Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department

Peritonsillar abscess (PTA) can be a life-threatening disease and may lead to significant complications without drainage. To describe the utility of ultrasound (US) in the evaluation of potential PTA and US-guided PTA drainage. The authors performed a retrospective US quality assurance review of all patients over 18 years of age scanned by emergency physicians for possible PTA. All patients presenting with PTA signs and symptoms including erythema and swelling of the tonsillar pillar and uvular deviation were eligible to be scanned. Patients confirmed to have an abscess on US had US-guided drainage followed by intravenous antibiotics in the emergency department and discharge home on oral antibiotics. Scans were performed by credentialed attending emergency physicians and residents. Researchers recorded patient symptoms, US findings, results of abscess drainage if performed, and any complications of drainage. All US examinations were performed with sheathed endocavity broadband US transducers on minimum depth and maximum resolution settings. Statistical analysis included descriptive statistics. Forty-three patients received intraoral US examinations for suspected PTA. Thirty-five (81%) were diagnosed as having abscess on US. All abscesses were drained with an 18- or 14-gauge needle under US guidance. There were no drainage complications. There was one false positive with a focal area of edema yielding no pus on needle aspiration under direct US visualization. No patient returned unexpectedly after drainage. These data suggest that intraoral US of suspected PTA allows for reliable diagnosis and safe and accurate abscess drainage.