Ep. 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). --- CHECK OUT OUR SPONSOR PearsonRavitz https://pearsonravitz.com/backtable --- 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. --- 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.