Issue

Vol. 2 No. 2 (2025)

Date Log

Submitted
September 8, 2026
Published
December 31, 2025

Copyright (c) 2025 Khalid Hamoud J. Alanazi, Norah Abdulaziz Alsaeed, Radhyah Hassan Masoud Alfaifi, Haya Nasser Fahad Aldosari, Abdullah Ali Sharahit, Safar Saad Alamoudh, Ameerah Yaha Alshamrani, Nehad Khalaf Khawaji, Muhaya Ali Khalifh Alotibi, Manal Nayaf Almutairi

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Peritonsillar Abscess: Diagnosis, Treatment, and Prevention of Complications-An Updated Review for Healthcare Professionals.

https://doi.org/10.64483/202522767
Khalid Hamoud J. Alanazi
Saudi Red Crescent Authority – Arar, Saudi Arabia, Saudi Arabia
Norah Abdulaziz Alsaeed
King Salman Hospital, Riyadh, Ministry of health., Saudi Arabia
Radhyah Hassan Masoud Alfaifi
Faifa General Hospital, Jazan, Ministry of health, Saudi Arabia
Haya Nasser Fahad Aldosari
Imam Abdulrahman Al Faisal Hospital, Riyadh First Health Cluster, Ministry of health., Saudi Arabia
Abdullah Ali Sharahit
Jazan General Hospital, Ministry of health, Saudi Arabia
Safar Saad Alamoudh
King Salman Hospital, Riyadh First Health Cluster, Ministry of health., Saudi Arabia
Ameerah Yahya Alshamrani
Security Forces Hospital, Ministry of Interior, Saudi Arabia
Nehad Khalaf Khawaji
Sabya General Hospital, Ministry of health , Saudi Arabia
Muhaya Ali Khalifh Alotibi
Dawadmi General Hospital, Third Health Cluster – Riyadh, Saudi Arabia, Ministry of health., Saudi Arabia
Manal Nayaf Almutairi
Ministry of Health – Riyadh, Saudi Arabia, Saudi Arabia

Corresponding Author(s) : Khalid Hamoud J. Alanazi

mmkzo0001@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)

Abstract

Background: Peritonsillar abscess, also known as quinsy, is the most common deep neck space infection and may cause severe throat pain, dysphagia, dehydration, airway compromise, and extension into adjacent cervical spaces.


Aim: This article reviews etiology, epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, management, prognosis, and complications of peritonsillar abscess.


Methods: A narrative review was prepared using established clinical literature concerning peritonsillar infection, emergency airway assessment, laboratory evaluation, imaging, antimicrobial therapy, procedural drainage, and otorhinolaryngology management.


Results: Peritonsillar abscess usually develops after acute tonsillitis or pharyngitis when polymicrobial infection extends into the peritonsillar space. Common manifestations include unilateral throat pain, fever, odynophagia, dysphagia, drooling, trismus, muffled voice, tonsillar displacement, and uvular deviation. Diagnosis is frequently clinical, while ultrasonography and contrast-enhanced computed tomography are useful when the diagnosis is uncertain, drainage is planned, or deep neck extension is suspected. Management begins with airway assessment, analgesia, hydration, and antimicrobial therapy targeting streptococci and oral anaerobes. Needle aspiration, incision and drainage, or selected tonsillectomy may be required depending on abscess characteristics, symptom severity, recurrence, and accessibility. Most patients recover within several days after timely treatment. However, delayed intervention may result in airway obstruction, aspiration, parapharyngeal spread, mediastinitis, vascular injury, septic thrombophlebitis, or sepsis.


Conclusion: Peritonsillar abscess requires prompt recognition and coordinated multidisciplinary care. Early airway evaluation, appropriate imaging, antimicrobial treatment, drainage when indicated, and close follow-up are essential to prevent serious complications and optimize recovery.

Keywords

Peritonsillar abscess, quinsy, tonsillitis, deep neck infection, airway obstruction, drainage, otorhinolaryngology.
Alanazi, K. H. J., Alsaeed, N. A., Alfaifi, R. H. M., Aldosari, H. N. F., Sharahit, A. A., Alamoudh, S. S., … Almutairi, M. N. (2025). Peritonsillar Abscess: Diagnosis, Treatment, and Prevention of Complications-An Updated Review for Healthcare Professionals. Saudi Journal of Medicine and Public Health, 2(2), 3819–3830. https://doi.org/10.64483/202522767
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
References
  1. 1. Schraff S, McGinn JD, Derkay CS. Peritonsillar abscess in children: a 10-year review of diagnosis and management. Int J Pediatr Otorhinolaryngol. 2001 Mar;57(3):213-8.
  2. 2. Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, González-Valdepeña H, Bluestone CD. Head and neck space infections in infants and children. Otolaryngol Head Neck Surg. 1995 Mar;112(3):375-82.
  3. 3. Ahmed Ali S, Kovatch KJ, Smith J, Bellile EL, Hanks JE, Truesdale CM, Hoff PT. Predictors of intratonsillar abscess versus peritonsillar abscess in the pediatric patient. Int J Pediatr Otorhinolaryngol. 2018 Nov;114:143-146.
  4. 4. Alansari K, Sheikh R, Sheehan PZ, Joseph V, Hoffman RJ. Confluent Retropharyngeal, Lateral Pharyngeal, and Peritonsilar MRSA Abscess in an Infant. Pediatr Emerg Care. 2018 Sep;34(9):e161-e164.
  5. 5. Grant MC, Raggio B, Barton B, Guarisco JL. Establishing the Need for an Evidence-Based Treatment Algorithm for Peritonsillar Abscess in Children. Clin Pediatr (Phila). 2018 Oct;57(12):1385-1390.
  6. 6. Passy V. Pathogenesis of peritonsillar abscess. Laryngoscope. 1994 Feb;104(2):185-90.
  7. 7. Geißler K, Markwart R, Requardt RP, Weigel C, Schubert K, Scherag A, Rubio I, Guntinas-Lichius O. Functional characterization of T-cells from palatine tonsils in patients with chronic tonsillitis. PLoS One. 2017;12(9):e0183214.
  8. 8. Serrano C, Bedini I, Demarchi MV. Bilateral peritonsillar abscess. A case report and review of controversies surrounding diagnosis and management. Arch Argent Pediatr. 2024 Feb 01;122(1):e202303034.
  9. 9. Klug TE. Incidence and microbiology of peritonsillar abscess: the influence of season, age, and gender. Eur J Clin Microbiol Infect Dis. 2014 Jul;33(7):1163-7.
  10. 10. Herzon FS. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope. 1995 Aug;105(8 Pt 3 Suppl 74):1-17.
  11. 11. Millar KR, Johnson DW, Drummond D, Kellner JD. Suspected peritonsillar abscess in children. Pediatr Emerg Care. 2007 Jul;23(7):431-8.
  12. 12. Kim DK, Lee JW, Na YS, Kim MJ, Lee JH, Park CH. Clinical factor for successful nonsurgical treatment of pediatric peritonsillar abscess. Laryngoscope. 2015 Nov;125(11):2608-11.
  13. 13. Freire GSM, Dos Santos JHZ, Rolón PA, Pinheiro GB, Sampaio ALL. Peritonsillar abscess: epidemiology and relationship with climate variations. J Laryngol Otol. 2017 Jul;131(7):627-630.
  14. 14. Bank S, Jensen A, Nielsen HM, Kristensen LH, Voldstedlund M, Prag J. Fusobacterium necrophorum findings in Denmark from 2010 to 2014 using data from the Danish microbiology database. APMIS. 2016 Dec;124(12):1087-1092.
  15. 15. Gomez Urena EO, Sheehy J, Krastev I. A case of bilateral peritonsillar abscesses as a complication of acute mononucleosis. IDCases. 2023;33:e01829.
  16. 16. Yaxley KL. Infectious mononucleosis complicated by peritonsillar abscess and postural orthostatic tachycardia syndrome: A case report. SAGE Open Med Case Rep. 2020;8:2050313X20915413.
  17. 17. Wikstén J, Kaltiainen E, Pitkäranta A, Blomgren K. Renewal of peritonsillar abscess: Impact of the bacterial species of the infection and clinical features of the patient-A prospective comparative aetiological study. Clin Otolaryngol. 2017 Dec;42(6):1358-1362.
  18. 18. Klug TE. Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess. Dan Med J. 2017 Mar;64(3)
  19. 19. Inman JC, Rowe M, Ghostine M, Fleck T. Pediatric neck abscesses: changing organisms and empiric therapies. Laryngoscope. 2008 Dec;118(12):2111-4.
  20. 20. Ehlers Klug T, Rusan M, Fuursted K, Ovesen T. Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark. Clin Infect Dis. 2009 Nov 15;49(10):1467-72.
  21. 21. Plum AW, Mortelliti AJ, Walsh RE. Microbial Flora and Antibiotic Resistance in Peritonsillar Abscesses in Upstate New York. Ann Otol Rhinol Laryngol. 2015 Nov;124(11):875-80.
  22. 22. Akhavan M. Ear, Nose, Throat: Beyond Pharyngitis: Retropharyngeal Abscess, Peritonsillar Abscess, Epiglottitis, Bacterial Tracheitis, and Postoperative Tonsillectomy. Emerg Med Clin North Am. 2021 Aug;39(3):661-675.
  23. 23. Szuhay G, Tewfik TL. Peritonsillar abscess or cellulitis? A clinical comparative paediatric study. J Otolaryngol. 1998 Aug;27(4):206-12.
  24. 24. Galioto NJ. Peritonsillar abscess. Am Fam Physician. 2008 Jan 15;77(2):199-202.
  25. 25. Spires JR, Owens JJ, Woodson GE, Miller RH. Treatment of peritonsillar abscess. A prospective study of aspiration vs incision and drainage. Arch Otolaryngol Head Neck Surg. 1987 Sep;113(9):984-6.
  26. 26. Galioto NJ. Peritonsillar Abscess. Am Fam Physician. 2017 Apr 15;95(8):501-506.
  27. 27. Long B, Gottlieb M. Managing Peritonsillar Abscess. Ann Emerg Med. 2023 Jul;82(1):101-107.
  28. 28. Johnson BC, Alvi A. Cost-effective workup for tonsillitis. Testing, treatment, and potential complications. Postgrad Med. 2003 Mar;113(3):115-8, 121.
  29. 29. Voruz F, Revol R, Combescure C, Monnier Y, Becker M, Dulguerov N. Diagnosis of Peritonsillar Abscess-A Prospective Study Comparing Clinical with CT Findings in 133 Consecutive Patients. Diagnostics (Basel). 2025 Jan 20;15(2)
  30. 30. Blaivas M, Theodoro D, Duggal S. Ultrasound-guided drainage of peritonsillar abscess by the emergency physician. Am J Emerg Med. 2003 Mar;21(2):155-8.
  31. 31. Strong EB, Woodward PJ, Johnson LP. Intraoral ultrasound evaluation of peritonsillar abscess. Laryngoscope. 1995 Aug;105(8 Pt 1):779-82.
  32. 32. Secko M, Sivitz A. Think ultrasound first for peritonsillar swelling. Am J Emerg Med. 2015 Apr;33(4):569-72.
  33. 33. Nogan S, Jandali D, Cipolla M, DeSilva B. The use of ultrasound imaging in evaluation of peritonsillar infections. Laryngoscope. 2015 Nov;125(11):2604-7.
  34. 34. Gibbons RC, Costantino TG. Evidence-Based Medicine Improves the Emergent Management of Peritonsillar Abscesses Using Point-of-Care Ultrasound. J Emerg Med. 2020 Nov;59(5):693-698.
  35. 35. Kikuta S, Oshima T. Accurate Diagnosis of Peritonsillar Abscesses Using Relative CT Number Measurements in Low-Density Areas of Contrast CT Images. J Clin Med. 2025 Jun 18;14(12)
  36. 36. Krishnaprasadh D, Pozun A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 15, 2025. Pediatric and Neonatal Resuscitation.
  37. 37. Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob. 2020 Jul 30;19(1):32.
  38. 38. Repanos C, Mukherjee P, Alwahab Y. Role of microbiological studies in management of peritonsillar abscess. J Laryngol Otol. 2009 Aug;123(8):877-9.
  39. 39. Mcleod R, Brahmabhatt P, Owens D. Tonsillectomy is not a procedure of limited value - the unseen costs of tonsillitis and quinsy on hospital bed consumption. Clin Otolaryngol. 2017 Jun;42(3):573-577.
  40. 40. Hur K, Zhou S, Kysh L. Adjunct steroids in the treatment of peritonsillar abscess: A systematic review. Laryngoscope. 2018 Jan;128(1):72-77.
  41. 41. Urban MJ, Masliah J, Heyd C, Patel TR, Nielsen T. Peritonsillar Abscess Size as a Predictor of Medical Therapy Success. Ann Otol Rhinol Laryngol. 2022 Feb;131(2):211-218.
  42. 42. Şahan MH, Bayar Muluk N. MRI evaluation of distance between tonsillary fossa and internal carotid artery in children. Int J Pediatr Otorhinolaryngol. 2020 Oct;137:110209.
  43. 43. Deutsch MD, Kriss VM, Willging JP. Distance between the tonsillar fossa and internal carotid artery in children. Arch Otolaryngol Head Neck Surg. 1995 Dec;121(12):1410-2.
  44. 44. Chang BA, Thamboo A, Burton MJ, Diamond C, Nunez DA. Needle aspiration versus incision and drainage for the treatment of peritonsillar abscess. Cochrane Database Syst Rev. 2016 Dec 23;12(12):CD006287.
  45. 45. Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H, Ohori J, Kurono Y. Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. Auris Nasus Larynx. 2016 Apr;43(2):182-6.
  46. 46. Johnson RF. Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess. Laryngoscope. 2017 Oct;127 Suppl 5:S1-S9.
  47. 47. Huang Z, Vintzileos W, Gordish-Dressman H, Bandarkar A, Reilly BK. Pediatric peritonsillar abscess: Outcomes and cost savings from using transcervical ultrasound. Laryngoscope. 2017 Aug;127(8):1924-1929.
  48. 48. Windfuhr JP, Remmert S. [Trends and complications in the management of peritonsillar abscess with emphasis on children]. HNO. 2005 Jan;53(1):46-57.
  49. 49. Stevens HE. Vascular complication of neck space infection: case report and literature review. J Otolaryngol. 1990 Jun;19(3):206-10.
  50. 50. Ramirez S, Hild TG, Rudolph CN, Sty JR, Kehl SC, Havens P, Henrickson K, Chusid MJ. Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a Children's Hospital. Pediatrics. 2003 Nov;112(5):e380.
  51. 51. Goldenberg NA, Knapp-Clevenger R, Hays T, Manco-Johnson MJ. Lemierre's and Lemierre's-like syndromes in children: survival and thromboembolic outcomes. Pediatrics. 2005 Oct;116(4):e543-8.
  52. 52. Greinwald JH, Wilson JF, Haggerty PG. Peritonsillar abscess: an unlikely cause of necrotizing fasciitis. Ann Otol Rhinol Laryngol. 1995 Feb;104(2):133-7.
  53. 53. Wenig BL, Shikowitz MJ, Abramson AL. Necrotizing fasciitis as a lethal complication of peritonsillar abscess. Laryngoscope. 1984 Dec;94(12 Pt 1):1576-9.
  54. 54. Klug TE, Rusan M, Clemmensen KK, Fuursted K, Ovesen T. Smoking promotes peritonsillar abscess. Eur Arch Otorhinolaryngol. 2013 Nov;270(12):3163-7.
  55. 55. Kim SY, Lim H, Choi HG. Smoking and Alcohol Consumption Are Associated With the Increased Risk of Peritonsillar Abscess. Laryngoscope. 2020 Dec;130(12):2833-2838.
  56. 56. Farmer SE, Khatwa MA, Zeitoun HM. Peritonsillar abscess after tonsillectomy: a review of the literature. Ann R Coll Surg Engl. 2011 Jul;93(5):353-5.
  57. 57. Wang YP, Wang MC, Lin HC, Chou P. The impact of prior tonsillitis and treatment modality on the recurrence of peritonsillar abscess: a nationwide cohort study. PLoS One. 2014;9(10):e109887.
  58. 58. Suskind DL, Park J, Piccirillo JF, Lusk RP, Muntz HR. Conscious sedation: a new approach for peritonsillar abscess drainage in the pediatric population. Arch Otolaryngol Head Neck Surg. 1999 Nov;125(11):1197-200.
  59. 59. Martínez Pascual P, Pinacho Martinez P, Friedlander E, Martin Oviedo C, Scola Yurrita B. Peritonsillar and deep neck infections: a review of 330 cases. Braz J Otorhinolaryngol. 2018 May-Jun;84(3):305-310.
Read More
Author biographies is not available.
Download
PDF
Statistic
Read Counter : 7 Download : 20