differentiating tonsillar abscess and...
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Differentiating tonsillar abscess and cellulitis
Dr Lamiaa Eltatawy
Q PEM 201813 of January 2018
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DISCLOSURE
I do not have any relevant financial relationship
with commercial interest to disclose.
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Learning Objective :
Differentiate between an abscess and cellulitis
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So …. What is the difference ??
Definition
Presentation
Diagnosis
Management
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Definition:
Peritonsillar cellulitis :
Its an inflammatory reaction of
the tissue between the capsule
of the palatine tonsil and the
pharyngeal muscles that is
caused by infection, but not
associated with pus collection .
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Peritonsillar abscess :
Its Collection of pus between the
capsule of the tonsil usually at
its upper pole and the
pharyngeal muscles
A complication of acute tonsillitis
or may apparently arise de novo
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Presentation :PTC:
• Sore throat
• Dysphagia
• FAHM
• Swollen congested tonsils +/-
exudate
• Enlarged tender JD lymph nodes
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PTA- Quinsy:
Quinsy triad:
1- Trismus
2- Uvular deviation
3- Dysphonia (Hot potato voice )
Other presentations :
• Ill toxic looking patient
• Drooling of saliva
• Striking asymmetric tonsillar enlargement with oedema and hyperaemia of
the soft palate.
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Diagnosis :• Diagnosis of PTA can be made clinically without laboratory or imaging
studies in patient with medial displacement of tonsil and uvular deviation
• However Clinical features and imaging cannot always distinguish PTA from cellulitis
• A 24-hour trial of ABx may be helpful , failure to respond to a trial of appropriate ABx suggests PTA
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Cont…• Response is improvement in at least one clinical parameter:
Sore throat - Fever -Trismus or tonsillar bulge.
• Intraoral or submandibular US can help distinguish PTA from cellulitis and guide for needle aspiration
• Imaging may be necessary to differentiate PTA from deep neck space infections , CT scan with IV contrast is the preferred imaging modality .
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• ABx therapy is recommended for all patients with suspected peritonsillar infection .
• Peritonsillar cellulitis responds to antimicrobial therapy and supportive care alone (good hydration and pain control )
• Empiric therapy should include coverage for Group A streptococcus, S. aureus, and respiratory anaerobes.
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How about Quinsy??• Abscess drainage , ABx and supportive care are the cornerstone of management for PTA
• Prompt surgical intervention is indicated in patients with:
Airway compromise, Complications, Enlarging masses, or significant comorbidities.
• The 3 main methods are:
1. Needle aspiration
2. Incision and drainage
3. Abscess Tonsillectomy (either unilateral or bilateral)
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Thank you
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References Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J
Oral Maxillofac Surg 2004; 62:1545.
Szuhay G, Tewfik TL. Peritonsillar abscess or cellulitis? A clinical comparative paediatric study. J Otolaryngol
1998; 27:206.
Galioto NJ. Peritonsillar abscess. Am Fam Physician 2008; 77:199.
The American Academy Of Family Physician