Peritonsillar Abscess in Emergency Medicine Treatment & Management

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

Prehospital Care

Prehospital care for peritonsillar abscess includes transport with supplemental oxygen.

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Emergency Department Care

  • ABCs, paying attention to the patient's airway, should be evaluated. If the patient's airway is compromised, he or she needs immediate endotracheal intubation. If this cannot be completed, then a cricothyroidotomy or a tracheotomy may need to be performed. Alternatively, if the resources are available, one study concluded that awake fiberoptic bronchoscopy was the method of choice for intubating patients with significant pharyngeal edema.[3]
  • These patients are often dehydrated because of their avoidance of food and liquid and will need fluid resuscitation.
  • Antipyretics should be administered for elevated temperature, and adequate analgesia should be provided for pain.
  • Needle aspiration should be performed to drain the abscess and should provide moderate pain relief. Larger abscesses may require incision and drainage, and if the emergency provider is not comfortable with this procedure, an otolaryngologist may be consulted. See Drainage, Peritonsillar Abscess.
  • Empiric antibiotics should be administered.
  • The use of steroids as adjunctive treatment has been reported as safe and effective. One study demonstrated a statistically significant difference favoring use of steroids as well as no significant increase in the frequency of complications.[6, 3]
  • Patients can be managed on an outpatient basis unless they show signs of toxicity, sepsis, airway compromise, or complications.
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Consultations

Otolaryngologist, anesthesiologist for difficult airway management

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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

  1. Galioto NJ. Peritonsillar abscess. Am Fam Physician. Jan 15 2008;77(2):199-202. [Medline].

  2. Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. Jun 2008;41(3):459-83, vii. [Medline].

  3. Johnson RF, Stewart MG. The contemporary approach to diagnosis and management of peritonsillar abscess. Curr Opin Otolaryngol Head Neck Surg. Jun 2005;13(3):157-60. [Medline].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

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

  9. 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].

  10. 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].

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

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

  13. 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].

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

  15. 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].

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

  17. 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].

  18. 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].

  19. 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].

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

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

  22. 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].

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

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

 
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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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