Difference between revisions of "Peritonsillar abscess"

Line 24: Line 24:
[[File:PTA Singh.gif|thumbnail|Endocavitary probe shows hypoechoic circumscribed area consistent with abscess<ref>http://www.thepocusatlas.com/soft-tissue-vascular/</ref>]]
**Differentiates cellulitis from abscess
**Differentiates cellulitis from abscess

Revision as of 18:13, 28 February 2018


  • Abbreviation: PTA
  • Abscess between tonsillar capsule and superior constrictor and palatopharyngeus muscles
    • Location affected: superior > middle > inferior pole
  • Microbiology

Clinical Features

Right sided peritonsillar abscess



  • Trismus
  • Muffled voice ("hot potato voice")
  • Contralateral deflection of swollen uvula

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections



Dentoalveolar Injuries

Odontogenic Infections



Endocavitary probe shows hypoechoic circumscribed area consistent with abscess[2]
  • Ultrasound
    • Differentiates cellulitis from abscess
    • Can use an intraoral approach using a endocavitary probe or transcutaenous approach using a linear probe
    • Can identify depth of neck vasculature prior to aspiration
  • CT with IV contrast
    • Differentiates PTA from parapharyngeal or retropharyngeal space infection



  • The recurrence rate after aspiration is 10% and the cure rate is 93% to 95%. Recurrence rate for aspiration alone may be higher than I&D [3][4]
  • May need IV pain meds, sedation or procedural sedation

Needle Aspiration

  1. Apply anesthetic spray to overlying mucosa
  2. Have patient hold suction and use as needed
  3. Use laryngoscope or disassembled vaginal speculum with wand as tongue depressor and light source
  4. Inject 1-2mL of lidocaine with epinephrine into mucosa of anterior tonsillar pillar using 25 gauge needle
  5. Cut distal tip off of needle sheath and place over 18ga needle to expose 1 cm of needle to prevent accidentally plunging deeper than desired
  6. Aspirate using 18 gauge needle just lateral to the tonsil
    • Use static ultrasound to determine depth of vasculature.
    • Though always a concern, carotid injury has not been clearly documented as a complications[5]
    • May require multiple aspirations to find the abscess
      • First try superior then middle then inferior poles
    • Consider spinal needle if patient has significant trismus


  1. #11 or #15 blade scalpel
  2. Do not penetrate more than 1cm
  3. Only advance posteriorly
  4. May be indicated if significant pus with needle aspiration


Coverage for Streptococcus species, anerobes, Eikenella, H. influenza, S. auresus

Outpatient Options

Inpatient Options


Decreases duration and severity of pain


  • Generally may be discharged with ENT follow-up
  • If no pus can be obtained but there is high suspicion for a PTA, admit with IV antibiotics (30% neg aspiration still have PTA)
  • In pediatric patients 50% respond to med management[6]

Return Precautions



Indications for tonsillectomy

  • Airway obstruction
  • Recurrent severe pharyngitis or PTA
  • Failure of abscess resolution with drainage

See Also


  1. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
  2. http://www.thepocusatlas.com/soft-tissue-vascular/
  3. Johnson RF, Stewart MG. The contemporary approach to diagnosis and man- agement of peritonsillar abscess. Curr Opin Otolaryngol Head Neck Surg. 2005;13:157
  4. Wolf M. Peritonsillar abscess: repeated needle aspiration versus incision and drainage. Ann Otol Rhinol Laryngol. 1994 Jul;103(7):554-7.
  5. Herzon FS, Martin AD. Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep. 2006;8(3):196.
  6. Blotter JW, Yin L, Glynn M, et al. Otolaryngology consultation for peritonsillar abscess in the pediatric population. Laryngoscope. 2000;110(10 Patient 1):1698.