Peritonsillar abscess formation is an uncommon complication of infectious mononucleosis (IM). Early case reports implicated corticosteroids in the development of such abscesses, however, subsequent studies suggested that these drugs do not promote the formation of abscesses at several sites outside the central nervous system. It has recently been demonstrated that zwitterionic polysaccharides, in bacterial capsules, form complexes with CD4(+) T lymphocytes leading to abscess formation. A patient is presented who developed peritonsillar abscess a few days after initiation of corticosteroid therapy for IM; the medical literature was reviewed in respect of this subject. It appears that the occurrence of these abscesses in IM is not strongly linked to corticosteroid treatment. The authors, therefore, recommend that steroids should not be withheld from patients with severe IM on the basis that they may precipitate the development of peritonsillar abscess.

Background Nasal preparation prior to flexible laryngoscopy is a common ENT practice. Co-phenylcaine is increasingly used because it is safe and has both anaesthetic and vasoconstrictive properties. Lidocaine 4% and epinephrine 1:1000 nasal packing is another method used in our department. Methods A prospective case series was performed on eighty-one patients requiring flexible laryngoscopy. Patients were enrolled into either a co-phenylcaine or a lidocaine/epinephrine packing group. Visual analogue scales (VAS) were used to record unpleasantness of nasal preparation and flexible laryngoscopy. Decongestion and ease of endoscope passage were recorded by the doctors. Results Bad taste was statistically significantly worse when using cophenylcaine for nasal preparation ( P = 0.001). However, there was no statistically significant difference in overall unpleasantness from nasal preparation or from subsequent flexible laryngoscopy between the two groups. There was no statistically significant difference in degree of decongestion or ease of endoscope passage between the two groups. Conclusion There is no statistically significant advantage of using cophenylcaine spray over non-proprietary lidocaine 4% and epinephrine 1:1000 nasal packing. However cost and bad taste is less with nasal packing.