillar abscess, initial treatment, surgeon’s expe- rience, procedure duration, intra- and postoperative anti-inflamma- tory medications, and side of bleeding were analyzed. RESULTS: Bleeding occurred in 27 patients (13%). Ipsilateral hemorrhage was observed in 8 patients (4%) and contralateral hemorrhage in 19 patients (9%). The higher incidence of PTH in the side contralateral to the abscess was found to be statistically significant (P = 0.02). Male gender (P = 0.042), smoking (P = 0.009), and aspirin intake (P = 0.008) were statistically significant factors associated with an increased PTH risk. CONCLUSION: The risk of bleeding following abscess tonsil- lectomy seems higher than reported in elective tonsillectomy. This high incidence is mainly due to patients with prior aspirin intake or to bleeding in the side contralateral to the abscess. Postoperative bleeding could be reduced by performing a unilateral acute abscess tonsillectomy in selected patients. An algorithm is proposed for the management of peritonsillar abscess based on age, prior history of pharyngo-tonsillar infections, aspirin intake, and clinical improve- ment after initial drainage and antibiotherapy. EBM RATING: C. © 2005 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved. Q uinsy or peritonsillar abscess (PTA) is the most com- mon head and neck abscess. 1 It is usually a complica- tion of pharyngo-tonsillitis and its incidence is estimated at 30 cases per 100,000 inhabitants per year. 2 Various options have been proposed for the acute treatment of PTA, includ- ing intravenous antibiotics alone, needle aspiration, incision & drainage, or acute abscess tonsillectomy. 1,2 While several studies show a comparable efficacy in PTA treatment with needle aspiration or incision & drainage (see 1 and 2 for a review), there is a lack of concrete criteria to select the optimal treatment for PTA. Compared to other treatment strategies, acute abscess tonsillectomy (also known as quinsy tonsillectomy) has the advantage of immediate and definitive remedy of the abscess and is associated with an almost absent risk of abscess recurrence. In his exhaustive review on the subject, Herzon 2 found the incidence of recurrent PTA to vary between 0% and 22%, with an average of about 12%. Herbild and Bonding 3 concluded that recurrent PTA and tonsillitis are more com- mon if patients were younger than 40 years at the time of the initial PTA. In addition, a history of prior recurrent tonsil- litis was associated with a higher recurrent PTA rate. Using a slightly different age cut-off, Nielsen and Greisen 4 found similar results: 63% of patients younger than 30 years had recurrent PTA or tonsillitis, while only 12% of patients older than 30 years had similar problems after the initial treatment of PTA by incision & drainage. Following a previous study in our institution, 5 the treat- ment modalities for PTA in our department were changed following the treatment algorithm published by Marchal et al. 5 Because of the previously cited studies, 3,4 we chose an age of 35 years as a cut-off for PTA as an indication for tonsillectomy. Patients younger than 35 years, with at least 2 annual episodes of acute tonsillitis or at least 1 previous episode of PTA, have been undergoing an acute abscess tonsillectomy. Patients without history of tonsillitis or peri- tonsillar abscess and patients older than 35 years were treated with needle aspiration and/or incision & drainage of the PTA, followed by intravenous antibiotherapy. If no From the Department of Oto-Rhino-Laryngology–Head and Neck Sur- gery, Geneva University Hospital, Geneva, Switzerland. Reprint requests: Roland Giger, MD, Department of Oto-Rhino-Lar- yngology–Head and Neck Surgery, University Hospital of Geneva, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland. E-mail address: Roland.Giger@hcuge.ch. Otolaryngology–Head and Neck Surgery (2005) 133, 729-734 0194-5998/$30.00 © 2005 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved. doi:10.1016/j.otohns.2005.07.013