Association of Air Pollution With Increased Risk of Peritonsillar Abscess Formation
So Young Kim, MD1; Il Gyu Kong, MD2; Chanyang Min, PhD3,4; et al Hyo Geun Choi, MD2
Author Affiliations Article Information
1Department of Otorhinolaryngology–Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
2Department of Otorhinolaryngology–Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
3Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
4Graduate School of Public Health, Seoul National University, Seoul, Korea
JAMA Otolaryngol Head Neck Surg. 2019;145(6):530-535. doi:10.1001/jamaoto.2019.0742
Key Points
Question  Is there an association between meteorological conditions and/or air pollution and peritonsillar abscess formation?

Findings  In this nested case-control study of 3819 participants with peritonsillar abscesses, abscess formation was associated with high concentrations of nitrogen dioxide (NO2) and particulate matter 10 micrometers or less in diameter (PM10).

Meaning  The air pollutants of NO2 and PM10 may be risk factors for peritonsillar abscess formation.

Abstract
Importance  Several studies reported an association between peritonsillar abscess formation and climate conditions, including seasonal changes; however, the results were inconsistent.

Objective  To evaluate the association between meteorological conditions and/or air pollution and peritonsillar abscess formation.

Design, Setting, and Participants  In this nested case-control study, 3819 participants with peritonsillar abscesses were matched (1:4) for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 15 276 control participants. The Korean Health Insurance Review and Assessment Service-National Sample Cohort (HIRA-NSC) data from 2002 through 2013 were used.

Exposures and Main Outcomes and Measures  The meteorological data included the mean daily temperature (°C), highest daily temperature (°C), lowest daily temperature (°C), daily temperature difference (°C), relative humidity (%), spot atmospheric pressure (hPa), sulfur dioxide ([SO2], parts per million [ppm]), nitrogen dioxide (NO2, ppm), ozone (O3, ppm), carbon monoxide (CO, ppm), and particulate matter less than 10 μg (PM10, μg/m3) for the previous 14 days, 10 days, 7 days, 5 days, or 3 days before the matched index date. These factors were measured in 94 or 273 locations hourly. The crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of meteorological data for peritonsillar abscess formation were analyzed using unconditional logistic regression analysis. Subgroup analyses were conducted according to age and sex.

Results  The male to female ratio of study participants was 1.43 (11 260 to 7835). Because the age groups were classified using 5-year intervals, the mean age could not be defined. The mean differences of NO2 and PM10 concentrations for the 14 days between peritonsillar abscess group and control group were 1.78 ppb (95% CI, 1.47-2.09) and 1.33 μg/m3 (95% CI, 0.67-1.99), respectively. The aORs of NO2 (0.1 ppm) and PM10 (10 μg/m3) during the 14 days prior to the index date for peritonsillar abscess formation were 12.8 (95% CI, 8.4-19.5) and 1.04 (95% CI, 1.02-1.06), respectively. The other meteorological conditions did not reach statistical significance.

Conclusions and Relevance  Peritonsillar abscess formation was associated with high concentrations of NO2 and PM10.