Introduction
A peritonsillar abscess (PTA) is a common bacterial deep neck space
infection which, historically, has been thought of as an evolution of an
incompletely or poorly treated acute bacterial tonsillitis (1). A PTA
forms within the peritonsillar space, a potential space located between
the palatine tonsil, the superior pharyngeal constrictor muscle, and the
lateral pharyngeal wall (1,2). The collection of purulent material
within the peritonsillar space leads to medial displacement of the
ipsilateral tonsil with concurrent displacement of the uvula to the
contralateral side. Surrounding soft tissue inflammation often leads to
spasm of the masseter muscle, leading to trismus or impaired mouth
opening. Additionally, soft tissue edema and swelling within the
oropharynx leads to significant dysphonia; classically, these symptoms
of uvular deviation, trismus, and dysphonia, known as quinsy’s triad,
are pathognomonic for a PTA (1,2).
The overall incidence of a PTA is estimated to be 1 in 10,000, with a
mild bias for adults between the ages of 20 and 40. There is no defined
predilection for ethnicity, or gender. Successful treatment of a PTA, in
the absence of life-threatening complications, often involves
decompression of the abscess cavity followed by systemic antibiotic
therapy (1-3). The classical triad of trismus, uvular deviation and
dysphonia suggests that a peritonsillar abscess is largely a clinical
diagnosis, meaning diagnostic imaging such as x-ray or computer
tomography (CT) is not necessary to make a diagnosis; however, CT scans
continue to be ordered in some Emergency Departments for patients with a
PTA (4). The use of inappropriate CT scans on patients with suspected
PTA can lead to inappropriate and excessive utilization of healthcare
resources, occupy patient time, result in inappropriate exposure to
ionizing radiation, and lead to overburdening of radiologist physicians
through excessive diagnostic imaging.
While the utility of CT scans in diagnosing various types of deep neck
space infections is unquestioned (5), the clinical rationale regarding
the use of CT imaging in the diagnosis and treatment of a peritonsillar
abscess remains unclear. The goal of this study was to assess the
clinical history and physical examination findings of two groups of
patients diagnosed with peritonsillar abscess, and to identify whether
any differences in subjective and/or objective clinical findings could
be identified to guide the role of CT imaging in the management of
peritonsillar abscesses.