From the Guidelines
When documenting dysphonia in a patient with tonsillar abscess, describe the voice as hoarse, raspy, or muffled with a "hot potato" quality, and assess the patient to categorize dysphonia severity, develop a treatment plan, and prioritize patients who may need escalated care, as recommended by the clinical practice guideline: hoarseness (dysphonia) update 1. To describe dysphonia on physical exam in a patient with a tonsillar abscess, note the patient's difficulty producing normal vocal sounds, changes in pitch, and any strain when speaking.
Key Findings to Document
- Severity of dysphonia (mild, moderate, severe)
- Whether dysphonia worsens with prolonged speech
- Associated findings such as:
- Throat pain
- Drooling
- Trismus (limited mouth opening)
- Muffled or "hot potato" speech
- Visible tonsillar asymmetry, erythema, or deviation of the uvula away from the affected side The purpose of this assessment is to promote awareness of dysphonia as a condition that may decrease a patient’s quality of life (QOL) or as a harbinger of a serious underlying condition, as stated in the clinical practice guideline: hoarseness (dysphonia) update 1.
Clinical Considerations
- The clinician should assess the quality of the voice, as a breathy voice may signify vocal fold paralysis or another cause of incomplete vocal fold closure, and a strained voice with altered pitch or pitch breaks is common in spasmodic dysphonia (SD) 1.
- The clinician should identify factors that modify management, such as recent surgical procedures involving the head, neck, or chest, recent endotracheal intubation, presence of concomitant neck mass, respiratory distress or stridor, history of tobacco abuse, and whether the patient is a professional voice user, as recommended in the clinical practice guideline: hoarseness (dysphonia) update 1. By following these guidelines, clinicians can provide accurate documentation of dysphonia in patients with tonsillar abscess and develop effective treatment plans to improve patient outcomes.
From the Research
Description of Dysphonia on Physical Exam
To describe dysphonia on physical exam in a patient with a tonsillar abscess, consider the following:
- The patient's voice may be described as a "hot potato" voice, which is a characteristic finding in peritonsillar abscess 2
- Dysphonia may be associated with other symptoms such as fever, sore throat, dysphagia, and trismus 2, 3
- A comprehensive physical examination, including a thorough examination of the ears, nose, throat, and neck, is essential in evaluating patients with dysphonia 4
- The physical exam may also include an assessment of the patient's posture, cranial nerve function, and general physical condition 4
Associated Findings
- Tonsillar abscess is typically characterized by peritonsillar swelling, which can be probed by needle aspiration 5
- The abscess may be drained, and antibiotic therapy should be initiated to treat the underlying infection 2, 5, 3
- In some cases, incision and drainage or immediate tonsillectomy may be required 5, 3