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Key Features

  • Tonsillar infection occasionally penetrates the tonsillar capsule, spreading to the surrounding tissues, causing peritonsillar cellulitis

  • If untreated, necrosis occurs and a peritonsillar abscess forms

  • Most common pathogen is β-hemolytic streptococci, but others include group D streptococci, Streptococcus pneumoniae, and anaerobes

Clinical Findings

  • Patient complains of a severe sore throat even before the physical findings become marked

  • A high fever is usually present, and the process is almost always unilateral

  • The tonsil bulges medially, and the anterior tonsillar pillar is prominent

  • The soft palate and uvula on the involved side are edematous and displaced toward the uninvolved side

  • As the infection progresses, trismus, ear pain, dysphagia, and drooling may occur


  • Differentiating peritonsillar cellulitis from abscess is often difficult

  • In some children, it is possible to aspirate or drain the peritonsillar space to diagnose and treat an abscess


  • If drainage is not possible and there are no airway symptoms, it is reasonable to admit a child for 12–24 hours of intravenous antimicrobial therapy

  • Aggressive treatment of cellulitis can usually prevent suppuration

  • Therapy with a penicillin or clindamycin is appropriate

  • Failure to respond to therapy during the first 12–24 hours indicates a high probability of abscess formation and otolaryngology consultation is indicated

  • Recurrent peritonsillar abscesses are so uncommon (7%) that routine tonsillectomy for a single incident is not indicated unless other tonsillectomy indications exist

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