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Comprehensive Otolaryngology

(013) Acute Intratonsillar Abscess: A Rare Diagnosis in an Adult

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Alexandra F. Corbin, BS

    Medical Student
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Buffalo, NY, United States

    • Co-Author(s)

  • JF

    Jacob Fried, MD

    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, USA

    • Co-Author(s)

  • Arunima Vijay, BA

    Medical Student
    University of Florida
    Odessa, Florida, United States

    • Senior Author(s)

  • Michele M. Carr, DDS MD PhD

    Professor
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Williamsville, NY, United States

Disclosure(s):
Arunima Vijay, BA: No relevant relationships to disclose.
Alexandra F. Corbin, BS: No relevant relationships to disclose.


Introduction: Intratonsillar abscess (ITA) has been reported rarely and primarily in children. This report presents an uncommon case of acute ITA in an adult, discusses the evaluation and treatment plan, and reviews the literature on ITA.

Methods: Case report and literature review.

Results: A 32-year-old female presented to Urgent Care with 1 week of worsening throat pain, progressive dysphagia, trismus, voice changes, and fevers. She was diagnosed with peritonsillar abscess (PTA) and sent to the ED. Otolaryngologic exam showed no respiratory distress, mild cervical lymphadenopathy, a midline uvula with tonsillar asymmetry, 2+ right tonsil and 3+ left tonsil. Both tonsils were erythematous with yellow-white exudate. The left tonsil appeared to have active drainage at the inferior pole, lateral to the tongue base. IV clindamycin and dexamethasone were started. CT demonstrated a 1.5 x 1.1 x 1.1 cm left palatine intratonsillar abscess with a septation and 2 mm calcification. Labs did not show elevated WBC or abnormalities in CBC or CMP. Needle aspiration of the ITA was unsuccessful. The left tonsil was then probed with a curved hemostat, leading to purulent drainage, pressure relief, and voice improvement. She was discharged on oral clindamycin and dexamethasone, and her symptoms were resolved at 1 week follow-up.

Literature shows that of 46 reported cases of ITA, only 11 were in adults. 24 patients resolved with antibiotics alone, 9 resolved with needle aspiration and antibiotics, and 13 required further intervention. Currently, there is no standardized treatment protocol for the management of ITA.

Conclusions: ITA differs from PTA in examination findings, although a cervical CT with contrast may be needed for definitive diagnosis. This report and literature review supports antibiotics and/or needle aspiration as a first-line treatment approach for acute ITA. If this is unsuccessful, incision and drainage (I&D) with antibiotics is recommended. Tonsillectomy is reserved for cases that recur after I&D.