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

Peritonsillar Abscess

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

Introduction

Background

Peritonsillar abscess (PTA) is a common infection of the head and neck region. Combinations of aerobic and anaerobic bacteria colonize the peritonsillar space. This potential space is bounded by the tonsillar pillars anteroposteriorly, the piriform fossa inferiorly, and the hard palate superiorly.

Right peritonsillar abscess. The soft palate, whi...

Right peritonsillar abscess. The soft palate, which is erythematous and edematous, is displaced anteriorly. The patient has a "hot potato–sounding" voice.

[ CLOSE WINDOW ]
Right peritonsillar abscess. The soft palate, whi...

Right peritonsillar abscess. The soft palate, which is erythematous and edematous, is displaced anteriorly. The patient has a "hot potato–sounding" voice.


Pathophysiology

Peritonsillar abscess is an infection that begins superficially and progresses into the deep soft tissues. The exact mechanism of the initial abscess formation is not known. Abscesses form between the palatine tonsil and its capsule, usually at the superior pole. It is believed that these abscesses most likely arise from an acute episode of tonsillitis, which then progresses to involve the soft tissues surrounding this area. Another proposed mechanism is necrosis and pus formation in the capsular area, which then obstructs the weber glands, which then swell, and the abscess forms.

Frequency

United States

According to Herzon, peritonsillar abscess is the most common infection of the peritonsillar region.1  In the United States, the incidence is somewhere around 30 cases per 100,000 persons per year, accounting for approximately 45,000 cases annually.

International

A higher rate due to recurrence and antibiotic resistance is reported internationally.

Mortality/Morbidity

  • The death rate of peritonsillar abscess is unknown.
  • Morbidity of peritonsillar abscess is due mostly to pain, cost of treatment, lost time from work and school, and complications.

Race

No racial predilection of peritonsillar abscess is noted.

Sex

The male-to-female ratio of peritonsillar abscess is equal.

Age

Peritonsillar abscess can occur in anyone aged 10-60 years according to one source, although peritonsillar abscess is most commonly seen in those aged 20-40 years.1 The younger children who get peritonsillar abscess often are immunocompromised.

Clinical

History

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

  • Sore throat, which may be unilateral
  • Dysphagia
  • Change in voice
  • Headache
  • Malaise
  • Fever
  • Neck pain
  • Otalgia
  • Odynophagia

Physical

Physical findings of peritonsillar abscess include the following:

  • Mild/moderate distress
  • Fever
  • Tachycardia
  • Dehydration
  • Drooling, salivation, trouble handling oral secretions
  • Trismus (inability or difficulty in opening the mouth)
  • Hot potato/muffled voice (sounds like they are talking with hot food in their mouth)
  • 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
  • Exudate on the tonsil

Causes

Peritonsillar abscesses (PTAs) are usually polymicrobial when the drained pus is cultured. The most common aerobic species found are Streptococcus species (especially Streptococcus pyogenes), and the most common anaerobic species found are Prevotella species and Peptostreptococcus species.2  

More on Peritonsillar Abscess

Overview: Peritonsillar Abscess
Differential Diagnoses & Workup: Peritonsillar Abscess
Treatment & Medication: Peritonsillar Abscess
Follow-up: Peritonsillar Abscess
Multimedia: Peritonsillar Abscess
References
[ CLOSE WINDOW ]

References

  1. Herzon FS. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope. Aug 1995;105(8 Pt 3 Suppl 74):1-17. [Medline].

  2. Sakae FA, Imamura R, Sennes LU, Araujo Filho BC, Tsuji DH. [Microbiology of peritonsillar abscesses]. Rev Bras Otorrinolaringol (Engl Ed). Mar-Apr 2006;72(2):247-51. [Medline].

  3. Herzon FS, Martin AD. Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep. May 2006;8(3):196-202. [Medline].

  4. Losanoff JE, Missavage AE. Neglected peritonsillar abscess resulting in necrotizing soft tissue infection of the neck and chest wall. Int J Clin Pract. Dec 2005;59(12):1476-8. [Medline].

  5. Ahmed K, et al. Radiology in focus: The role of ultrasound in the management of peritonsillar abscess. J Laryngol Otol. 1994;108:610-612.

  6. Aldakhail AA, Khan MI. A retrospective study of peritonsillar abscess in Riyadh Medical Complex [corrected]. Saudi Med J. Aug 2006;27(8):1217-21. [Medline].

  7. Araujo Filho BC, Sakae FA, Sennes LU, Imamura R, de Menezes MR. Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses. Rev Bras Otorrinolaringol (Engl Ed). May-Jun 2006;72(3):377-81. [Medline].

  8. Blokmanis A. Ultrasound in the diagnosis and management of peritonsillar abscesses. J Otolaryngol. Aug 1994;23(4):260-2. [Medline].

  9. Tintinalli J, et al, eds. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill; 1996:1077-1078.

  10. Fauci AS, et al. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998:183.

  11. Garcia Callejo FJ, Nunez Gomez F, Sala Franco J, Marco Algarra J. [Management of peritonsillar infections]. An Pediatr (Barc). Jul 2006;65(1):37-43. [Medline].

  12. Hanna BC, McMullan R, Hall SJ. Corticosteroids and peritonsillar abscess formation in infectious mononucleosis. J Laryngol Otol. Jun 2004;118(6):459-61. [Medline].

  13. Kieff DA, Bhattacharyya N, Siegel NS, Salman SD. Selection of antibiotics after incision and drainage of peritonsillar abscesses. Otolaryngol Head Neck Surg. Jan 1999;120(1):57-61. [Medline].

  14. Lamkin RH, Portt J. An outpatient medical treatment protocol for peritonsillar abscess. Ear Nose Throat J. Oct 2006;85(10):658, 660. [Medline].

  15. Lyon M, Blaivas M. Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. Acad Emerg Med. Jan 2005;12(1):85-8. [Medline].

  16. Martin Campagne E, del Castillo Martin F, Martinez Lopez MM, Borque de Andres C, de Jose Gomez MI, Garcia de Miguel MJ. [Peritonsillar and retropharyngeal abscesses: study of 13 years]. An Pediatr (Barc). Jul 2006;65(1):32-6. [Medline].

  17. Ozbek C, Aygenc E, Tuna EU, Selcuk A, Ozdem C. Use of steroids in the treatment of peritonsillar abscess. J Laryngol Otol. Jun 2004;118(6):439-42. [Medline].

  18. Passy V. Pathogenesis of peritonsillar abscess. Laryngoscope. Feb 1994;104(2):185-90. [Medline].

  19. Roberts J. Emergency department considerations in the diagnosis and treatment of peritonsillar abscess. Emerg Med News. 1996;2:4-7.

  20. Sakaguchi M, Sato S, Asawa S, Taguchi K. Computed tomographic findings in peritonsillar abscess and cellulitis. J Laryngol Otol. May 1995;109(5):449-51. [Medline].

  21. Strong EB, Woodward PJ, Johnson LP. Intraoral ultrasound evaluation of peritonsillar abscess. Laryngoscope. Aug 1995;105(8 Pt 1):779-82. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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 

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.