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Updated: Dec 25 2021

Peritonsillar Abscess

Images abscess.jpg
  • Snapshot
    • A 13-year-old boy presents with a sore throat, difficulty swallowing, inability to fully open his mouth, trismus, drooling, and a "hot-potato" voice. Visual inspection of the back of the throat is presented.
  • Introduction
    • Infection of the oropharynx secondary to untreated and/or long-standing tonsilitis
    • Surrounds tonsil and extends onto the soft palate
  • Epidemiology
    • Occurs in children usually ages > 10 years
    • Pathogenesis
      • Caused by Group A Strep in most cases
        • other pathogens include S. aureus, S. pneumoniae, and anaerobic bacteria
  • Presentation
    • Symptoms
      • vocal changes, sometimes called "hot-potato" voice
      • drooling
      • difficulty swallowing
      • limited oral extension
    • Physical exam
      • torticollis
      • displacement of the affected tonsil medially and laterally
      • deviation of the uvula to the contralateral side
        • not seen in epiglottitis and can be used to differentiate
      • cervical lymphadenopathy
        • key in differentiating from retropharyngeal abscess
  • Imaging
    • may be helpful in specifically identifying abscess collection, though usually not required for making diagnosis
  • studies
    • Culture
      • to identify responsible pathogen
  • Differential
    • Retropharyngeal abscess
    • Tonsillitis
      • hemorrhagic tonsillitis can occur as a complication
        • presents with tonsillar bleeding and requires cauterization if mild
  • diagnosis
    • Diagnosis is based primarily on clinical observations
  • Treatment
    • Prevention
      • identification and treatment of tonsillits before it progresses to abscess
    • Surgical intervention
      • needle aspiration
        • indicated in all cases for resolution
      • incision and drainage
        • may be necessary if incomplete resolution after needle aspiration
      • tonsillectomy
        • sometimes indicated in combination with I&D
      • antibiotics
        • may be required for complete resolution of infection
  • Complications
    • Respiratory obstruction, difficulty swallowing
  • Prognosis
    • Very good to excellent with early diagnosis and treatment
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