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Peritonsillar Abscess

Peritonsillar abscess is the most common deep neck infection in children and adolescents. It is a
bacterial infection that often follows an acute pharyngitis or tonsillits. The infection forms in the
“peritonsillar space”, a potential space between the palatine tonsils and the surrounding capsule.
Peritonsillar abscesses can also occur without infection. These abscess are attributed to inflammation of
the Weber’s glands, which are salivary glands superior to the tonsil in the soft palate.

1. In the US, there are 30 per 100,000 persons years (45,000 cases annually).
2. Most infections occur during November to December and April to May, coinciding with the highest incidence
of streptococcus pharyngitis and exudative tonsilitis.

Clinical Presentation
1. Unilateral sore throat
a. occasionally accompanied by ipsilateral ear pain
b. Fever
2. Muffled "hot potato" voice
3. Dysphagia with pooling of saliva and drooling
4. Trismus: inability to open the mouth due to muscle inflammation and spasm of the masticator muscle
a. Caused by irritation and reflex spasm of the Internal Pterygoid muscle

Cervical adenopathy Causative Organisms 1. Prevotella and Veillonella Differential Diagnosis 1. Respiratory Anaerobes . Torticollis Physical Findings 1. Staphylococcus Aureus.Fusobacterium. exudative tonsillar tissue with possible “pointing" of abscess 4. Inferior and medial displacement of the tonsil 5. Streptococcus Pyogenes (Group A Streptococcus) 2. Patient may appear toxic and very uncomfortable 2. Epiglottitis . Rancid or fetor breath 1. Localized erythema of the soft palate and uvula pushed to the contralateral side 3. including MRSA 3.5. Erythematous. https://www.studyblue. Dental infections 2.

Internal Jugular Vein thrombosis and thrombophlebitis 8. Peritonsillar Cellulitis 4. or chest 3. Throat culture to rule out GAS Imaging Used to differentiate PTA from peritonsilar cellulitis a. Cellulitis of the jaw. Necrotizing Fascitis 4.distortion of soft tissue i. Pharyngitis 6. Gram stain. Carotid Artery pseudoaneurysm and rupture 9. CBC with differential and electrolytes . Mononucleosis 7. Salivary gland infections 9. Endocarditis. Leukemia or Lymphoma Complications 1.increased WBCs with predominant PMN Leukocytes b. Pericarditis.used for establishing therapy a. Labs . Clinical diagnosis based on symptoms 2. Cervical Adenitis 8.3. neck. Mediastinitis 5. Aspiration Pneumonia 7. Airway obstruction 2. Rules out epiglottis and retropharyngeal abscess . Pleural effusion 6. culture and susceptibility test c. Septicemia Diagnosis 1. Lateral neck radiograph . Retropharyngeal Abscess 5.

out patient procedure with topical analgesia. Distinguishes from cellulitis which presents as a homogenous or striated area with no distinct fluid collection Treatment a. More painful and involves more bleeding than aspiration. Antimicrobial Therapy . CT scan with IV contrast . Demonstrates spread to contiguous deep neck spaces iii. Needle aspiration should be attempted and will alleviate the symptoms. b.begin with Penicillin 2. Indications . Drainage a.b. Fluid resuscitation Tonsillectomy a. Patient uncooperative b.significant upper airway obstruction or other complications a. Distinguishes from cellulitis. i.echogenic cavity with irregular borders i. 3. Supportive Care a. c. Antipyretics c. which shows a loss of fat planes and lack of enhancement ii. Send specimens for culture. 1. Previous episodes of severe recurrent pharyngitis or peritonsillar abscess . Used for children younger than 5 yrs old due to physical limitations from a small oropharynx Ultrasonography . 4.hypodense fluid collection with rim enhancement seen on affected tonsil c. Incision and Drainage . Analgesics b.

2002. 7. 6. Journal of Emergency Medicine 2005. Interval Tonsillectomy . Chudnofsky Carl.77(2):199-202 8.123(6):630-632. Fasano Charles J. Journal of American Academy of Family Physicians 2008 Jan 15. Peritonsillar Abscess in children: a 10 year review of diagnosis and management. Archives of Otolaryngology Head and Neck Surgery 1997.uchicago. b. International Journal of Pediatric Otolaryngology 2001. Friedman Norman R. McGinn Johnathan. 29(1):45– .57 (3):313-318 9. https://pedclerk.c.performed immediately b.bsd. Peritonsillar Abscess. Schraff Scott. American Family Physician Vol. Quinsy Tonsillectomy or “tonsillectomy a chaud” . Peritonsillar abscess in early childhood.performed after resolution of infection 5. Galioto Nicholas. Peritonsillar Abscess: Diagnosis and Treatment. Vanderbeek Paul. Failure of abscess resolution with other drainage techniques Timing a. Steyer Terrence. Bilateral peritonsillar abscesses: not your usual sore throat. 65 Number 1 January 1. Mitchell Ron B. Presentation and management.