Peritonsillar abscess, deep neck infection, and proton pump inhibitor: A nested case-control study.

OBJECTIVE

To investigate the association between proton pump inhibitor (PPI) use and the risk of peritonsillar abscess (PTA) and deep neck infection (DNI).

METHODS

This nested case-control study utilized data from the Health Screening Cohort of the Korean National Health Insurance Service (2002-2013). A total of 1953 patients with PTA and 5797 patients with DNI were identified and matched with controls at a 1:4 ratio based on age, sex, income, and residential area. PPI exposure was classified according to prescription timing and cumulative duration. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using overlap propensity score weighting while adjusting for potential confounders.

RESULTS

Current PPI use was associated with an increased risk of PTA (adjusted OR 2.83, 95% CI 2.17-3.68). For DNI, increased odds were observed among both past PPI users (adjusted OR 1.85, 95% CI 1.55-2.21) and current users (adjusted OR 2.80, 95% CI 2.35-3.34). A duration-dependent association was noted for both PTA and DNI, with progressively higher odds ratios observed with longer cumulative PPI exposure (all p < 0.001).

CONCLUSIONS

PPI use was associated with increased odds of developing peritonsillar abscess and deep neck infection, particularly among current users and those with prolonged exposure. These findings suggest the need for careful consideration of long-term PPI prescription in clinical practice. However, given the observational design of this study, these findings should be interpreted as an association rather than a causal relationship.

LEVEL OF EVIDENCE: Level III.