Fast Five Quiz: Sore Throat

Arlen D. Meyers, MD, MBA


November 06, 2019

Untreated or incompletely treated tonsillitis can lead to potentially life-threatening complications. Acute oropharyngeal infections can spread distally to the deep neck spaces and then into the mediastinum. Such complications may require thoracotomy and cervical exposure for drainage. Spread beyond the pharynx is suspected in persons with symptoms of tonsillitis who also have high or spiking fevers, lethargy, torticollis, trismus, or shortness of breath. Radiologic imaging using plain films of the lateral neck or CT scans with contrast is warranted for patients in whom deep neck spread of acute tonsillitis (beyond the fascial planes of the oropharynx) is suspected.

Open-mouth breathing and voice change (ie, a thicker or deeper voice) result from obstructive tonsillar enlargement. The voice change with acute tonsillitis is usually not as severe as that associated with peritonsillar abscess. In peritonsillar abscess, the pharyngeal edema and trismus cause a hot-potato voice. Tender cervical lymph nodes and neck stiffness are observed in acute tonsillitis. Examine skin and mucosa for signs of dehydration.

Physical examination of a peritonsillar abscess almost always reveals unilateral bulging above and lateral to one of the tonsils. Trismus is always present in varying severity. The abscess rarely is located adjacent to the inferior pole of the tonsil. Inferior pole peritonsillar abscess is a difficult diagnosis to make, and radiologic imaging with a contrast-enhanced CT scan is helpful. Tender cervical adenopathy and torticollis (neck turned in the "cock-robin" position) may be present. Ipsilateral otalgia may be observed.

Read more about the presentation of patients with acute tonsillitis and patients with peritonsillar abscess.


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