Peritonsillar Abscess & Cellulitis

Key Features

• Results when infection penetrates the tonsillar capsule and involves the surrounding tissues

Clinical Findings

• Peritonsillar abscess (quinsy) and cellulitis present with

  • Severe sore throat

  • Odynophagia

  • Trismus

  • Medial deviation of the soft palate and peritonsillar fold

  • Abnormal muffled ("hot potato") voice

Diagnosis

• Abscess may be confirmed by aspirating pus from the peritonsillar fold just superior and medial to the upper pole of the tonsil

• A 19-gauge or 21-gauge needle should be passed medial to the molar and no deeper than 1 cm, because the internal carotid artery may lie more medially than its usual location and pass posterior and deep to the tonsillar fossa

Treatment

• Most commonly, patients present to the emergency department and receive a dose of parenteral amoxicillin (1 g), amoxicillin-sulbactam (3 g), or clindamycin (600–900 mg)

• Less severe cases and patients who are able to tolerate oral intake may be treated for 7–10 days with oral antibiotics, including

  • Amoxicillin, 500 mg three times a day

  • Amoxicillin-clavulanate, 875 mg twice a day

  • Clindamycin, 300 mg four times daily

• Methods for surgical management include needle aspiration, incision and drainage, and tonsillectomy

• Some clinicians incise and drain the area and continue with parenteral antibiotics, whereas others aspirate only and monitor as an outpatient

• To drain the abscess and avoid recurrence, it may be appropriate to consider immediate tonsillectomy (quinsy tonsillectomy)