Signs and Symptoms of Peritonsillar Abscess
Peritonsillar abscess presents with a characteristic constellation of symptoms including severe sore throat, fever, dysphagia, trismus, and a "hot potato" (muffled) voice, often with unilateral tonsillar swelling and deviation of the uvula. 1
Cardinal Presenting Features
Primary Symptoms
- Severe sore throat with unilateral predominance and pain on swallowing (odynophagia) 1, 2, 3
- Fever as a systemic manifestation of the infection 1, 2, 3
- Trismus (difficulty opening the mouth due to muscle spasm) is a hallmark finding 1, 2, 3
- Dysphagia (difficulty swallowing) 1
- "Hot potato" voice - a characteristic muffled quality to speech 1
Additional Clinical Manifestations
- Drooling may occur in severe cases due to difficulty managing oral secretions 4
- Neck tenderness or swelling may be present, indicating potential spread of infection 4
- Malaise and general systemic symptoms 5
Physical Examination Findings
Oropharyngeal Signs
- Unilateral tonsillar enlargement with peritonsillar swelling 6
- Deviation of the uvula away from the affected side 2
- Asymmetric tonsils - though this can have other causes, peritonsillar abscess should be considered in the differential 6
Important Clinical Context
Male patients aged 21-40 years who are smokers are at significantly higher risk of developing peritonsillar abscess after initial presentation of uncomplicated sore throat. 7
Distinguishing Features from Uncomplicated Pharyngitis
Patients presenting with unusually severe signs and symptoms warrant evaluation for peritonsillar abscess, specifically: 7
- Difficulty swallowing beyond typical pharyngitis
- Drooling
- Neck tenderness
- Neck swelling
Occult Presentation Caveat
In rare cases, peritonsillar abscess can present as isolated unilateral tonsillar enlargement without other acute infectious symptoms (no fever, trismus, or throat pain), making diagnosis challenging. 6 This occult presentation underscores the importance of maintaining clinical suspicion when evaluating asymmetric tonsils.
Clinical Urgency
Prompt recognition is critical to avoid potentially serious complications including airway obstruction, aspiration, or extension of infection into deep neck tissues. 1 The combination of fever, severe unilateral throat pain, trismus, and muffled voice should trigger immediate evaluation for peritonsillar abscess. 1, 2