0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

COMPLICATIONS

■ Scarlet fever: Sand paper rash
■ Rheumatic fever: A combination of carditis, arthritis, and dermatologic
findings seen 2–6 weeks after strep pharyngitis
■ Seen rarely today because of the use of antibiotics
■ Abscess formation or mastoiditis (see Figure 14.20)
■ Poststrep glomerulonephritis (not prevented with antibiotics)

Peritonsillar Abscess

ETIOLOGY

■ Classically a complication of group A streptococcal pharyngitis
■ Adolescents or young adults (rare in children <12 years old)
■ Most common deep HEENT infection

SYMPTOMS/EXAM

■ Severe sore throat and odynophagia
■ Fever, trismus, and drooling
■ Hot potato voice (dysarthria)
■ Tender peritonsillar mass that displaces the uvula and soft palate medially
■ Peritonsillar cellulitis will have minimal or no trismus and no fluctuance.

DIAGNOSIS

■ Clinical
■ CT with contrast (1- to 3-mm cuts) if unsure or to assess for presence of
lateral or retropharyngeal abscess

TREATMENT

■ Needle aspiration and/or I+D
■ Outpatient antibiotics if nontoxic and tolerating PO

FIGURE 14.20. Peritonsillar abscess.

(Reproduced, with permission, from Stone CK, Humphries RL. Current Diagnosis & Treatment : Emergency
Medicine, 6th ed. New York: McGraw-Hill, 2008:523 and 532.)

A

Needle aspiration sites for

peritonsillar abscess

Palatoglossal arch

Palatopharyngeal arch

Posterior wall of

oral pharynx

1

2

3

B