From the Research
Physical exam findings of a peritonsillar abscess typically include unilateral tonsillar swelling with displacement of the affected tonsil toward the midline, along with contralateral deviation of the uvula away from the affected side. Patients often present with severe sore throat, trismus (difficulty opening the mouth), muffled or "hot potato" voice, drooling, and odynophagia (painful swallowing) 1. On examination, the peritonsillar area appears erythematous and edematous, with the soft palate on the affected side showing marked swelling and sometimes a fluctuant mass indicating abscess formation. Cervical lymphadenopathy, particularly of the jugulodigastric nodes on the affected side, is commonly present 2. Patients may also have fever, halitosis, and ear pain referred to the same side as the abscess. These findings result from the collection of purulent material between the tonsillar capsule and the pharyngeal constrictor muscle, typically following progression of acute tonsillitis. The physical exam is crucial for differentiating a peritonsillar abscess from tonsillitis or peritonsillar cellulitis, as an abscess requires drainage in addition to antibiotic therapy 3. Some key points to consider in the physical exam include:
- Unilateral tonsillar swelling
- Displacement of the affected tonsil toward the midline
- Contralateral deviation of the uvula away from the affected side
- Erythematous and edematous peritonsillar area
- Cervical lymphadenopathy, particularly of the jugulodigastric nodes on the affected side
- Fever, halitosis, and ear pain referred to the same side as the abscess. The most recent and highest quality study suggests that incision and drainage are the preferable treatment for peritonsillar abscess, due to the lower risk of postoperative bleeding, shorter absence from work, and shorter inpatient stay 3.