Management and Diagnosis of Peritonsillar Abscess

Peritonsillar abscess is a deep-neck space infection that develops between the tonsillar capsule and the superior constrictor muscle. It frequently follows acute tonsillitis and presents with severe throat pain, odynophagia, trismus, ipsilateral swelling of the soft palate, uvular deviation and a characteristic “hot potato” voice. Rapid recognition and intervention are essential to prevent airway compromise and more extensive deep-neck or systemic complications. Initial bedside assessment relies on inspection and palpation, but clinical signs alone show variable sensitivity and specificity. Point-of-care ultrasound offers non-invasive confirmation and guidance for aspiration. Contrast-enhanced computed tomography remains the most reliable modality in equivocal cases or where deeper extension is suspected. First-line management centres on drainage—either needle aspiration or incision and drainage—combined with empirical broad-spectrum antibiotics targeting both aerobic streptococci and anaerobic flora. Corticosteroids may be employed adjunctively to reduce oedema and pain. Recurrent abscesses warrant evaluation of underlying risk factors, consideration of interval tonsillectomy and tailored antimicrobial regimens in the context of rising resistance patterns. Current practice emphasises a patient-centred approach, balancing outpatient care with indicators for hospital admission, and coordination between otolaryngology, radiology and microbiology services to optimise outcomes.

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Management and Diagnosis of Peritonsillar Abscess publication trend

The graph below shows the total number of articles in management and diagnosis of peritonsillar abscess across all publications each year (not limited to Nature Index journals).

Technical terms

Peritonsillar abscess: A collection of pus between the tonsillar capsule and adjacent muscles, causing severe unilateral throat pain and swelling.

Trismus: Reduced ability to open the jaw, often indicating masticator muscle involvement and abscess extension.

Hot potato voice: Muffled, “bull neck” phonation resulting from swelling of the oropharyngeal tissues.

Needle aspiration: A minimally invasive technique using a syringe and needle to evacuate pus under topical or local anaesthesia.

Incision and drainage: A minor surgical procedure involving a scalpel incision to decompress and evacuate the abscess cavity.

Computed tomography (CT): Cross-sectional imaging with contrast enhancement to delineate abscess walls, guide management and exclude deeper spread.

Ultrasound: Real-time imaging using sound waves to visualise fluid collections and assist needle guidance at the bedside.

Next generation sequencing (NGS): High-throughput DNA sequencing techniques that identify bacterial communities directly from clinical specimens without culture.

C-reactive protein (CRP): An acute-phase reactant measured in serum to gauge systemic inflammation and assist in differentiating abscess from cellulitis.

References

1. Diagnosis of Peritonsillar Abscess—A Prospective Study Comparing Clinical with CT Findings in 133 Consecutive Patients. Diagnostics (2025).
2. Unveiling the etiology of peritonsillar abscess using next generation sequencing. Annals of Clinical Microbiology and Antimicrobials (2023).
3. Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses. Brazilian Journal of Otorhinolaryngology (2006).
4. The Impact of Prior Tonsillitis and Treatment Modality on the Recurrence of Peritonsillar Abscess: A Nationwide Cohort Study. PLOS ONE (2014).
5. Peritonsillar abscess may not always be a complication of acute tonsillitis: A prospective cohort study. PLOS ONE (2020).
6. A Novel Technique for Intraoral Ultrasound-Guided Aspiration of Peritonsillar Abscess. Diagnostics (2018).