Peritonsillar Abscess in Emergency Medicine Follow-up

  • Author: Audrey J Tan, DO; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: May 24, 2010
 

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.
  • Emergent tonsillectomy is no longer commonly recommended as studies have 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 needle decompression or incision and drainage.
  • To prevent recurrence, interval tonsillectomy may be considered 3-4 weeks after resolution of edema and symptoms.
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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).
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Complications

Complications of peritonsillar abscess may include the following:

  • Necrotizing soft tissue infection of the neck and chest wall[7]
  • 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)
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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.

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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.

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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, State University of New York Downstate Medical Center, Kings County Hospital

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.

Acknowledgments

The authors and editors of eMedicine 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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