The role of ultrasound in the management of peritonsillar abscess

Abstract

A distinction between a peritonsillar abscess and peritonsillitis is useful clinically, as the former requires surgical drainage while the latter merely requires treatment with antibiotics. To evaluate the diagnostic implications of performing ultrasonography of the tonsils in patients with clinically diagnosed peritonsillar abscess, 27 patients underwent ultrasound examination before needle aspiration of the abscess was performed. Ultrasound was able to detect peritonsillar abscess in91 per cent of the cases (sensitivity rate), with a false negative rate of nine per cent and a false positive rate of 20 per cent. The specificity of the test was 80 per cent, and was able to differentiate abscess from peritonsillitis in 88.9 per cent. On the basis of these results we conclude that ultrasonography of the tonsils in patients thought to have peritonsillar abscess is a useful adjunct, enhancing diagnostic accuracy and reducing unnecessary surgical drainage.

Ultra-sonografia intra-oral e transcutânea cervical no diagnóstico diferencial de celulite e abscessos periamigdalianos

“…The sensitivity of transcutaneous US (80%) was lower compared to intraoral US (92.5%) in the same patients, however it was more specific (92.8%) compared to intra-oral US (90%). Ahmed et al 9 , in a study of 27 patients, reported a 90% sensitivity for transcutaneous US, better than our results, however inferior to the rate obtained with intra-oral US. Transcutaneous US had 5 false negative results, limiting its use to the diagnosis of peritonsillar abscesses.…”

“…al. 9 have suggested that needle aspiration is an accurate procedure for this diagnosis, in contrast to Scott et al 7 , that reached 89% sensitivity compared with computerized tomography. Computerized tomography is effective to diagnose deep neck affections, however, it is expensive, subject to complications due to use of contrast and difficult to access in emergency units 1,3 .…”

“…Peritonsillar abscesses (PAs) may be treated with needle aspiration, drainage of pus or tonsillectomy, while cellulitis (PC) is treated with antibiotics 3,7,8 . The differential diagnosis between cellulitis and peritonsillar abscesses is made by needle aspiration and careful aspiration of the peritonsillar space 8,9 . Frequently repeated needle aspiration is needed to locate the possible abscess.…”

Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess

“…Ultrasound (US) has been shown to reliably distinguish PTA from PTC in a number of small‐scale studies with adult patients . There is currently no literature addressing the use of US for peritonsillar infection in an exclusively pediatric population.…”

A randomised trial comparing intraoral ultrasound to landmark‐based needle aspiration in patients with suspected peritonsillar abscess

“…External (from the neck) ultrasound as a diagnostic procedure has been investigated in a series of 27 patients, where needle aspiration by an investigator blinded to the ultrasound result was taken as the gold standard . Trans‐cutaneous ultrasound had a sensitivity of 91% and a specificity of 80%.…”