Pediatric Peritonsillar Abscess Follow-up

  • Author: Itzhak Brook, MD, MSc; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 8, 2012
 

Further Inpatient Care

Admit patients with peritonsillar abscesses (PTAs) with the following conditions:

  • Airway compromise
  • Dehydration and inability to tolerate oral intake
  • Uncertain outpatient compliance
  • Unclear diagnosis
  • Suspected local or systemic complications
  • Toxic appearance

Include intravenous fluids, intravenous antibiotics, and analgesia.

Reevaluate patients daily for possible further surgical intervention including repeat aspiration, incision and drainage, or abscess tonsillectomy in the operating room.

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Further Outpatient Care

Arrange for follow-up in 24 hours.

Arrange for patient reassessment for further surgical intervention such as elective tonsillectomy.

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Transfer

Transfer to an institution where ENT has experience in treating peritonsillar abscess in children.

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Deterrence/Prevention

In patients with peritonsillar abscess who have a history of recurrent tonsillitis or peritonsillar abscess, interval tonsillectomy is recommended to prevent further episodes.

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Complications

Note the following possible complications:

  • Airway compromise
  • Aspiration of abscess contents (spontaneously or with incision and drainage) and development of aspiration pneumonia
  • Parapharyngeal abscess
  • Septic thrombophlebitis involving the internal jugular vein (Lemierre syndrome) or internal carotid artery leading to septicemia with metastatic foci of infection, especially in the lung (Lemierre syndrome, caused by Fusobacterium)
  • Carotid artery rupture
  • Pseudoaneurysm of the carotid artery
  • Sepsis
  • Hemorrhage as a result of iatrogenic injury to major vessels on attempted aspiration or incision and drainage
  • Mediastinitis
  • Necrotizing fasciitis
  • Contiguous spread to the pterygomaxillary space
  • Septic and nonseptic complications of group A streptococcus infection
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Prognosis

Prognosis is good for full recovery when patients are treated with a combination of a drainage procedure and the appropriate antibiotic therapy.

After one aspiration, 80-90% of PTAs resolve.

An additional 5-10% of PTAs resolve with repeat aspiration.

If patients have not already undergone an abscess tonsillectomy, PTA is considered as a relative indication for interval tonsillectomy in the following patients:

  • Patients who have had recurrent tonsillitis prior to PTA
  • Patients who have a recurrent PTA

In rare instances, PTA can recur after a bilateral tonsillectomy.

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Patient Education

Instruct patients to return for further care with occurrence of the (1) difficulty breathing and/or (2) an inability to tolerate oral intake

For patient education resources, see the Ear, Nose, and Throat Center, as well as Peritonsillar Abscess, Tonsillitis, and Antibiotics.

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Contributor Information and Disclosures
Author

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Gershon Segal, MD, to the development and writing of this article.

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Examination of the oropharynx demonstrates unilateral swelling and erythema of the left tonsil with deviation of the uvula to the contralateral side. Courtesy of Michael Altieri, MD, Medifor, Inc. Used with permission.
CT scan with contrast demonstrates a 2-cm low-attenuation mass with a minimally enhancing wall in the right peritonsillar region. Associated edema, ipsilateral jugulodigastric lymphadenopathy, compression of the internal jugular vein, and deviation of the airway are present.
 
 
 
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