The vast majority (>70%) of
peritonsillar abscess are polymicrobial and present aerobic and anaerobic organisms.
Treatment of
peritonsillar abscess is intraoral drainage of pus followed by antibiotics.
Standard follow-up for a minimum of 2 years, consisting of a detailed clinical examination and frequent cross-sectional imaging, is important in all cases of suspected
peritonsillar abscess in which the clinical course does not exactly match the typically described course of the disease.
Treatment of
peritonsillar abscess remains controversial.
More recently, we conducted a study to assess the effectiveness of an antibiotic-steroid protocol in Native Americans, who have a particularly high incidence of
peritonsillar abscess. The Indian Health Service, a subsidiary of the United States Department of Health and Human Services, had been spending large sums of money to air-evacuate patients from rural field hospitals and clinics to our referral hospital in Phoenix for definitive otolaryngologic care because the outlying practitioners were not comfortable treating
peritonsillar abscess.
A diagnosis of bilateral
peritonsillar abscess was suspected when fluctuance was elicited on finger palpation.
Two mechanisms have been proposed to explain development of
peritonsillar abscess. One is by direct spread of an inadequately treated acute tonsillitis, where the infection directly spreads to peritonsillar space and results in peritonsillar cellulitis and abscess.
Aberrant RP course of internal carotid artery (ICA) is a very rare cause of RP swelling, usually presenting as a pulsatile pseudotumor, but may be misdiagnosed as
peritonsillar abscess or parapharyngeal neoplasm (3).
Whether it was strep throat, quinsy (
peritonsillar abscess) or bacterial epiglottitis, the microbial battle began years earlier in the gingival crevices, before he became edentulous.
Our study showed very few peritonsillar infections (2.4%), though this could be a result of not including the ICD-9 code for
peritonsillar abscess. Their second most common location was retropharyngeal (22.0%), which was similar to our results.