Peritonsillar abscess
Background
- Abscess between tonsillar capsule and superior constrictor and palatopharyngeus muscles
- Microbiology
- Polymicrobial: strep/staph, anaerobes, eikenella, haemophilus
Clinical Features
- Symptoms
- Fever
- Sore throat
- Odynophagia/dysphagia
- Signs
- Trismus
- Muffled voice ("hot potato voice")
- Contralateral deflection of swollen uvula
DDX
- Peritonsillar cellulitis
- Mono
- Lymphoma
- Herpes simplex tonsillitis
- Retropharyngeal Abscess
- Internal carotid artery aneurysm
Diagnosis
- Ultrasound
- Differentiates cellulitis from abscess
- CT w/ IV contrast
- Differentiates PTA from parapharyngeal or retropharyngeal space infection
Treatment
- No difference in outcome when comparing needle aspiration with I&D
- Needle Aspiration
- Apply anesthetic spray to overlying mucosa
- Inject 1-2mL of lidocaine with epi into mucosa of anterior tonsillar pillar using 25ga needle
- Aspirate using 18ga needle just lateral to the tonsil, no more than 1cm (internal carotid artery nearby)
- May require multiple aspirations to find the abscess
- Abx
- Outpatient
- Amoxicillin/clavulanate 875 mg PO BID x 7-10d OR
- Clindamycin 600mg PO TID x7-10d OR
- Inpatient
- Ampicillin/Sulbactam 3 gm (75mg/kg) IV QID OR
- Pipericillin/Tazobactam 4.5 gm IV TID OR
- Ticarcillin/Clavulanate 3.1 g IV QID OR
- Clindamycin 600-900mg IV TID
- Outpatient
- Steroids
- Improves duration and severity of pain
- Methylprednisolone 125mg IV x1 OR dexamethasone 10mg PO/IM x1
Complications
- Airway obstruction
- Rupture abscess with aspiration of contents
- Hemorrhage due to erosion of carotid sheath
- Retropharyngeal abscess
- Mediastinitis
See Also
Source
Tintinalli