A peritonsillar abscess is a collection of pus between the tonsil and the throat wall, usually as a complication of tonsillitis. It is the most common deep neck infection in teens and young adults, and it needs drainage.
Key symptoms
- Severe sore throat, worse on one side
- Painful swallowing and drooling
- Muffled hot potato voice
- Trouble opening the mouth (trismus)
- Fever and ear pain on the same side
What you find on exam
- Swollen, bulging soft palate above one tonsil
- Uvula pushed to the opposite side
- Trismus and drooling
- Tender, swollen neck lymph nodes
- Airway, hydration and vital signs
Tests
- Clinical diagnosis in most patients
- Needle aspiration confirms pus and is also treatment
- Intraoral ultrasound or CT neck with contrast if unclear or deep spread is suspected
- Rapid strep test or culture and blood count; mono test if suspected
Treatment basics
- Needle aspiration or incision and drainage
- Antibiotics: IV ampicillin-sulbactam or oral amoxicillin-clavulanate; clindamycin if penicillin allergy
- A single dose of dexamethasone may ease pain and swelling
- Pain control and IV fluids if the patient cannot drink
- Tonsillectomy for recurrent abscesses
Red flags
- Stridor, trouble breathing or sitting forward to breathe
- Neck swelling spreading down, stiff neck or chest pain
- Unable to swallow saliva or drink
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.