1230 A Case of Intratonsillar Abscess Presenting as a Non-Resolving Acute Tonsillitis With Dysphonia, With Learning Points

Abstract

Abstract Peritonsillar abscess (quinsy) and tonsillitis are two commonly diagnosed and treated pathologies in ENT departments. However, intratonsillar abscess is rarely reported in medical literature and textbooks, therefore understanding of when to clinically suspect such pathology is likely less known amongst junior ENT doctors. We present a case of a healthy adult treated for a large intratonsillar abscess, at a district general hospital in the United Kingdom. A 27-year-old man with one previously treated quinsy, presented with 6 days of worsening sore throat, fevers, and dysphonia. Clinical examination showed mild trismus, tonsillitis with an asymmetrically large right tonsil, appearance of right peritonsillar swelling, and a normal neck exam. Clinically this was initially treated as a right peritonsillar abscess, with needle aspiration of the peritonsillar space, however 3 aspiration attempts revealed no pus. He was admitted and treated as tonsillitis with peritonsillar cellulitis by antibiotics, but over four days little improvement was seen with rising inflammatory markers. Particularly the “hot-potato voice” dysphonia did not improve at all. Given the smoothly enlarged right tonsil and absence of peritonsillar swelling, suspicion for an intratonsillar abscess was raised. Needle aspiration into the tonsil revealed 7 millilitres of thick pus, causing immediate improvement in voice and symptoms. We suggest that intratonsillar abscess could be suspected in patients appearing as quinsy but with dry aspiration attempts, or in unilateral unresolving tonsillitis. Direct tonsil aspiration can sometimes avoid radiation from CT scanning in patients who are systemically well with no suspicion of deep neck infections.