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BackTable / ENT / Podcast / Episode #190
Managing Retropharyngeal Abscesses in Children
with Dr. John McClay
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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BackTable, LLC (Producer). (2024, September 10). Ep. 190 – Managing Retropharyngeal Abscesses in Children [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. John McClay
Dr. John McClay is a pediatric otolaryngologist at Cook Children's in Frisco, Texas.
Dr. Gopi Shah
Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.
Synopsis
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.
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
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.
Transcript Preview
[Dr. John McClay]
A CT really shows you how you treat them. If there's no abscess, the child's swallowing, give them a dose of IV antibiotics and give them oral antibiotics and let them go home. If they have a small abscess, less than 2 to 2.5 centimeters in the medial compartments, medial to the carotid sheath, then they'll probably respond to IV antibiotics. If they're bigger than that, then they probably won't. You can make determinations with the CT, even though CT is radiation and that's the argument. You don't want to do it because of radiation, but it's really a good test to guide what you're going to do because you don't have to admit them. You're saving a ton of money there for the healthcare system and plus the child didn't have to get admitted.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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