Peritonsillar Abscess

Clinical Presentation

Needle Aspiration

Post drainage care

Management

Incision and Drainage (I&D)

Reference

Clinical Presentation

Tonsillitis is one of the most common presenting complaints at sickcall for the 18 to 24 year old age group. A purulent exudate is commonly seen covering the tonsils and the throat is usually erythemic. Peritonsillar abscess is a complication of acute tonsillitis. Identification of the patient with a peritonsillar abscess is usually made by observation alone. On exam the tonsillar fossa is bulging, red, and fluctuant to palpation. The uvula deviates to the unaffected side. The classic clinical presentation can include unilateral sore throat, ear pain, foul breath, trismus, inability to swallow saliva, and a "hot potato" voice.

Management

Management of a peritonsillar abscess can be carried out as an outpatient depending upon the status of hydration, degree of sepsis, and the patient’s ability for self-care. The first priority is to decompress the pus within the abscess either by needle aspiration (18-gauge spinal needle) or by formal incision and drainage (I&D). IV fluids should be given to correct dehydration. Begin IV antibiotics (PenVK 1 to 2 million units every 4 hours or Cleocin 600 mg IV every 8 hours).

Needle Aspiration

The landmarks for needle aspiration are as follows: from the uvula base draw a line laterally to the intersection of a line drawn posteriorly, parallel and medial to the maxillary molars. Insert the 18 gauge spinal needle and aspirate as you advance to a depth of 2 cm. If you fail to obtain pus, draw back and try again more inferiorly or more medially along the tonsillar pillar.

Incision and Drainage (I&D)

The following supplies should be gathered to perform a formal I&D: a Yankauer suction , #12 curved blade on a long handle, long hemostat, and culture swabs. After injection with local anesthetic, incise the anterior pillar in a curvilinear line from the base of the uvula to the area posterior to the last mandibular molar staying on the anterior tonsil pillar. After incision of the mucosa use blunt dissection with a hemostat spreading the tissues of the peritonsillar space until the abscess is entered. Give one large spread with the hemostat to open the abscess and suction the pus. Don't forget cultures. In some instances, an abscess is not found despite blunt dissection. Often a peritonsillar cellulitis is the only pathology. In this case I&D is also beneficial and speeds recovery by decompressing the tissues.

Post drainage care

After the pus is evacuated by needle or formal I&D, ensure the patient is on high dose antibiotics as described above. As well as vigorous saline gargles hourly. Maintain IV hydration, analgesia, and have the patient return in 24 hours to be evaluated. Re-open the abscess pocket to assure complete drainage. Resolution of symptoms are rapid after appropriate treatment. Continued symptoms beyond 48 hours indicate incomplete drainage, a persistent abscess, or a misdiagnosis. In this instance, consider mononucleosis and obtain a monospot. Institute steroid therapy - the response is often dramatic after a single dose of steroids. An otolaryngology consultation to recommended for a patient that has had a peritonsillar abscess.

Reference

  1. DeWeese and Saunders Textbook of Otolaryngology.

Prepared by LCDR David A. Bianchi, MC, USN, Department of Otolaryngology, National Naval Medical Center, Bethesda, MD. Reviewed by CAPT David H. Thompson, MC, USN, Department of Otolaryngology, National Naval Medical Center, Bethesda, MD. (1998).

Preface  ·  Administrative Section  ·  Clinical Section

The General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This web version of The General Medical Officer Manual, NAVMEDPUB 5134 is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy version, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified. This formatting © 2006 Medical Education Division, Brookside Associates, Ltd. All rights reserved.

Home  ·  Textbooks and Manuals  ·  Videos  ·  Lectures  ·  Distance Learning  ·  Training  ·  Operational Safety  ·  Search


This website is dedicated to the development and dissemination of medical information that may be useful to those who practice Operational Medicine. This website is privately-held and not connected to any governmental agency. The views expressed here are those of the authors, and unless otherwise noted, do not necessarily reflect the views of the Brookside Associates, Ltd., any governmental or private organizations. All writings, discussions, and publications on this website are unclassified.

© 2006 Medical Education Division, Brookside Associates, Ltd. All rights reserved

Other Brookside Products

Contact Us

Advertise on this Site