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Peritonsillar Abscess

Peritonsillar Abscess is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Suppurative complication of tonsillitis where infection spreads outside the tonsillar capsule between the palatine tonsil and pharyngeal muscles
  • Most common deep infection of the head and neck (incidence of 30/100,000 per year)
  • In the US, 45,000 cases annually
  • Occurs in all ages, more commonly in young adults (mean age 20–40 yr)
  • Occurs most commonly Nov–Dec, April–May (coincides with highest incidence rates of streptococcal pharyngitis)
  • Complications:
    • Airway compromise (uncommon)
    • Sepsis (uncommon)
    • Recurrence (12–15%)
    • Extension to lateral neck or mediastinum
    • Spontaneous perforation and aspiration pneumonitis
    • Jugular vein thrombosis (Lemierre syndrome)
    • Poststreptococcal sequelae (glomerulonephritis, rheumatic fever)
    • Hemorrhage from extension and erosion into carotid sheath
    • Severe dehydration
    • Intracranial extension (meningitis, cavernous sinus thrombosis, cerebral abscess)
    • Dural sinus thrombosis

Etiology

  • 2 theories explain the development of peritonsillar abscess (PTA):
    • Direct bacterial invasion into deeper tissues in the patient with acute pharyngitis
    • Acute obstruction and bacterial infection of small salivary glands (Weber glands) in the superior tonsil
  • Smoking may be a risk factor
  • Most common pathogens:
    • Group-A Streptococcus
    • Staphylococcal species, including methicillin-resistant Staphylococcus aureus (MRSA)
    • Anaerobes (Prevotella, Peptostreptococcus, Fusobacterium)
    • Polymicrobial

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Citation

Rosen, Peter, et al., editors. "Peritonsillar Abscess." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307148/all/Peritonsillar_Abscess.
Peritonsillar Abscess. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307148/all/Peritonsillar_Abscess. Accessed April 22, 2019.
Peritonsillar Abscess. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307148/all/Peritonsillar_Abscess
Peritonsillar Abscess [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 22]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307148/all/Peritonsillar_Abscess.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Peritonsillar Abscess ID - 307148 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307148/all/Peritonsillar_Abscess PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -