eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Peritonsillar Abscess: Follow-up

Author: Ninfa Mehta, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn; A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon; Mazen J El-Sayed, MD, Resident, Department of Emergency Medicine, University Of Maryland Medical Center
Contributor Information and Disclosures

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

 


More on Peritonsillar Abscess

Overview: Peritonsillar Abscess
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

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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 

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Contributor Information and Disclosures

Author

Ninfa Mehta, MD, Staff Physician, 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 Medical Association, and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Mazen J El-Sayed, MD, Resident, Department of Emergency Medicine, University Of Maryland Medical Center
Mazen J El-Sayed, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael Glick, DMD, Professor and Acting Chair, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey
Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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, David Geffen School of Medicine at UCLA; 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.

 
 
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