Diagnosis and management of peritonsillar abscess

Background: Peritonsillar abscess is the most prominent outcome of acute tonsillitis, affecting adults aged 15 to 35 years.  This acute infection causes pus to build up in the peritonsillar tissue, which is typically caused by recurrent infections or untreated tonsillar cellulitis, particularly around the tonsil's upper pole.  The primary clinical signs include discomfort in the throat, fever, trouble swallowing, and unilateral tonsillar enlargement, which may be accompanied with trismus.  Prompt care through early identification and treatment with incision, drainage, and antibiotics is critical to avoiding significant complications such as infection spread to surrounding tissues and breathing blockage.

Objective: To provide an overview of a peritonsillar abscess in an adult patient, and also address the diagnosis, treatment, and outcome of the incision and drainage therapy.

Case Report: A 28-year-old male came with a persistent painful throat for one week that had deteriorated during the previous three days, along with a high fever, inability to swallow solid food, difficulty opening his lips, and a muffled voice (hot potato voice).  The examination revealed edema in the left peritonsillar region, with the uvula displaced to the right, as well as bilateral tonsillar hypertrophy.  Laboratory tests revealed leukocytosis, but a chest X-ray revealed no abnormalities.  The patient had an abscess incision and drainage surgery, and pus samples were collected for culture and sensitivity testing.  Intravenous antibiotics and supportive care were given, followed by a scheduled tonsillectomy.  The patient's symptoms improved following the surgery, and he felt better throughout the follow-up visit.

Clinical question: What is the diagnosis enforcement and management of a patient with peritonsillar abscess?

Methods: Evidence-based literature study of diagnosis enforcement and management of a patient with peritonsillar abscess.

Result: In the last 10 years, five key studies provided insights into diagnosing and managing peritonsillar abscess. Diagnosis relies on clinical signs, physical exam, and procedures like needle aspiration or imaging (ultrasound and CT). Ultrasound enhances diagnostic safety and guides treatment, while CT is useful in complex cases but may delay care. Broad-spectrum antibiotics targeting group A streptococcus and anaerobes are essential, with macrolides avoided due to resistance.

Conclusion: A 28-year-old adult was diagnosed with a left peritonsillar abscess, presenting with uvular deviation, enlarged tonsils (T2/T4), and left-sided peritonsillar fluctuation and edema. Aspiration yielded pus and blood, followed by successful incision and drainage. The patient recovered well with antibiotics and routine drainage and is scheduled for a tonsillectomy.