Pediatric Peritonsillar Abscess Follow-up

Updated: May 03, 2016
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Russell W Steele, MD  more...
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Follow-up

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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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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Transfer

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

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Deterrence/Prevention

Adequate antimicrobial treatment of group A Streptococcus tonsillitis may reduce the risk of peritonsillar abscess. In patients with peritonsillar abscess who have a history of recurrent tonsillitis or peritonsillar abscess, interval tonsillectomy is recommended to prevent further episodes.

Poor oral hygiene, inappropriate antibiotic use, and smoking all are risk factors for peritonsillar abscess in adults, [30, 31] and eliminating these risk factors may reduce its occurrence.

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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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