Introduction
The SARS-CoV-2 (COVID-19) pandemic led to necessary changes in the
management of common ENT emergency presentations internationally,
including tonsillitis and peritonsillar abscess (quinsy, PTA), two of
the most common emergency presentations to ENT.1 It
has been demonstrated that COVID-19 infection leads to high viral titres
in the nasal and oral cavities,2 with virus
transmission thought to be predominantly via aerosols or droplet
formation.3,4 Aspects of the management of tonsillitis
and PTA, including oral examination, PTA drainage and flexible
nasendoscopy, were considered to represent a potential route of
transmission of COVID-19.5,6
In March 2020, new UK guidelines were issued for the management of
tonsillitis and PTA presenting to emergency departments (ED), in light
of COVID-19.7 The major shifts in practice proposed
were: the avoidance of oral examination; the routine discharge of
patients who could swallow fluids and medications; the routine
administration of intravenous (IV) medications to effect this; and the
avoidance of PTA drainage if possible. These changes aimed to minimise
the personnel involved in managing the acute presentation, reduce oral
instrumentation, and to reduce admission rates, thus preserving hospital
bed capacity for the anticipated COVID-19 demand.
The implementation of these relatively untested guidelines resulted in
significant changes to established practices that had been shown to be
safe over many years. This article aims to:
- Report the findings of a 12-week prospective audit of acute
tonsillitis and PTA care, conducted during the initial peak of
COVID-19 in the UK.
- Explore factors relating to unscheduled re-presentation to hospital in
tonsillitis and PTA patients discharged from the ED.