Further Outpatient Care
If outpatient care is used, the patient can be discharged on an appropriate regimen of antibiotics and pain medications.
Relative indications for elective tonsillectomy can be identified in almost a third of all patients who present with peritonsillar abscess (eg, recurrent tonsillitis).
Further Inpatient Care
Observation, imaging studies, airway management, and intravenous hydration may be required.
Other methods of operative management strategy may be indicated and should be performed by an otolaryngologist.
Recurrence obviates the need for a second hospitalization for interval tonsillectomy after needle decompression or incision and drainage.
To prevent recurrence, interval tonsillectomy may be considered 3-4 weeks after resolution of edema and symptoms.
Complications
Complications of peritonsillar abscess may include the following:
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Necrotizing soft tissue infection of the neck and chest wall [24]
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Recurrence
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Aspiration, which may lead to pneumonia or pneumonitis
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Cervical abscess
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Sepsis
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Cerebral abscess
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Jugular vein thrombosis
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Carotid artery rupture/necrosis
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Carotid artery injury (from I&D or needle aspiration)
A retrospective cohort study by Mizuno et al indicated that in adult patients, the risk for recurrence of peritonsillar abscess is reduced in those aged 40 years or older and in patients who have been treated with intravenous antibiotics for at least 3 days, the adjusted hazard ratios (HRs) being 0.69 and 0.85, respectively. The risk of recurrence was reported to be increased in adult patients with a history of recurrent tonsillitis (adjusted HR = 1.79). [25]
Prognosis
Uncomplicated, treated peritonsillar abscess has a resolution rate of 94%. In the United States, the recurrence rate is 10%, regardless of whether a patient is treated with needle aspiration or incision and drainage. [16] The rate of recurrence jumps to 15% internationally.
Patient Education
For patient education resources, see the Ear, Nose, and Throat Center, as well as Peritonsillar Abscess, Tonsillitis, and Antibiotics.
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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.
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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.
