Drainage, Peritonsillar Abscess
The peritonsillar abscess (PTA) remains a common clinical entity in the emergency department and in an otolaryngology practice. The exact incidence has been estimated at 30 cases per 100,000 people per year.
PTA is rare in infants and children younger than 12 years. The mean age for this disease is 20-30 years; males and females are affected equally. PTA usually occurs near the superior pole of the palatine tonsil, in the space outside of the tonsillar capsule between the superior constrictor and the palatopharyngeus muscle.1
An untreated PTA can lead to numerous complications, including the following:
Erosion of the carotid artery
The development of sepsis (For information on the management of sepsis, please visit Medscape’s Sepsis Resource Center.)
The development of other localized serious bacterial infections, including mediastinitis and deep neck space infections, which arise from tracking of the infection from the tonsillar fossas to the deep fascial planes of the neck with extension into the chest
The most common treatments for PTAs include the following:2, 3
Needle aspiration: Needle aspiration can be therapeutic in itself; in some studies, up to 85% of patients were effectively treated with outpatient needle aspiration and oral antibiotics.4, 5 Aspiration can also be used to confirm the diagnosis and localize the PTA for incision and drainage.
Incision and drainage: Success rates of the incision and drainage technique are reported in the literature as similar to or slightly higher than reported success rates of the needle aspiration technique.
Quinsy tonsillectomy: Quinsy is an obsolete term for PTA. The quinsy tonsillectomy, then, is a tonsillectomy performed in the presence of a PTA. The different techniques of tonsillectomy are not discussed in this article.
Difficult or uncooperative patient