Diagnosis
H&P: Diagnosis of peritonsillar abscess is on the clinical presentation and PE.
Common presentation:
Risk Factors:
Complications:
DDx and Etiology:
Diagnostic testing:
-CT / MRI if
Treatment
-Drain the abscess: The key to treating a peritonsillar abscess is drainage of the abscess either by needle drainage or by incision and drainage. Immediate tonsillectomy is less favored because it is not a cost-effective option.
-Empiric Antibiotics to cover gram positives (strep) + Anaerobes.
-Abx treatment length = 10 to 14 days.
-Consider steroids.
Trismus (difficulty opening mouth) is almost universally present with peritonsillar abscess.
Common Presentation: A young adult with several days of a fever, sore throat, dysphagia, trismus, and a “hot potato” voice.
**Some patients can be treated, outpatient. However, the abscess must be drained first. If you can’t drain the abscess in your clinic, send the patient immediately to a provider who can or to the ER. After draining the abscess, if you want to discharge the patient to treat as an outpatient, observe him for a few hours after drainage of the abscess to ensure he can tolerate oral fluids, antibiotics, and pain medications. Monitor patients closely and have them follow up the next clinic day or the day after.
Clinical Vignette.
A 35-year-old female presents with a 7-day history of a progressively worsening sore throat (feels like “swallowing glass”), fever, difficulty opening mouth. She also complained of right ear pain. Her husband who is present says her voice is very different and she has been feeling really sick and fatigued. She cried in the PCP’s office talking about how she felt. Three days prior, she was seen in urgent care and put on some antibiotics but she reports that her symptoms haven’t improved. In fact, she thinks she is getting worse. On PE, the patient had trismus and her right tonsil was edematous and erythematous with some exudates on it and the uvula was displaced to the contralateral side. Cervical lymphadenopathy was present. The patient was sent to the ER where CT was done, the patient was admitted and ENT drained the abscess. The patient spent 3 days in the hospital.
Reference / Further Reading
https://www.aafp.org/afp/2017/0415/p501.html#afp20170415p501-f1
https://www.aafp.org/afp/2008/0115/p199.html#afp20080115p199-f1