Peritonsillar Abscess in Emergency Medicine Clinical Presentation

  • Author: Audrey J Tan, DO; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 30, 2012
 

History

Symptoms of peritonsillar abscess usually begin 3-5 days prior to evaluation.

  • Fever
  • Malaise
  • Headache
  • Neck pain
  • Throat pain markedly more severe on the affected side and occasionally referred to the ipsilateral ear
  • Dysphagia
  • Change in voice
  • Otalgia
  • Odynophagia
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Physical

Physical findings of peritonsillar abscess include the following:

  • Mild/moderate distress
  • Fever
  • Tachycardia
  • Dehydration
  • Drooling, salivation, trouble handling oral secretions
  • Trismus resulting from pain from inflammation and spasm of masticator muscles
  • Hot potato/muffled voice
  • Rancid or fetor breath
  • Cervical lymphadenitis in the anterior chain
  • Asymmetric tonsillar hypertrophy
  • Localized fluctuance
  • Inferior and medial displacement of the tonsil
  • Contralateral deviation of the uvula
  • Erythema of the tonsil
  • Exudates on the tonsil
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Causes

Peritonsillar abscesses are usually polymicrobial. A recent prospective study carried out to elucidate significant pathogens involved in peritonsillar abscesses demonstrated that the most prominent aerobic pathogen was Streptococcus pyogenes. Other aerobic pathogens isolated included Staphylococcus aureus,Neisseria species, and Corynebacterium species. In the same study, the most common anaerobic species found was Fusobacterium necrophorum, an obligate, anaerobic, Gram-negative rod. Other Fusobacterium species and Prevotella species were also isolated. Though the study was carried out in Denmark, studies within the United States have demonstrated similar results.[3, 7, 2, 8]

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Contributor Information and Disclosures
Author

Audrey J Tan, DO  Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center

Audrey J Tan, DO is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ninfa Mehta, MD  Fellowship Director in Ultrasound Division, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Ninfa Mehta, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Glick, DMD  Dean, University of Buffalo School of Dental Medicine

Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, A Antoine Kazzi, MD, and Mazen J El-Sayed, MD, to the development and writing of this article.

References

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Right peritonsillar abscess. The soft palate, which is erythematous and edematous, is displaced anteriorly. The patient has a "hot potato–sounding" voice.
Pus is aspirated through a wide-bore needle from the right peritonsillar abscess. An additional incision will be made to drain any other pus pockets.
 
 
 
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