Minor salivary gland infection as origin of peritonsillitis – novel theory and preliminary results

Abstract

Background

Peritonsillitis (PT) is defined as cellulitis in peritonsillar tissue without pus. The pathogenesis of peritonsillar infections is controversial.

Objective

To explore whether minor salivary glands are involved in the development of PT and to identify clinical findings that predict the evolution of PT to peritonsillar abscess (PTA).

Material and methods

We included 146 adult patients treated for acute tonsillitis (AT; n = 54), PT (n = 34), or PTA (n = 58) at the Helsinki University Hospital. The treating physician recorded tonsillar, oropharyngeal, and dental findings. We analysed serum C-reactive protein (S-CRP) and amylase (S-Amyl). For PTA, pus samples were analysed; for AT and PT, throat cultures were collected. Patients with PT or PTA (PT/PTA; n = 92) were classified into groups with or without tonsillar exudate or hyperaemia (tonsillar findings).

Results

The PT group without tonsillar findings had lower S-CRP than the PT group with tonsillar findings (p=.0275). The PT/PTA group without tonsillar findings had higher S-Amyl than the PT/PTA group with tonsillar findings (p=.0278). Three out of 34 (8.8%) patients with PT returned to the emergency department; 1 (2.9%) developed PTA.

Conclusions

Elevated S-Amyl in the PT/PTA group without tonsillar findings suggests that minor salivary glands are sometimes involved in the development of peritonsillar infections.

Chinese Abstract

背景：扁桃体周围炎 (PT) 定义为扁桃体周围组织中没有脓液的蜂窝织炎。扁桃体感染的发病机制存在争议。

目的：探讨小唾液腺是否与 PT 的发生有关, 并确认可预测 PT 发展为扁桃体周围脓肿 (PTA) 的临床发现。

材料和方法：我们纳入了赫尔辛基大学医院的146 名接受急性扁桃体炎治疗的成年患者（AT；n = 54）, PT（n = 34）或PTA（n ¼ 58）。主治医师记录扁桃体、口咽部和牙科检查结果。我们分析了血清 C 反应蛋白 (S-CRP) 和淀粉酶 (SAmyl)。对于 PTA, 分析了脓液样本；对于 AT 和 PT, 收集咽喉培养物。患有 PT 或 PTA（PT/PTA；n = 92）的患者根据有或没有扁桃体渗出液或充血（扁桃体发现）被分成小组。

结果：无扁桃体发现的 PT 组的 S-CRP 低于有扁桃体发现的 PT 组（p = .0275）。无扁桃体发现的 PT/PTA 组的 S-Amyl 高于有扁桃体发现PT/PTA组 (p= .0278)。 34 名 PT 患者中有 3 名（8.8%）返回急诊室； 1名 (2.9%) 发展成了 PTA。

结论：在无扁桃体发现的 PT/PTA 组中, 升高的 S-Amyl 表明小唾液腺有时与扁桃体周围感染的发生有关。

Keywords:

• Peritonsillar cellulitis
• minor salivary glands
• aetiology
• amylase
• peritonsillar abscess

Acknowledgements

A professional statistician, Timo Pessi, performed the statistical analysis in collaboration with the authors.

Ethics approval

All procedures involving human participants were conducted in accordance with the ethical standards of the Institutional or National Research Committee and with the Declaration of Helsinki. The Ethics Committee of Helsinki University Hospital approved the study protocol (HUS/1760/2016). All patients provided written informed consent prior to participation.

Disclosure statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Data availability statement

The datasets used or analysed during the study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the Helsinki University Hospital Research Funds.