Medical Versus Surgical Treatment for Peritonsillar Abscesses
Status:
Not yet recruiting
Trial end date:
2022-01-01
Target enrollment:
Participant gender:
Summary
Peritonsillar abscesses are major infections around the tonsils. The abscess is a collection
of pus that can cause a large amount of pain and discomfort, which can result in trouble
swallowing and drinking. Peritonsillar abscesses must be treated because they can spread to
other areas in the throat and neck, which can cause difficulty breathing, can even spread
throughout the rest of the body.
Over the years, many different treatments have been used for peritonsillar abscesses. In the
past, the entire tonsil was removed in the operating room while the patient was asleep. This
surgery can cause a large amount of bleeding, and so now smaller surgeries are performed
while the patient is awake. Small needles are put through the open mouth and into the abscess
to drain it. As well, a small cut can be made to drain the infection. These last two
treatments cause less problems than removing the whole tonsil, but there are still risks. The
surgeries are uncomfortable for patients and they can cause anxiety and fear. There are also
large blood vessels nearby that can be injured.
In the last few years, treatment of peritonsillar abscesses without surgery has been studied.
Patients receive strong antibiotics and anti-inflammatories (known as steroids) and they may
not need surgery. It is not yet known if this treatment works as well as surgery. In order to
figure this out, research must look at both options compared against each other in a large
study with many patients.
However, large research studies require a lot of planning, and so smaller studies are helpful
to figure out if the larger study is even possible. The current study would be a small trial
to plan for a larger study later on.
Patients will be randomly treated with either medications alone or with surgery. The main
part of the study will look at issues with planning the future study, such as how long it
takes to fill out forms, how many missing results there are at the end of the study, and how
patients and doctors feel about taking part in the research study. The future large study
will look at how well the treatment options reduce pain, how fast patients are able to
swallow normally again, how often patients need to change treatments, and whether there are
differences in quality of life with the treatment options. Because these things will be
looked at in detail in the future large study, the investigators will also look at them
during this small planning study, but the investigators will not be able to tell for certain
which treatment is better until the large study is completed.
The results of this study are important for planning and performing the larger study, and
they are important for getting future funding to do that study. Large studies are very
expensive, and major funding organizations, such as the Canadian Institutes of Health
Research, look for this early data when deciding who should get funding. The results of both
this pilot study and the future larger study could be practice changing for how peritonsillar
abscesses are treated, and will benefit both Nova Scotians and potentially the rest of world.