The role of repeated aspirations in the treatment of tubercular cervical lymphadenitis

Introduction: Tubercular lymphadenitis is the most common form of extrapulmonary tuberculosis. Tubercular lymphadenopathy can progress to abscess and fistula formation. Further during the course of treatment paradoxical upgrading reaction of lymphnodes like appearance of new lymphnodes and sinus formation can occur. Objective: The aim of the study was to evaluate the role of repeated aspirations as an adjunct to ATT in the treatment of tubercular lymphadenitis presenting with abscess. Material and Methods: The study involved 180 cases of cervical lymphadenopathy who presented in the ENToutpatient Department of Bundelkhand Medical College Sagar between Jan 2016 to Sep 2017. 102 cases were diagnosed by FNAC and 3 cases were diagnosed by excision biopsy as tubercular lymphadenitis. Only new cases of were included Out of the 105 cases of diagnosed with tubercular lymphadenitis 15 cases presented with cold abscess initially. All thepatients were started onanti-tubercular treatment. 10 cases developed abscess during the course of treatment. All cases presenting with abscess were subjected to repeated aspiration biweekly. Results: All cases of tubercular lymphadenitis and abscess showed complete recovery with 6 months of treatment. Conclusion:Repeated aspirations in cold abscess as an adjuvant to ATT is a less invasive procedure than surgical excision and reduces the complications like sinus formation. Close supervision by the ENT specialist is mandatory during the course of medical treatment to combat paradoxical upgrading reactions especially abscess formation.