Predictors of intratonsillar abscess versus peritonsillar abscess in the pediatric patient

Abstract

Objective: To determine the incidence of intratonsillar abscess (ITA) patients within the population of patients diagnosed with peritonsillar abscess (PTA) and to further characterize the differences in symptomatology and successful treatment strategies between the two groups.

Methods: This study is a retrospective chart review of patients diagnosed with PTA or ITA at our institution from 2000 to 2017. Descriptive and inferential statistics are reported, including univariate and multivariate analyses.

Results: A total of 335 pediatric (<18 years) patients presenting with a PTA or ITA were identified, 31 (9%) of whom were diagnosed with ITA. Patients with ITAs had significantly lower proportions of trismus, otalgia, and dysphagia and were less likely to experience acute progression from their initial symptoms. The ITA group had fewer attempted aspiration and drainage attempts, with those attempts significantly less successful than for the PTA group. Recurrence was uncommon in ITA patients in comparison to PTA patients.

Conclusions: Intratonsillar abscess should be considered in the differential diagnosis for patients presenting with sore throat and concern for a pharyngeal infection or abscess. These patients have a significantly lower proportion of otalgia, trismus, vocal changes, and dysphagia. Given the low success rate of drainage attempts and lower recurrence rate, diagnosing physicians should consider medical management rather than procedural drainage in this patient population.

Keywords: Deep neck space infection; Intratonsillar abscess; Otolaryngology; Peritonsillar abscess.