Pediatric Peritonsillar Abscess 

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

Background

Peritonsillar abscess (PTA) is a suppurative infection of the tissues adjacent to the palatine tonsil and is the most common abscess of the head and neck region. It is usually unilateral but can be bilateral in about 6% of instances.[1]

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Pathophysiology

Peritonsillar abscess generally occurs in the superior pole of the tonsil. It can also be present at the midpoint or inferior pole of the tonsil or have multiple loculations within the peritonsillar space. The development of the abscess is often gradual, with an early stage of peritonsillar cellulitis. If not properly treated, an abscess emerges.

Two mechanisms have been proposed to explain the development of a collection of pus in the loose connective tissue of the supratonsillar fossa. The more common explanation is that a peritonsillar abscess develops from the direct spread of an inadequately treated bacterial tonsillitis. An alternative explanation is that a peritonsillar abscess is an abscess formed in a group of salivary glands in the supratonsillar fossa, known as Weber glands.

Lymphatic drainage from an infected peritonsillar abscess is to the ipsilateral jugulodigastric nodes. Bacterial cultures that are also adequate for the recovery of anaerobic bacteria usually yield polymicrobial aerobic and anaerobic bacteria. Group A beta-hemolytic streptococci is recovered in 25-40% of the abscesses. Anaerobic bacteria is isolated in over 90% of aspirated pus,[2] and elevated antibody levels to these organisms is detected in most patients with peritonsillar abscess.[3] Methicillin-resistant Staphylococcus aureus (MRSA) has been isolated with greater frequency in peritonsillar abscesses in recent years.[4]

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Epidemiology

Frequency

United States

The estimated incidence is 30 cases per 100,000 person-years in patients aged 5-59 years.[5] The incidence in children younger than 18 years is 14 cases per 100,000 population. Approximately 25-30% of patients with peritonsillar abscess are in the pediatric age group.[6]

International

The mean annual incidence of peritonsillar abscess in Europe was 41 cases per 100,000 population.[7]

Mortality/Morbidity

The mortality rate is unknown. Mortality is often due to aspiration of a ruptured abscess or sequelae of sepsis. Morbidity stems principally from pain and dehydration. See Complications in the Follow-up section.

Race

No race predilection is known.

Sex

No sex predilection is reported.

Age

Peritonsillar abscess most commonly occurs in the third and fourth decades of life. Pediatric cases are more common in children older than 10 years, although cases have been described in children younger than 1 year.

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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.

References

  1. Pham V, Gungor A. Bilateral peritonsillar abscess: case report and literature review. Am J Otolaryngol. Jan-Feb 2012;33(1):163-7. [Medline].

  2. Brook I, Frazier EH, Thompson DH. Aerobic and anaerobic microbiology of peritonsillar abscess. Laryngoscope. Mar 1991;101(3):289-92. [Medline].

  3. Brook I, Foote PA Jr, Slots J. Immune response to anaerobic bacteria in patients with peritonsillar cellulitis and abscess. Acta Otolaryngol. Nov 1996;116(6):888-91. [Medline].

  4. Brook I. Role of methicillin-resistant Staphylococcus aureus in head and neck infections. J Laryngol Otol. Dec 2009;123(12):1301-7. [Medline].

  5. Goldstein NA, Hammerschlag MR. Peritonsillar, retropharyngeal, and parapharyngeal abscesses. In: Feigin RD, Cherry JD, Demmler-Harrison GJ, et al eds. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Saunders; 2009:177.

  6. Millar KR, Johnson DW, Drummond D, Kellner JD. Suspected peritonsillar abscess in children. Pediatr Emerg Care. Jul 2007;23(7):431-8. [Medline].

  7. Ehlers Klug T, Rusan M, Fuursted K, Ovesen T. Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark. Clin Infect Dis. Nov 15 2009;49(10):1467-72. [Medline].

  8. Hidaka H, Kuriyama S, Yano H, Tsuji I, Kobayashi T. Precipitating factors in the pathogenesis of peritonsillar abscess and bacteriological significance of the Streptococcus milleri group. Eur J Clin Microbiol Infect Dis. Apr 2011;30(4):527-32. [Medline].

  9. Marom T, Cinamon U, Itskoviz D, Roth Y. Changing trends of peritonsillar abscess. Am J Otolaryngol. May-Jun 2010;31(3):162-7. [Medline].

  10. Risberg S, Engfeldt P, Hugosson S. Peritonsillar abscess and cellulitis and their relation to a positive antigen detection test for streptococcal infection. Scand J Infect Dis. Oct 2010;42(10):747-51. [Medline].

  11. Brook I. Role of methicillin-resistant Staphylococcus aureus in head and neck infections. J Laryngol Otol. Dec 2009;123(12):1301-7. [Medline].

  12. Klug TE, Henriksen JJ, Fuursted K, Ovesen T. Significant pathogens in peritonsillar abscesses. Eur J Clin Microbiol Infect Dis. May 2011;30(5):619-27. [Medline].

  13. Rusan M, Klug TE, Henriksen JJ, Ellermann-Eriksen S, Fuursted K, Ovesen T. The role of viruses in the pathogenesis of peritonsillar abscess. Eur J Clin Microbiol Infect Dis. Feb 29 2012;[Medline].

  14. Brodsky L, Sobie SR, Korwin D, Stanievich JF. A clinical prospective study of peritonsillar abscess in children. Laryngoscope. Jul 1988;98(7):780-3. [Medline].

  15. Ahmed K, Jones AS, Shah K, Smethurst A. The role of ultrasound in the management of peritonsillar abscess. J Laryngol Otol. Jul 1994;108(7):610-2. [Medline].

  16. Brook I. Non-odontogenic abscesses in the head and neck region. Periodontol 2000. Feb 2009;49:106-25. [Medline].

  17. Patel KS, Ahmad S, O'Leary G, Michel M. The role of computed tomography in the management of peritonsillar abscess. Otolaryngol Head Neck Surg. Dec 1992;107(6 Pt 1):727-32. [Medline].

  18. Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA. Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis. J Laryngol Otol. Mar 1999;113(3):229-32. [Medline].

  19. Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg. Mar 2003;128(3):332-43. [Medline].

  20. Spires JR, Owens JJ, Woodson GE, Miller RH. Treatment of peritonsillar abscess. A prospective study of aspiration vs incision and drainage. Arch Otolaryngol Head Neck Surg. Sep 1987;113(9):984-6. [Medline].

  21. [Guideline] 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].

  22. Rivera AM, Boucher HW. Current concepts in antimicrobial therapy against select gram-positive organisms: methicillin-resistant Staphylococcus aureus, penicillin-resistant pneumococci, and vancomycin-resistant enterococci. Mayo Clin Proc. Dec 2011;86(12):1230-43. [Medline].

  23. Friedman NR, Mitchell RB, Pereira KD, Younis RT, Lazar RH. Peritonsillar abscess in early childhood. Presentation and management. Arch Otolaryngol Head Neck Surg. Jun 1997;123(6):630-2. [Medline].

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

  25. Gavriel H, Vaiman M, Kessler A, Eviatar E. Microbiology of peritonsillar abscess as an indication for tonsillectomy. Medicine (Baltimore). Jan 2008;87(1):33-6. [Medline].

  26. Herzon FS. Permucosal needle drainage of peritonsillar abscesses. A five-year experience. Arch Otolaryngol. Feb 1984;110(2):104-5. [Medline].

  27. Herzon FS, Nicklaus P. Pediatric peritonsillar abscess: management guidelines. Curr Probl Pediatr. Sep 1996;26(8):270-8. [Medline].

  28. Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg. Mar 2003;128(3):332-43. [Medline].

  29. Kew J, Ahuja A, Loftus WK, Scott PM, Metreweli C. Peritonsillar abscess appearance on intra-oral ultrasonography. Clin Radiol. Feb 1998;53(2):143-6. [Medline].

  30. 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].

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

  32. Richardson KA, Birck H. Peritonsillar abscess in the pediatric population. Otolaryngol Head Neck Surg. Nov-Dec 1981;89(6):907-9. [Medline].

  33. Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA. Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis. J Laryngol Otol. Mar 1999;113(3):229-32. [Medline].

  34. Spires JR, Owens JJ, Woodson GE, Miller RH. Treatment of peritonsillar abscess. A prospective study of aspiration vs incision and drainage. Arch Otolaryngol Head Neck Surg. Sep 1987;113(9):984-6. [Medline].

  35. Stringer SP, Schaefer SD, Close LG. A randomized trial for outpatient management of peritonsillar abscess. Arch Otolaryngol Head Neck Surg. Mar 1988;114(3):296-8. [Medline].

  36. Weinberg E, Brodsky L, Stanievich J, Volk M. Needle aspiration of peritonsillar abscess in children. Arch Otolaryngol Head Neck Surg. Feb 1993;119(2):169-72. [Medline].

 
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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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