Prehospital Care
Prehospital care for peritonsillar abscess includes transport with supplemental oxygen.
Emergency Department Care
Evaluation of peritonsillar abscesses begins with ABCs, paying close attention to the patient's airway. If the patient's airway is compromised, immediate endotracheal intubation is indicated. If this cannot be completed, a cricothyroidotomy or a tracheostomy may be required. 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. [9]
These patients are often dehydrated because of their avoidance of food and liquid and may need fluid resuscitation.
Antipyretics should be administered for elevated temperature; adequate analgesia should be provided for pain.
Acute surgical management should be carried out as discussed above, if indicated.
Empiric antibiotics should be administered.
Steroids are often used as adjunctive treatment. [22] A recent literature review carried out by Powell and Wilson indicates that patients treated with steroids have statistically significant reductions in pain and hospital stay. [16]
A literature review by Lee et al also suggested that corticosteroids are effective in the treatment of peritonsillar abscess, finding significant improvement during the first 24 hours following treatment in patients who underwent corticosteroid therapy with regard to pain-related parameters, body temperature, and dysphagia compared with patients treated with placebo. In addition, the corticosteroid patients had a significantly greater discharge rate than did the placebo group during the first 5 days posttreatment. However, by 48 hours posttreatment, patients in the corticosteroid and placebo groups had an equal tendency to return to normal activities and dietary intake. [23]
Patients can be managed in an outpatient setting unless they show signs of toxicity, sepsis, airway compromise, inability to swallow, or other complications.
Consultations
An otolaryngologist may be required if the patient's presentation is severe. An anesthesiologist or surgeon may be required for management of a difficult airway.
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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.
