Peritonsillar and Intratonsillar Abscess: A Review on Clinical Features, Managements and Complications

Abstract

Peritonsillar and intratonsillar abscesses are one of the not too frequent emergencies encountered by the ENT fraternity. The palatine tonsils which form part of the Waldeyer’s ring is situated in the oropharynx between the anterior and posterior pillars. Tonsillitis refers to inflammation of the tonsils whereas peritonsillitis refers to the different stages of disease process, either cellulitis with or without an abscess collection within the surrounding soft tissue of the tonsils. Peritonsillar abscess is often unilateral while peritonsillitis may be bilateral in 20% of cases whereas intratonsillar abscess is rare with an incidence of 7%. The shared symptoms of peritonsillitis and intratonsillar abscess includes fever, trismus, deviation of uvula and referred pain. These shared symptoms have placed many physician in a dilemma, often resulting in an intratonsillar abscess to be missed. The complications include retropharyngeal abscess, parapharyngeal abscess, mediastinitis and upper airway obstruction. The medical therapy consists of intravenous antibiotics and intravenous fluids. A needle aspiration is useful when a diagnosis is uncertain. Aspiration of pus is diagnostic confirming a peritonsillar abscess from a peritonsillar cellulitis. Incision and drainage can be performed for intratonsillar abscess not responding to treatment or a failed needle aspiration which is preferably performed under general anesthesia for children. Elective tonsillectomy should be indicated for patients with recurrent peritonsillar abscess. CT contrast is useful to identify complications arising mainly in retropharyngeal or parapharyngeal abscess and to know its extension, spread and drainage approaches.