eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat
Peritonsillar Abscess: Follow-up
Updated: Mar 11, 2009
Follow-up
Further Inpatient Care
- Observation, imaging studies, airway management, and intravenous hydration may be required.
- Other methods of operative management strategy may be indicated and should be performed by an otolaryngologist.
- Incision and drainage formerly was the treatment of choice; however, great care must be taken in suctioning the purulent material to avoid aspiration, which may lead to pneumonitis and/or pneumonia. When performing incision and drainage be sure to have a small blade or use a cross clamp to have only a small (approximately 0.5 cm) of the blade exposed while making the incision. This will prevent any exposure of the needle to the carotid artery.
- Emergent tonsillectomy came under criticism because studies of the procedure demonstrated that desired outcomes did not occur as rapidly as supporters had predicted.
- Costs were increased considerably.
- Bleeding complications were higher (1-7%).
- Less invasive and equally effective alternatives are now available in uncomplicated cases.
- Emergent tonsillectomy is used to treat patients with a history of 3 or more peritonsillar abscesses (PTAs).
- Recurrence obviates the need for a second hospitalization for interval tonsillectomy after incision and drainage. Whether recurrence is an indication for tonsillectomy remains unclear.
- To prevent recurrence, interval tonsillectomy may be considered 3-4 weeks after disappearance of edema and symptoms. The value of such a strategy is somewhat controversial. Tonsillectomy reduces the need for admission for recurrences of peritonsillar abscess (PTA); however, that need is rare since most PTAs now are treated percutaneously and on an outpatient basis.
Further Outpatient Care
- If outpatient care is used, the patient can be discharged (after needle aspiration treatment) on an appropriate regimen of antibiotics and pain medications.
- Relative indications for elective tonsillectomy can be identified in almost a third of all patients who present with PTA (eg, recurrent tonsillitis).
Complications
Complications of peritonsillar abscess may include the following:
- Necrotizing soft tissue infection of the neck and chest wall4
- Recurrence
- Aspiration, which may lead to pneumonia or pneumonitis
- Cervical abscess
- Mediastinitis
- Meningitis
- Sepsis
- Cerebral abscess
- Jugular vein thrombosis
- Carotid artery rupture/necrosis
- Carotid artery injury (from I&D or needle aspiration)
Prognosis
- Uncomplicated, treated peritonsillar abscess has a resolution rate of 94%. In the United States, the recurrence rate is 10%, although this rate jumps to 15% internationally.
Patient Education
- For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education articles Peritonsillar Abscess, Tonsillitis, and Antibiotics.
More on Peritonsillar Abscess |
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| Differential Diagnoses & Workup: Peritonsillar Abscess |
| Treatment & Medication: Peritonsillar Abscess |
Follow-up: Peritonsillar Abscess |
| Multimedia: Peritonsillar Abscess |
| References |
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References
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Further Reading
Keywords
peritonsillar abscess, tonsillitis, throat abscess, head and neck infection, peritonsillar abscess treatment, peritonsillar abscess symptoms, peritonsillar space, PTA, quinsy, peritonsillar cellulitis, retropharyngeal abscess, drainage of throat abscess
Follow-up: Peritonsillar Abscess