What Is a Peritonsillar Abscess?

This post was written with Consensus AI Academic Search Engine – please read our Disclaimer at the end of this article. A peritonsillar abscess (PTA), also known as quinsy, is a collection of pus that forms near the tonsils, typically as a complication of tonsillitis or pharyngitis. It is the most common deep infection of the head and neck in adults and can lead to severe throat pain, fever, dysphagia (difficulty swallowing), and trismus (difficulty opening the mouth)5 8.

Epidemiology

The incidence of peritonsillar abscess varies by region and healthcare system. In the United States, the incidence was estimated to be 30 per 100,000 person-years in 19944. PTAs can present to various healthcare providers, including primary care physicians, emergency physicians, surgeons, and otolaryngologists, depending on the healthcare system in place4.

Pathophysiology

Peritonsillar abscesses typically develop as a result of bacterial infection spreading from the tonsils to the surrounding tissues. The most commonly cultured organisms in PTAs are streptococci, which were found in 62% of cases in one study2. The infection leads to the formation of pus, which accumulates in the peritonsillar space, causing the characteristic symptoms of the abscess.

Diagnosis

Diagnosing a peritonsillar abscess involves a combination of clinical examination and imaging techniques. Physical examination alone has limited sensitivity, and traditional management often involves blind needle aspiration, which has a false negative rate of 10-24%9. Intraoral ultrasound has been shown to improve diagnostic accuracy significantly, correctly identifying pus versus cellulitis in 100% of cases compared to 64% with traditional landmark-based needle aspiration4 7. Computed tomography (CT) scans can also be used to differentiate between PTA and peritonsillar cellulitis, enhancing diagnostic accuracy and reducing unnecessary drainage procedures3.

Clinical Presentation

Patients with a peritonsillar abscess typically present with severe sore throat, fever, dysphagia, and trismus. The affected tonsil may appear swollen and displaced towards the midline, and there may be visible pus in the peritonsillar area. Other symptoms can include muffled voice (often described as “hot potato voice”) and ear pain on the affected side.

Conclusion

Peritonsillar abscess is a serious complication of tonsillitis that requires prompt diagnosis and management. While traditional methods like physical examination and blind needle aspiration are commonly used, advanced imaging techniques such as intraoral ultrasound and CT scans have proven to enhance diagnostic accuracy and improve patient outcomes. Understanding the pathophysiology, clinical presentation, and diagnostic methods is crucial for effective management of this condition.

Disclaimer

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