Peritonsillar Abscess in Emergency Medicine Clinical Presentation

Updated: Oct 13, 2022
  • Author: Jorge Flores, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Symptoms of peritonsillar abscess usually begin 3-5 days prior to evaluation.

  • Fever

  • Malaise

  • Headache

  • Neck pain

  • Throat pain markedly more severe on the affected side and occasionally referred to the ipsilateral ear

  • Dysphagia

  • Change in voice

  • Otalgia

  • Odynophagia



Physical findings of peritonsillar abscess include the following:

  • Mild/moderate distress

  • Fever

  • Tachycardia

  • Dehydration

  • Drooling, salivation, trouble handling oral secretions

  • Trismus resulting from pain from inflammation and spasm of masticator muscles

  • Hot potato/muffled voice

  • Rancid or fetor breath

  • 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

  • Exudates on the tonsil



Peritonsillar abscesses are usually polymicrobial. A prospective study carried out to elucidate significant pathogens involved in peritonsillar abscesses demonstrated that the most prominent aerobic pathogen was Streptococcus pyogenes. Other aerobic pathogens isolated included Staphylococcus aureus,Neisseria species, and Corynebacterium species. In the same study, the most common anaerobic species found was Fusobacterium necrophorum, an obligate, anaerobic, Gram-negative rod. Other Fusobacterium species and Prevotella species were also isolated. A literature review demonstrated that the Streptococcus milleri group, a facultative anaerobic group of bacteria, is also commonly associated with peritonsillar infection. Though these studies are European publications, studies within the United States have demonstrated similar results. [5, 13, 4, 14, 15]

The aforementioned literature review by Klug et al reported that the most prevalent bacteria in peritonsillar abscess are viridans group streptococci (25%), beta-hemolytic streptococci (20%), Fusobacterium necrophorum (13%), Staphylococcus aureus (11%), Prevotella species (10%), and Bacteroides species (9%). [11]