Peritonsillar abscess
Formal Definition
An accumulation of pus in the peritonsillar space (between the tonsillar capsule and the superior pharyngeal constrictor muscle), the most common deep-space neck infection; presents with severe sore throat, odynophagia, trismus (jaw stiffness), muffled "hot potato" voice, uvular deviation away from the affected side, and peritonsillar bulge.
How It's Used on the Ward
"PTA" or "they have a hot potato voice" — the classic presentation that prompts ENT call and needle aspiration.
Example
""18-year-old with 5 days of worsening sore throat, now trismus and a hot potato voice: exam shows left peritonsillar bulge with uvular deviation to the right — peritonsillar abscess. IV antibiotics (ampicillin-sulbactam), IV dexamethasone, ENT called for needle aspiration at bedside.""
Clinical Context
Trismus (limited mouth opening due to pterygoid muscle spasm) is the most distinguishing feature from simple tonsillitis or peritonsillar cellulitis. Uvular deviates AWAY from the abscess (mass effect). Treatment: needle aspiration (first-line, can be done bedside) or incision and drainage. IV antibiotics (streptococcal + anaerobic coverage). IV steroids reduce pain and trismus. Airway management priority: abscess can rapidly obstruct the airway — have intubation/cricothyrotomy equipment ready. Quinsy tonsillectomy (immediate): reserved for recurrent PTA, failed drainage, airway compromise. Complications: parapharyngeal/retropharyngeal extension, Lemierre syndrome (septic thrombophlebitis of the internal jugular vein — rare but serious).
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