Key PointsPrevious studies have linked recurrent or persistent BPPV to age, anxiety or/and depression and medical comorbidityFactors such as the socioeconomical status have not been assessed.In our retrospective powered cohort we showed that there is a positive correlation between recurrent or persistent BPPV and ageWe found no correlation with the presence of underlying anxiety/depression and recurrent or persistent BPPV and age.While one would have expected that the socioeconomical and educational status would have had an impact on recurrent/persistent BPPV, using the Scottish Index of Multiple Deprivation, we did not identify such link.
Background Peritonsillar abscess is a common clinical problem. Management involves drainage of the abscess and administration of antibiotics. The choice of antibiotic is related to the polymicrobial growth of aspirate cultures, leading to prescriptions of co-amoxiclav, or metronidazole in addition to phenoxymethylpenicillin. However there is little evidence to support this. Objectives The aim of this review was to assess clinical effectiveness of phenoxymethylpenicillin vs phenoxymethylpenicillin plus anaerobic cover in the management of peritonsillar abscess. Design/Setting A systematic review of literature and clinical trial databases in accordance with the PRISMA 2020 statement. Studies were screened for eligibility by two independent reviewers. Main outcome measure Three studies were included, two comparing oral penicillin to oral penicillin plus metronidazole, one comparing IM/oral penicillin to IM/oral sulbactam-ampicillin. Clinical outcomes were assessed in all, including recurrence rate, symptom improvement and duration of pyrexia. Results There was no significant difference in any clinical outcome across all studies between the two groups. One study found a significant increase in diarrhoea and vomiting as a side effect in the group receiving metronidazole plus penicillin compared to penicillin alone (p=0.01). Conclusion On reviewing the literature, no significant clinical benefit has been demonstrated in the addition of either metronidazole or more broad-spectrum antibiotic cover compared to oral penicillin monotherapy for peritonsillar abscess when combined with incision and drainage protocols. Moreover, unnecessary broad-spectrum antibiotics contribute to increased side effects, costs, and antimicrobial resistance.
It is important to give parents accurate information about complication rates as part of the process of informed consent for surgery. National, routinely-collected data give an opportunity to estimate the rates of rare adverse events such as bleeding, blood transfusion and death.We reviewed data for all Scottish NHS hospitals over the time period 2000-2018 to identify all children (aged 0-16 years) undergoing tonsillectomy, and to identify adverse events occurring within 30 days of the procedure.Readmission to hospital was required in 2%.Surgical arrest of haemorrhage was required in 1%.Blood transfusion occurred in 0.1% and death occurred in one child out of 50,194.