Nothing is more satisfying than draining an abscess, right? But when is medical management sufficient or even better? In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. John McClay joins host Dr. Gopi Shah to educate listeners on the diagnosis and management of pediatric retropharyngeal abscess (RPA).

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SYNPOSIS

First, Dr. McClay reviews the symptoms, pathophysiology, and workup of neck abscesses (including RPA) in children. When evaluating any suspected neck abscess, he uses CT results to evaluate its precise size and location. Then, he addresses the role of surgery in treatment of neck abscesses. While many patients will improve with IV antibiotics alone, he mentions that most abscesses lateral to the carotid sheath and greater than 2 cm in size require surgical drainage. Finally, the conversation shifts to cover important topics including antibiotic selection, the role of steroids, and cost-effective care.

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TIMESTAMPS

00:00 - Introduction

03:34 - Pathophysiology & Presentation of Retropharyngeal Abscess

09:54 - Physical Examination in the Child with Suspected Neck Abscess

17:43 - The Importance of CT Scans

31:40 - Treatment of Neck Abscesses: Antibiotics vs Surgery

37:56 - The Role of Steroids in Abscess Treatment

53:41 - Applying Value-Based Care as a Pediatric Otolaryngologist

55:44 - Recap & Final Pearls

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RESOURCES

Dr. McClay’s website:

https://www.johnmcclaymd.com/pediatric-sinus-center/

Pearson Ravitz

https://pearsonravitz.com/

McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg. 2003 Nov;129(11):1207-12.

Johnson RF. Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess. Laryngoscope. 2017 Oct;127 Suppl 5:S1-S9.