Peritonsillar Cellulitis or Abscess (QUINSY)

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

Diagnosis

• 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

Treatment

• 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