Clin Exp Otorhinolaryngol.  2016 Jun;9(2):89-97. 10.21053/ceo.2014.01851.

The Efficacy of Corticosteroids in the Treatment of Peritonsillar Abscess: A Meta-Analysis

• Lee YJ
• Jeong YM
• Lee HS
• Hwang SH

• KMID: 2165049
• DOI: http://doi.org/10.21053/ceo.2014.01851

Abstract

Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during treatment result in patient dissatisfaction. The goal of this study was to perform a systematic review and meta-analysis of the efficacy of systemic steroids on the clinical course of PTA. Two reviewers independently searched the databases (MEDLINE, Scopus, and the Cochrane Database) from inception to December 2014. Studies comparing systemic administration of steroids (steroid group) with placebo (placebo group), where the outcomes of interest were pain, body temperature, hospitalization, and oral intake during the posttreatment period, were included. Baseline study characteristics, study quality data, numbers of patients in the steroid and control groups, and outcomes were extracted. Sufficient data for meta-analysis were retrieved for 3 trials with a total of 153 patients. Pain-related parameters (patient-reported scores and trismus), body temperature, and dysphagia during the first 24 hours after treatment were significantly improved in the steroid group compared with placebo group. The discharge rate during the first 5 days of the posttreatment period was significantly higher in the steroid group than the control group. However, although more patients in the steroid group returned to normal activities and dietary intake at 24 hours after treatment, the differences between the groups were not significant and disappeared after 48 hours. In the treatment of PTA, systemic administration of steroids with antibiotics could reduce pain-related symptoms, as well as provide a benefit with respect to the clinical course. However, further trials with well-designed research methodologies should be conducted to confirm our results.

Keyword

Peritonsillar Abscess; Steroids; Pain; Systemic Review

MeSH Terms

Adrenal Cortex Hormones*
Anti-Bacterial Agents
Body Temperature
Deglutition Disorders
Hospitalization
Humans
Inflammation
Peritonsillar Abscess*
Steroids
Trismus
Adrenal Cortex Hormones
Anti-Bacterial Agents
Steroids

Figure

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  Fig. 1. Diagram of the study selection process.

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  Fig. 2. Systemic steroids versus control regarding pain. Odds ratio of the percentage of improvement of trismus at 4, 12, and 24 hours (A) from starting treatment, and standard mean difference in pain at 24 hours, 48 hours, and 7 days (B) from starting treatment. CI, confidence interval; Total, number of participants per group.

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  Fig. 3. Systemic steroids versus control regarding body temperature. Odds ratio of the percentage of normalized body temperatures at 12, 24, and 48 hours (A) from starting treatment, and standard mean difference in the degree of body temperatures at 24 and 48 hours (B) from starting treatment. CI, confidence interval; Total, number of participants per group.

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  Fig. 4. Systemic steroids versus control regarding patient recovery. Odds ratio of the discharge rate at 3, 4, and 5 days (A) from starting treatment, and odds ratio of the percentage of patients reporting return to normal activities at 24 hours, 48 hours, and 7 days (B) from starting treatment. CI, confidence interval; Total, number of participants per group.

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  Fig. 5. Systemic steroids versus control regarding dysphagia. Odds ratio of percentage of swallowing water without pain at 4, 12, and 24 hours (A) from starting treatment, and standard mean difference in the percentage of patients reporting return to a normal diet at 24 hours, 48 hours, and 7 days (B) from starting treatment. CI, confidence interval; Total, number of participants per group.

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