Overview
Peritonsillitis involves inflammation of the peritonsillar tissue, often without abscess formation, and can arise from minor salivary gland infections 1. It presents with symptoms like dysphagia, trismus, and voice changes, distinguishing it from peritonsillar abscess by the absence of pus 6.Diagnosis
Clinical Presentation: Dysphagia, trismus, drooling, voice change, fever, unilateral tonsillar enlargement, and uvular deviation 6.
Age Consideration: Abscess more common in older patients (mean age 15.0 years) compared to cellulitis (mean age 10.8 years) 6.
Diagnostic Imaging: Preoperative ultrasonography can verify abscess presence in approximately 90% of cases, useful when clinical examination is limited 4.
Laboratory Tests: Elevated S-Amyl levels may indicate involvement of minor salivary glands 1.Management
Initial Treatment: Parenteral antibiotics and drainage for both cellulitis and abscess 7.
Antibiotics: Beta-hemolytic streptococci, including Group A and non-Group A, and other anaerobes are commonly isolated; penicillin V, ampicillin, and erythromycin are effective in vitro 5.
Surgical Intervention: Immediate tonsillectomy in severe cases or recurrent episodes; interval tonsillectomy considered after second episode in patients without prior tonsillitis history 37.
Observation: "Wait and observe" approach is common for isolated attacks, with high rates of symptom resolution without further intervention 3.Special Populations
Pediatrics: Similar management principles apply, but observation post-treatment shows good outcomes with 83.2% remaining asymptomatic 3.
Comorbidities: No specific guidelines provided in abstracts regarding comorbidities; management focuses on treating the infection and addressing complications 7.Key Recommendations
Initial Management with Antibiotics and Drainage: For both peritonsillar cellulitis and abscess, initiating with parenteral antibiotics and drainage is recommended (Evidence: Moderate 7).
Consider Interval Tonsillectomy After Recurrent Episodes: Recommend interval tonsillectomy after a second episode of peritonsillitis in patients without a history of recurrent tonsillitis (Evidence: Moderate 3).
Use Ultrasonography for Diagnostic Clarity: Employ preoperative ultrasonography to confirm abscess presence when clinical examination is inconclusive (Evidence: Moderate 4).References
1 Vanhapiha N, Sanmark E, Blomgren K, Wikstén J. Minor salivary gland infection as origin of peritonsillitis - novel theory and preliminary results. Acta oto-laryngologica 2022. link
2 Bhutta MF, Worley GA, Harries ML. "Hot potato voice" in peritonsillitis: a misnomer. Journal of voice : official journal of the Voice Foundation 2006. link
3 Raut VV. Management of peritonsillitis/peritonsillar. Revue de laryngologie - otologie - rhinologie 2000. link
4 Boesen T, Jensen F. Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 1992. link
5 Haeggström A, Engquist S, Hallander H. Bacteriology in peritonsillitis. Acta oto-laryngologica 1987. link
6 Shoemaker M, Lampe RM, Weir MR. Peritonsillitis: abscess or cellulitis?. Pediatric infectious disease 1986. link
7 Fried MP, Forrest JL. Peritonsillitis. Evaluation of current therapy. Archives of otolaryngology (Chicago, Ill. : 1960) 1981. link