Peritonsillar Abscess

Epi: unlikely under 6 yo
CX
- Sore throat
- Odynophagia (pain on swallowing)
- Trismus (can’t move jaw 2/2 irritation of pterygoid voice – can’t open voice all the way)
- Voice changes (hot potatoe voice) – sounds like they don’t want to swallow or have a goober in the back of their mouth
- Uvular deviation
- Abscess felt on exam (fluctuance in peritonsillar region)
- Intraoral US
Complications
- Airway obstruction
- Rupture into asp PNAcarotid artery thrombosis
Tx
- Peds: medical management. 50% respond to med management. Admit
- Adults:
  - Can admit w/o drainage for IV Abx. If no improvement, drain
  - Drain
    - Procedure
      - Abscess is not in tonsille
      - Internal carotid is 2.5 cm postero-lateral to tonsille
      - IV pain meds, sedation, may need procedural sedation (mida, keta, glycopyrrolate)
      - Need aspiration v. Aspiration
        
        Needle
        
        Anesthetize w lido w epi
        
        Long needles: 18-20 gauge w 10ml syringe. Cut off distal rip of plastic needle guard n tape it on to prevent it from going too far.
        
        Only advance posteriorly. Do not advance laterally (carotid).
      - Equipment (tape over end of scapel to prevent over penetrating). Do nor incise the tonsille itself.

Can use laryngoscope or bottom half of vaginal speculum n have assistant hold it.
Dispo
- If no pus, admit (30% neg aspiration still have PTA).
- Abx: clinda or amp-sulbactam, +/- vanc.
- Methylpred for sx
- If dc, 24 hr f/u