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.