Presentation of Case. A 1-year-old boy presented with a two-day history of worsening sore throat, loss of appetite, vomiting, and fever. [hindawi.com]

A 19-year-old woman presented to the emergency department with a 10-day history of intermittent odynophagia, voice changes, and fever. [nejm.org]

If no abscess is present, the antibiotic usually starts to clear the infection within 48 hours. If a peritonsillar abscess is present, a doctor must insert a needle in it or cut into it to drain the pus. [merckmanuals.com]

Peritonsillar abscess (ReelDx + Lecture) Presentation ReelDx Lecture Pearls Diagnosis Treatment 47-year-old with pharyngitis and difficulty swallowing ( watch video ) Patient will present as → a 19-year-old male who you are seeing for follow-up from the [smartypance.com]

• Large Pericardial Effusion

  The scan of the chest showed air density and swelling in the anterior and posterior mediastinum, large bilateral pleural effusions, a large pericardial effusion, and air density in the pericardial space (fig. 2). [anesthesiology.pubs.asahq.org]

• Stridor

  Kırk iki yaşında erkek hasta stridor, solunum güçlüğü, ağızdan salya akması, boğuk ses, ateş ve çene kitlenmesi ile başvurdu. Bilgisayarlı tomografide iki taraflı intratonsiller apse izlendi. [manuscriptmodule.com]

  Sore throat associated with stridor and increased respiratory effort can signal imminent respiratory distress and requires immediate evaluation and management in a hospital emergency department.4
 Making the diagnosis [clinicaladvisor.com]

  Stridor is a late sign Consider direct laryngoscopy if any concern. Aspirate that pus! We rarely admit paratonsilar abscesses. Usually ENT/the ED aspirates them, they get better and go home. Ultrasound can increase the yield of aspiration. [ucsfmed.wordpress.com]

  Stridor and shortness of breath should prompt the clinician to consider epiglottitis. It may be difficult to differentiate peritonsillar cellulitis from true abscess by physical examination alone. [journals.lww.com]

  Patients younger than 4 years old present more frequently with agitation, cough, drooling, lethargy, respiratory distress, rhinorrhea, and stridor and less frequently with positive physical signs on oropharyngeal examination and trismus compared with [cancertherapyadvisor.com]

• Tonsillar Mass

  Quinsy abscess Needle aspiration: All such patients require needle aspiration of the tonsillar mass and cultures. Aspiration of pus differentiates abscess from cellulitis. [smartypance.com]

  These patients can present similarly with tonsillar erythema and exudates, cervical lymphadenopathy, and fever but would not have tonsillar mass or uvula deviation. [emdocs.net]

• Tracheal Deviation

  The scan of the neck showed air density and swelling in the left and anterior parapharyngeal spaces, with tracheal deviation (fig. 1). [anesthesiology.pubs.asahq.org]

• Tender Larynx

  Usual (tender) None Tender larynx Rare None None Usual Source: Goldman L, Ausiello D, eds. [clinicaladvisor.com]

• Tachycardia

  Dysphagia Neck pain/swelling Due to lymphadenopathy Jugulodigastric area of affected side Physical examination Fever, tachycardia, dehydration Throat/pharynx exam Swollen and fluctuant tonsil with Uvula deviation AWAY from abscess side Tonsil displaced [fprmed.com]

  Fever Malaise Headache Neck pain Throat pain (more severe on the affected side; occasionally referred to the ipsilateral ear) Dysphagia Change in voice Otalgia Odynophagia Physical findings may include the following: Mild-to-moderate distress Fever Tachycardia [emedicine.medscape.com]

  Furthermore, TTN truncating positive patients more frequently suffer from sustained ventricular tachycardia ( 28 ). [frontiersin.org]

• Halitosis

  […] and severity of recurrent Otitis, pharyngitis, PT abscess Unresponsive to antibiotics Snoring Poor appetite or slow weight gain Halitosis No evidence that routine elective tonsillectomy prevents future PTA Diagnostic testing Usually not necessary CBC [fprmed.com]

  Other common symptoms include a "hot potato" voice (speaking as if a hot object is in the mouth), drooling, redness of the tonsils, white patches (exudates), swollen lymph nodes in the neck, and severe bad breath (halitosis). [merckmanuals.com]

  However, additional symptoms of trismus, pyrexia, and halitosis are more common. On examination, a significant peri-tonsilar swelling is seen with a deviated uvula (Fig. 2). All quinsies will require drainage. [teachmesurgery.com]

  Other symptoms include: Fever "Hot potato" voice Drooling Bad breath ( halitosis ) Trismus (difficulty opening mouth) is always present but may vary in severity Painful swallowing (odynophagia) Difficulty swallowing (dysphagia) Ear pain Diagnosing Peritonsillar [verywell.com]

• Recent Dental Work

  You will be at an increased risk for developing peritonsillar abscess under the falling situations: Tonsillitis Chronic and recurrent tonsillitis Smoking Respiratory infections Weakened immune system Recent dental work You are also likely to have an [verywellhealth.com]

  Risk factors for the development of peritonsillar abscess or retropharyngeal abscess include immune deficiency, recent dental work, chronic or recurrent tonsillitis, alcohol abuse, and cocaine abuse. [anesthesiology.pubs.asahq.org]

• Tongue Ulcer

  Ulceration (traumatic) of tongue Type 1 Excludes atrophic glossitis ( K14.4 ) tonsil J36 circumtonsillar J36 intratonsillar J36 peritonsillar J36 posttonsillar J36 tonsil J36 (s) (lingual) tonsillopharyngeal J36 Angina (attack) (cardiac) (chest) (heart [icd10data.com]

• Onset in Adolescence

  Epidemiology Annual incidence is 30/100,000 people with a peak onset during adolescence By contrast, appendicitis has an incidence of 233/100,000 people. [ucsfmed.wordpress.com]

Asymmetry of soft palate with uvular deviation Neck ROM Quality of voice Lymphadenopathy Workup: Labs: CBC Imaging Not required, but consider CT scan if significant decreased neck ROM with pain on turning, to assess posterior pharyngeal space involvement [medicine.uiowa.edu]

Cost-effective workup for tonsillitis. Testing, treatment, and potential complications. Postgrad Med. 2003 Mar;113(3):115-8, 121. [PubMed: 12647478] 9. Galioto NJ. Peritonsillar Abscess. Am Fam Physician. 2017 Apr 15;95(8):501-506. [ncbi.nlm.nih.gov]

[…] out other causes) Intraoral ultrasonography Computed tomography (CT) of the head and neck with intravenous (IV) contrast (if incision and drainage fails, if the patient cannot open his or her mouth, or if the patient is young and uncooperative) See Workup [emedicine.medscape.com]

[…] trismus; tonsil prolapse/tonsillar fossa Posterior compartment: septicemia; minimal pain or trismus Carotid erosion; airway obstruction; intracranium, lung, contiguous spread to mediastinum; septicemia Antibiotics, drainage, artificial airway Diagnosis Workup [tonsilitisunderstood.blogspot.com]

• Pulmonary Infiltrate

  First, the presence of abnormal chest radiograph findings (widened mediastinum, blunted costophrenic angles, pulmonary infiltrates) in a patient with peritonsillar abscess should lead the physician to suspect caudad spread of the process. [anesthesiology.pubs.asahq.org]

• Excessive Drooling

  Clinical features include a unilateral odynophagia, dysphagia, voice changes (sometimes classically referred to as a ‘hot potato’ voice), trismus, and excessive drooling 5. Additionally, patients may be systemically unwell with fever and malaise 5. [radiopaedia.org]

Secondly, it allows assessment (including effectiveness and opportunity costs) of new or alternative treatments, and comparison with the existing prevalent treatment. 1– 3 Thirdly, it highlights areas of treatment requiring further research. [pmj.bmj.com]

However, in the absence of treatment, an abscess can cause serious issues. [medicalnewstoday.com]

Prevention, and Complications Prognosis very good to excellent with early diagnosis and treatment Prevention identification and treatment of tonsillits before it progresses to abscess Complications respiratory obstruction, difficulty swallowing Please [medbullets.com]

Treatment and prognosis Compared to peritonsillar abscess, incision and drainage or needle aspiration of intratonsillar abscess is less likely to be successful if attempted 1. [radiopaedia.org]

• Sepsis • Pneumonia • Airway obstruction • Cellulitis Treatment of Peri-tonsillar Abscess • Antibiotics • Needle Aspiration • Incision and drainage Prognosis of Peri-tonsillar Abscess Peritonsillar abscess gets cured with proper treatment Diet / management [drthindhomeopathy.com]

Outlook (Prognosis) Peritonsillar abscess goes away with treatment in most cases. The infection may return in the future. [mountsinai.org]

Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

Peritonsillar abscess is usually a complication of tonsillitis and thus has a similar clinical presentation and infective etiology 4. [radiopaedia.org]

Etiology Often progresses from exudative tonsillitis->tonsillar cellulitis->abscess Usually bacterial and polymicrobial with an over-representation of GAS, s milleri and anaerobes esp fusobacterium. [ucsfmed.wordpress.com]

Are also known etiologies. It is more rare in preschool age children, as the lymph tissue is predominantly located in the retro pharynx, thus accounting for the prevalence of retropharyngeal abscesses. Most cases in pediatrics will be seen in teens. [pemcincinnati.com]

We also studied the ratio of anaerobic and aerobic germs found, specifying each etiological agent found. [scielo.br]

24th June 2011, Volume 124 Number 1336 Emily Macassey, Patrick J D Dawes Article Authors References In this issue of the NZMJ, Love et al 1 report interesting observations about patterns of epidemiology and microbiology of peritonsillar abscess (PTA) [nzma.org.nz]

Epidemiology Annual incidence is 30/100,000 people with a peak onset during adolescence By contrast, appendicitis has an incidence of 233/100,000 people. [ucsfmed.wordpress.com]

Tonsillitis, Pharyngitis Epidemiology Sore throat is a common complaint in children and adolescents. Most cases of pharyngitis are viral and self-limited. [pedsinreview.aappublications.org]

Pertinent epidemiological data will be collected from the emergency room consultation note dictated by the treating physician and stored in a separate database. In the microbiology laboratory, the fluid aspirate will undergo aerobic culture. [clinicaltrials.gov]

Epidemiology Tonsillitis is predominantly a disease of children. Peritonsillar abscess usually affects teenagers and young adults but can occur in younger children.[2] This picture may, however, be changing. [patient.info]

Peritonsillar abscess is rare below five years of age.[6][7] Pathophysiology The exact pathophysiology of peritonsillar abscess formation remains unknown to date. [ncbi.nlm.nih.gov]

Pathophysiology The pathophysiology of PTA is unknown. The most widely accepted theory involves the progression of an episode of exudative tonsillitis first into peritonsillitis and then into frank abscess formation. [emedicine.medscape.com]

Quinsy Pathophysiology Tonsillitis is a common infection of tissue in the throat. It is mainly caused by bacteria. [healthhype.com]

[…] infection (50%) Most common in aged 20-40 yrs 10–18 y old (most) 6 mo–5 y old (rare) Younger children w/ peritonsillar abscess- often immunocompromised Yearly occurrence coincides w/ rates of strep pharyngitis & exudative tonsillitis Nov-Dec & April-May Pathophysiology [fprmed.com]

Tonsillitis is inflammation of the pharyngeal tonsils (see separate article Tonsillitis).[1]In peritonsillar abscess, there is pus trapped between the tonsillar capsule and the lateral pharyngeal wall.[2] Pathophysiology It usually starts with acute follicular [patient.info]

Prevention Tonsillitis should be diagnosed and treated as soon as possible to help prevent a peritonsillar abscess from developing. Treatment Your doctor will prescribe antibiotics to treat the infection. [drugs.com]

Prevention of a Peritonsillar Abscess There is no reliable method for preventing a peritonsillar abscess other than limiting risks: Do not smoke, maintain good dental hygiene, and promptly treat oral infections. [webmd.com]