Updated: 2/2/2020

Peritonsillar Abscess

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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
  • Caused by Group A Strep in most cases
    • other pathogens include S. aureus, S. pneumoniae, and anaerobic bacteria
  • Epidemiology
    • occurs in children usually ages > 10 years
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
Evaluation
  • Diagnosis is based primarily on clinical observations
  • Imaging
    • may be helpful in specifically identifying abscess collection, though usually not required for making diagnosis
  • 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 
Treatment
  •  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
Prognosis, Prevention, and Complications
  • Prognosis
    • very good to excellent with early diagnosis and treatment
  • Prevention
    • identification and treatment of tonsillits before it progresses to abscess
  • Complications
    • respiratory obstruction, difficulty swallowing
 

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Questions (4)
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(M2.PD.16.4688) An 18-year-old male with a history of recurrent pharyngitis presents to your clinic with fever, sore throat and decreased oral intake. The patient states that his symptoms have been present for about 1-week, although over the past couple of days they have gotten much worse. The patient's vital signs are as follows: temperature is 102.2 deg F (39.0 deg C), pulse is 94/min, blood pressure is 110/68 mmHg and respirations are 14/min. On physical exam the patient appears uncomfortable, barely opening his mouth when speaking. There is tender lymphadenopathy bilaterally. Examination of the oropharynx is demonstrated in Figure A. A heterophile test is performed and later comes back negative. What is the most likely diagnosis in this patient? Tested Concept

QID: 107548
FIGURES:
1

Lymphoma

0%

(0/3)

2

Retropharyngeal abscess

33%

(1/3)

3

Peritonsillar cellulitis

0%

(0/3)

4

Infectious mononucleosis

0%

(0/3)

5

Peritonsillar abscess

67%

(2/3)

M 6 E

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(M2.PD.13.2) A 12-year-old boy presents with a fever and a sore throat. He is generally healthy; however, he has had a sore throat that he states has required drainage 3 times in the past several weeks. His symptoms keep recurring several days later. Otherwise, the patient is not currently taking any medications and is up to date on his vaccinations. His temperature is 100.5°F (38.1°C), blood pressure is 104/64 mmHg, pulse is 115/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is the most appropriate treatment for this patient? Tested Concept

QID: 104432
FIGURES:
1

Amoxicillin

10%

(6/61)

2

Penicillin

5%

(3/61)

3

Incision and drainage

77%

(47/61)

4

Needle aspiration

5%

(3/61)

5

Observation and reassurance

2%

(1/61)

M 7 E

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