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 ETIOLOGY 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