Diagnosis Of Peritonsillar Abscess Research Articles

The Use of Point of Care Ultrasound in Diagnosis of Peritonsillar Abscess

The use of point of care ultrasound (POCUS) for diagnosis and treatment of peritonsillar abscess (PTA) is increasing [1]. Proven advantages include improved diagnostic accuracy and treatment success rates as well as decreased otolaryngology consultation, computed tomography (CT) usage, return visits to the emergency department (ED), and length of stay [1]. We present a case of a patient with a PTA that was diagnosed and successfully treated utilizing POCUS, avoiding the need for otolaryngology consultation and CT.

Variability in advanced imaging of pediatric neck infections in US emergency departments.

To describe the use of computed tomography (CT) and ultrasound (US) imaging for the evaluation of neck infections in pediatric patients in United States emergency departments (EDs). This is a cross-sectional analysis, using the National Emergency Department Sample database, of pediatric patients evaluated for common neck infections between 2012 and 2018. We used bivariable analysis to assess for differences in US and CT use by ED type. We performed multivariable logistic regression to adjust for potential confounding factors including patient characteristics (sex, age, insurance status, discharge diagnosis) and ED characteristics (metropolitan statistical area, pediatric center). Results are reported as odds ratios and adjusted odds ratios with 95% confidence intervals. There were 19,363 ED visits for pediatric neck infections in the database over the study period, representing 84,439 national visits. Of those imaged, 80.8% were imaged with CT and 19.2% were imaged with US. Pediatric patients evaluated in general EDs as compared to pediatric EDs (aOR 5.32, 95% CI 3.06, 9.24) and patients with a diagnosis of peritonsillar abscess (aOR 2.11, 95% CI 1.34, 3.33) and retropharyngeal abscess (aOR 6.12, 95% CI 2.14, 17.53) were more likely to be imaged with CT scan. Children with neck infections evaluated in general EDs are significantly more likely to undergo CT scans when compared to those evaluated in pediatric EDs. To reduce exposure to radiation in children, we propose the dissemination of US-first protocols in general EDs for the evaluation of pediatric neck infections.

Feasibility of an inexperienced examiner using trans-cervical ultrasound in the diagnosis of peritonsillar abscesses

Background A peritonsillar abscess (PTA) is a common complication to acute tonsillitis. Needle aspiration (NA) is the gold standard for diagnosis of PTA. NA is usually painful and not risk-free. Ultrasound (US) is a noninvasive, portable radiological modality that could potentially be used in the diagnosis of PTA and selection of patients for NA. The reliability of US is dependent on the experience of the examiner which limits is usefulness. Aim To evaluate the reliability of US in the diagnosis of PTA by an inexperienced examiner. Methods Thirty patients with suspected PTA were included. They were first examined with trans-cervical US by a medical student then clinically examined by a physician that performed a NA if clinically motivated. They were then followed for at least two days. Results Three patients were excluded from analysis because no NA was performed. In these patients, US correctly classified them as negative for PTA. In the remaining 27 patients, the sensitivity and negative predictive value was 100%. The specificity was 64.3% and the positive-predictive value was 72.2%. Conclusion US can be very useful in the diagnosis of PTA and the selection for NA even with an inexperienced examiner. Significance The results highlight the usefulness of ultrasound in otolaryngology.

Using telemedicine to facilitate social distancing in otolaryngology: A systematic review

Objectives As the coronavirus 2019 pandemic puts strains on current models of otolaryngology practice, telemedicine is an attractive way for otolaryngologists to reduce in-person appointments while still addressing the health of their patients. This systematic review of the literature aims to identify the evidence basis for using telemedicine in otolaryngology practice to limit person-to-person interactions while achieving comparable quality to in-person services. Methods The authors gathered articles from three databases (Embase, PubMed and Web of Science), performed a comprehensive literature review of articles published on telemedicine since 2002, and selected articles for inclusion based on their relevance to otolaryngology and the potential of the intervention to improve patient social distancing. Results A total of 7153 articles were identified from the initial query. After review, 35 met the inclusion criteria. Of the included articles, 32 (91%), found their specific telemedicine intervention to be effective when compared to in-person services. Twenty articles (57%) were related to remote otoscopy. Other telemedical interventions included videoconferencing for peri-operative visits, diagnosis of peritonsillar abscess, telephone-based voice evaluations and evaluation of nasal fractures. Conclusions Video-otoscopy is the most well-supported telemedical intervention which limits physical contact between otolaryngologists and their patients. Other interventions have also demonstrated efficacy but have yet to be as widely validated as video-otoscopy. Telehealth facilitators play a key role in providing high-quality telehealth services. More invasive procedures, such as laryngoscopy, require further evidence to demonstrate definite benefits in a telemedicine setting.

Clinical Profile and Management of Peritonsillar Abscess in a Sub Saharan Africa

Background: Peritonsillar abscess is a common pathology that presents to an otolaryngologist with poor documentation especially in developing countries.
 The aim of this study was to describe the clinical profile and management of peritonsillar abscess in our practice.
 Material and Method: This was a retrospective study of patients presenting to our Ear, Nose and Throat facility with diagnosis of peritonsillar abscess. Information obtained includes detailed demographic characteristics, clinical findings and management of the patients. All obtained data were collated, entered into computer system and analyzed using SPSS version 18.0.
 Results: Prevalence of peritonsillar abscess was 0.2%. There were 38.9% males and male to female ratio was 1:1.6. Duration of illness at presentation with more than 1 week was 75.9% and single episode occurred in 85.2%. Right peritonsillar abscess accounted for 66.7% and aspirated pus of more than 5 ml was recorded in 48.1%. Majority (87.0%) of the patients was referred and 42.6% of such referral is by family physician. Patients seen in ear, nose and throat outpatient clinic were 83.3%.
 Common symptoms at presentation were fever, sore throat, odynophagia and otalgia in 100%, 94.4%, 90.7% and 59.3% respectively. All the patients (100%) had enlarged tonsils and with deviated uvula on clinical examination followed by 98.1% exudate on the tonsils and 31.5% trismus. Test aspirate confirmed peritonsillar abscess in 68.5% and all revealed growth of bacteria. Common isolated bacteria were 35.2% Streptococcus species and 11.1% Staphyloccocus aureus.
 Isolated Streptococcus species and Staphylococcus aureus had 100% sensitivity to cefuroxime, gentamicin, azithromycin, ceftazidine, Amoxicillin and Streptomycin.
 Prior prehospital treatment was received by 81.5% patients. Hospital treatments were surgical intervention and medical treatment in 90.7% and 100% respectively. Recurrences occurred in 3.7% during followed up.
 Conclusion: Peritonsillar abscess are common disorder with female preponderance in this study. The prevalence recorded in this study was 0.2%. It usually mimic other causes of fever hence eye index of suspicion is essential. Surgical treatment remains the effective mode of management in our study.

Validating peritonsillar abscess drainage rates using the Pediatric hospital information system data.

To evaluate the accuracy of the Children's Hospital Association's Pediatric Health Information System (PHIS) registry data in determining surgical drainage rates as compared to a chart review on the same cohort of children with diagnosis of peritonsillar abscess. Retrospective analysis. Our analysis included 200 children, ages 2 to 17 years, treated for a peritonsillar abscess from 2011 to 2016. The primary outcome was to determine the sensitivity, specificity, predictive values, receiver operating characteristics (ROC), and likelihood ratios of surgical drainage rates comparing the PHIS database to manual chart review of the same patients. One hundred and fifteen (58%) children underwent drainage by chart review, whereas 87 (44%) had a drainage procedure by PHIS data. Age was a significant predictor of abscess drainage by chart review (age coefficient = 0.10; standard error = 0.04; 2 = 5.8; P = 0.02; odds ratio = 1.1; 95% confidence interval [CI] = 1.01-1.19). When using the chart review as the reference value for surgical drainage, the PHIS data had a sensitivity of 76% and 100% specificity. The positive and negative predictive values were 100% and 75%, respectively. The ROC area was 0.88 (95% CI, 84 to 92). Cases that lacked a clear procedure note composed the false negative cases in the PHIS. At our institution, the PHIS Administrative data was adequate at predicting surgical drainage of the peritonsillar abscess when compared to chart review. 4 Laryngoscope, 130:238-241, 2020.

Diagnosis and Treatment of Peritonsillar Abscess with Single Enhanced Computed Tomography

Background and Objectives Diagnostic features of peritonsillar abscess are an asymmetrically enlarged palatine tonsil with peripheral rim enhancement and central low density in the post-contrast computed tomography (CT). Although it is necessary to differentiate tumorous conditions of tonsils to compare pre- and post-contrast CT, pre-contrast CT may be less useful in the diagnosis of peritonsillar abscess. This study aims to evaluate of the efficacy of single post-contrast CT for diagnosis and treatment of peritonsillar abscess. Subjects and Method We retrospectively compared 29 patients with peritonsillar abscess, who were diagnosed by single post-contrast CT, with 36 patients diagnosed by pre- and post-contrast CT to determine the success rates of pus drainage and hospital days. Additionally, two otorhinolaryngologists made a judgment of abscess presence for sixty randomly mixed CT images of peritonsillar abscess or tonsillitis with pre- and post-contrast CT or single post-contrast CT. Results There were no significant differences in the success rate of drainage (p=0.622) and hospital days (p=0.504) between groups with/without pre-contrast CT. Abscess presence was judged by raters with/without pre-contrast CT. Inter-rater agreement value (Cohen’s kappa) was 0.825 (p＜0.01). Conclusion Single post-contrast CT of peritonsillar abscess may be a good alternative for diagnosis and treatment and may reduce unnecessary exposure to radiation. Key words: Computed tomography ㆍ Contrast media ㆍ Peritonsillar abscess ㆍ Sensitivity ㆍ Specificity

Is corticosteroid a treatment choice for the management of peritonsillar abscess?

ObjectiveTo investigate the effect of the single systemic use of corticosteroid following drainage procedure in patients with peritonsillar abscess (PTA). MethodsThis retrospective case-control trial included 32 patients with the diagnosis of PTA between December 2013 and January 2016 in our clinic. Patients were divided into two groups based on the approaches of two authors for the treatment after PTA drainage. The study group included the patients treated with single dose systemic corticosteroid after PTA drainage. Other patients who had no corticosteroid treatment were in the control group. Two groups were compared based on time to oral intake, grade of trismus, pain severity and duration of hospitalization. ResultsStatistically significant differences between two groups were observed in terms of time to oral intake, grade of trismus, pain severity and length of hospitalization. The degree of trismus and pain severity significantly decreased in study group comparing to control group at the end of the first day. This difference disappeared at Day 7. Time to oral intake and the duration of hospitalization were shorter in the study group than in control group. ConclusionCorticosteroid treatment following drainage procedure in patients with peritonsillar abscess improves pain severity and trismus thus it decreases time to oral intake and duration of hospitalization.

It’s Never Just a PTA: A Series of Deep Neck Infections with Literature Review

Infections of the head and neck are commonly treated by otolaryngologists. Peritonsillar abscesses are a relatively frequent occurrence that can be treated on an outpatient basis, unlike other deep neck infections which typically require operative drainage. Patients are often transferred to institutions with specialist coverage, and accepting physicians must be wary of the presumed diagnosis. We present two cases of extensive deep neck infections requiring multiple operative procedures in patients who were transferred with a diagnosis of peritonsillar abscess. These cases and review of literature is a reminder to all to ensure an independent evaluation and differential diagnosis when assessing any patient.

Is Needle Aspiration for Peritonsillar Abscess Still as Good as We Think? A Long-term Follow-up.

The aim was to study the therapeutic management, recurrence, and need for tonsillectomy in patients who underwent needle aspiration for peritonsillar abscess (PTA). A prospective observational design study was performed. Patients hospitalized in Shaare Zedek Medical Center between the years 2004 and 2007 with a diagnosis of PTA who underwent needle aspiration obtaining pus were included. A minimum 5-year follow-up was required for all patients. Recurrences, complications, the need for a repeated surgical procedure, length of hospital admission, and tonsillectomy were the primary end points. The study included 117 patients. One hundred four patients (88.9%) improved after 1 needle aspiration without any other intervention, whereas 13 patients (11.1%) required an additional procedure. Broad spectrum antibiotics showed a statistical advantage over penicillin only, regarding need for recurrent procedure (14.7% vs 4.7%, P = .02). No short- or long-term complications were documented. Seventeen patients (14.5%) had any recurrence. Primary recurrent tonsillitis, female sex, and younger age were predictive risk factors for recurrent events of PTA (32% vs 10%, P < .01). A total of 18 patients (15.4%) eventually underwent tonsillectomy. Needle aspiration is an effective first line procedure for patients with PTA. Tonsillectomy is not necessary in most cases. In our study, young age, female sex, and recurrent tonsillitis are negative prognostic factors for recurrence. These patients should be managed accordingly. Broad spectrum antibiotics may offer additional advantages when compared to penicillin only.

English

Background: Peritonsillar abscess is a common clinical condition encountered in the practice of otolaryngology. However, there is no consensus yet in terms of best treatment of peritonsillar abscess. The current prospective clinical study was performed to compare two common treatments of peritonsillar abscess, namely, needle aspiration versus incision and drainage for peritonsillar abscess Methods: A prospective study was performed on patients with diagnosis of peritonsillar abscess from January 2008 to December 2012. A total of 110 patients were enrolled in this study and were randomly allocated to two groups who were treated with needle aspiration and incision and drainage, respectively. Data collected included age, gender, clinical symptoms and treatment outcome. Results: There were 98 males and 12 females ranging from 12 to 79 years of age, with mean age of 31.0 ± 15.0 years. Complete remission of symptoms was achieved for all patients during the follow-up. No significant difference was observed regarding baseline characteristics including age, gender, location of the abscess, and duration of symptoms between the two groups. Pain scores taken one and 24 hours after either procedure suggested that patients treated with needle aspiration felt less pain compared with those treated with incision and drainage. Additionally, no significant difference in the median hospital stay was found between the two groups. There were two (3.6%) patients in the needle aspiration group who required incision and drainage after two needle aspirations. No significant side effects were observed in either group. Conclusions: The complication rate and length of hospital stay are similar between the needle aspiration and the incision and drainage groups. Needle aspiration is an efficient and safe procedure to treat peritonsillar abscess. Furthermore, needle aspiration was found to be superior to incision and drainage in terms of the post-procedure pain score for the patients. It is suggested that needle aspiration can be performed as the first-line treatment of peritonsillar abscess.

Use of Computed Tomography in the Emergency Department for the Diagnosis of Pediatric Peritonsillar Abscess

The objective of this study was to review our pediatric emergency department's (ED's) utilization of computed tomography (CT) in the diagnosis of peritonsillar abscess (PTA) and treatment outcomes. This study used case series with chart review. From January 2007 to January 2009, 148 patients were seen in our ED for possible PTA. Mean age at presentation was 11.8 years (range, 10 months to 18 years); 81 (54.7%) of 148 were females. Computed tomography was ordered in 96 (64.9%) of 148 patients, of which 73 (49.3%) 148 were confirmed to have PTA. Mean age of patients who underwent CT was younger when compared with those who did not have CT performed (mean, 11 vs 13 years; P = 0.02). Unilateral PTA was found in 65 (43.9%) of 148, bilateral in 8 (5.4%) of 148, and intratonsillar in 25 patients (16.9%). Concomitant CT findings of parapharyngeal space involvement were found in 19 (12.8%), and retropharyngeal space involvement in 11 (7.4%). Admission was necessary for 104 (71.2%) of 148 patients, whereas 42 were discharged from the ED. Transoral needle aspiration and/or incision and drainage were performed in the ED in 41 patients, with purulence identified in 33 (80.5%) of 41. Rapid strep testing was positive in 40 (32%) of 124 patients tested. Operative treatment was necessary in 44 patients (29.7%), 34 underwent incision and drainage, and 10 underwent quinsy tonsillectomy. Computed tomography is commonly utilized in the ED for the evaluation of PTA and is ordered more often in younger children.

Relation between Peritonsillar Infection and Acute Tonsillitis

To investigate the relationship between tonsillar and peritonsillar infections. Retrospective population-based study and a retrospective case series review. Tertiary academic medical facility. All individuals hospitalized with peritonsillar abscess (PTA) or peritonsillar cellulitis (PTC) during 2004-2008 were reviewed. Patient age, gender, diagnosis of PTA or PTC, recurrence, and date of presentation were recorded. In addition, a database of patients diagnosed in the community with acute tonsillitis (AT) was reviewed for the same time period. The weekly number of patients with AT was recorded, and a comparison between incidence of tonsillar infections and peritonsillar infection was performed. A total of 685 patients were hospitalized with either PTA (467) or PTC (218). Incidence of both upper respiratory infections and AT peaked in January and February of every year with a nadir in August. In contrast, PTA and PTC showed a consistent rate of infection throughout the year. Likewise, assessment based on weekly intervals showed that peaks of PTA and PTC did not follow those of acute tonsillitis with a 1 to 2 weekly lag as would be expected if peritonsillar infection is a complication of AT. Rather, an association between peritonsillar infection and tonsillitis was found within the same week (P = .04). Higher rates of occurrence of PTA or PTC following AT outbreaks were not found. These results lend further support to the theory that peritonsillar infection is associated not only with complications of AT but may occur from infection of Weber glands or other unknown causes.

S116 – Microbiology of PTA in the Age of Antibiotic Resistance

ObjectivesNumerous publications have demonstrated Group A Streptococcus pyogenes is the most common pathogen isolated from peritonsillar abscesses (PTAs). We have noted multiple patients presenting with PTAs despite being recently treated with penicillin for tonsillitis. The objective of this study was to assess the bacterial content of PTAs in our practice to determine proper antibiotic therapy.MethodsA retrospective chart review was conducted at 2 tertiary care hospitals. Charts of patients diagnosed with PTA from 2001 through 2005 were reviewed for microbiology studies. If cultures were drawn, the microbiology content and any available sensitivities were assessed.Results205 patients were given the diagnosis of PTA, with an average age of 26. Of these, 64 patients (31.2%) had culture results available for study. Most cultures demonstrated mixed organisms. At least 35.9% demonstrated anaerobic organisms, most commonly Fusobacterium species (20.3%). The 3 most common aerobic organisms isolated were Group A Streptococcus pyogenes (18.8%), Group C Streptococcus (15.6%), and Streptococcus viridans (14.1%). Interestingly, 1 culture (1.6%), grew Escherichia coli as a single pathogen and 2 cultures (3.1%) grew Group D Streptococcus resistant to clindamycin.ConclusionsMost prior studies of PTAs have found Streptococcus pyogenes to be the most common isolate. Our review of 64 cultures found the most frequent pathogen to be anaerobic species, particularly those from genus Fusobacte‐rium. Interestingly, at least 8 cultures (12.5%) isolated pathogens not sensitive to the antibiotic most commonly used in our practice after incision and drainage. These results support the use of broader spectrum antibiotics in the treatment of periton‐sillar abscess.

Posttransplant Lymphoproliferative Disease: A Case Report and Review for the General Pediatrician

This report describes a case of posttransplant lymphoproliferative disease in a 19-year-old male patient with an initial diagnosis of peritonsillar abscess. As the number of children receiving transplants continues to increase, the pediatrician must become familiar with the possible presentations of posttransplant lymphoproliferative disease and at least consider it as a diagnosis in any ill child under long-term treatment with immunosuppressive agents. The epidemiology, pathogenesis, clinical presentations, evaluation, prognosis, and treatment of posttransplant lymphoproliferative disease are reviewed for the primary care pediatrician.

Diagnosis of peritonsillar abscess in primary care

Diagnosis of peritonsillar abscess in primary care

Ultra-sonografia intra-oral e transcutânea cervical no diagnóstico diferencial de celulite e abscessos periamigdalianos

OBJETIVOS: O objetivo deste estudo é determinar a especificidade, sensibilidade e a acurácia da ultra-sonografia (USG) intra-oral e transcutânea no diagnóstico de celulite e abscesso periamigdalianos. FORMA DE ESTUDO: Clínico Prospectivo. MATERIAL E MÉTODO: Trinta e nove pacientes foram atendidos no pronto-socorro de otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo com diagnóstico clínico de celulite ou abscesso periamigdaliano. Em todos os pacientes, após a avaliação inicial, foram realizadas ultra-sonografias intra-oral e transcutânea. RESULTADOS: O USG intra-oral foi realizado em 35 casos e demonstrou sensibilidade de 95,2%, especificidade de 78,5% e a acurácia de 86,9%. A USG transcutânea foi factível em todos os 39 pacientes e diagnosticou abscesso periamigdaliano em 53,8% dos pacientes. A sensibilidade foi de 80%, a especificidade de 92,8% e a acurácia de 84,5%. CONCLUSÕES: O USG intra-oral foi bastante sensível no diagnóstico de abscessos periamigdalianos. O USG transcutâneo obteve especificidade superior ao intra-oral. Porém, quando o USG transcutâneo foi realizado em pacientes com trismo, este diagnosticou todos os abscessos periamigdalianos, já que se tratava de coleções grandes, comuns em pacientes com trismo. Estes exames tiveram acurácia semelhantes.

Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses

SummaryAimsThe objective of the present study was to determine the specificity, sensitivity and accuracy of intraoral and transcutaneous ultrasound (US) in the diagnosis of peritonsillar cellulitis and abscess.Study DesignClinical-Prospective.Materials and MetodsThirty nine patients were seen at the otorhinolaryngology emergency department of the University Hospital, of the School of Medicine, University of São Paulo, with a clinical diagnosis of peritonsillar cellulitis or abscess. After initial evaluation, all patients were submitted to intraoral and transcutaneous US.ResultsIntraoral US was performed on 35 cases and its sensitivity was of 95.2%, the specificity was of 78.5% and the accuracy was of 86.9%. Transcutaneous US was feasible in all 39 patients and diagnosed peritonsillar abscess in 53.8%. There were 5 false-negatives and 1 false-positive result, sensitivity was 80%, specificity was 92.8% and accuracy was 84.5%.ConclusionsIntraoral US was quite sensitive in the diagnosis of peritonsillar abscesses when performed by an experienced radiologist. Specificity was higher for transcutaneous US compared to intraoral US. However, when transcutaneous US was performed in patients with trismus, it was able to diagnose all peritonsillar abscesses, since they were large collections which are common in patients with trismus. These exams showed similar accuracy.

Prevalence of Penicillin Allergy in Adults with Peritonsillar Abscess

We noticed a seemingly high prevalence of penicillin allergy in patients who had been diagnosed with peritonsillar abscess (PTA) at our institution. To formally investigate this observation, we reviewed the emergency room (ER) records of 118 patients who had presented between Jan. 1, 1995, and Dec. 31, 1999, with suspected PTA. A diagnosis of PTA was confirmed by the presence of pus on incision and drainage in 78 of these patients (66.1%). The remaining 40 patients (33.9%) were diagnosed with peritonsillar cellulitis (PTC). Of the 78 patients with confirmed PTA, 13 (16.7%) self-reported an allergy to an antibiotic, including 11 (14.1%) who claimed to be allergic to penicillin. In the 40 patients with PTC, the corresponding figures were only 3 (7.5%) and 1 (2.5%). The difference between the PTA and PTC groups with respect to the prevalence of self-reported penicillin allergy was statistically significant (p < 0.05). We also compared the prevalence of antibiotic allergies in our patients with that of 1,893 consecutively presenting patients whose records had been entered into a pharmacy database at our institution. We found that the overall prevalence of patient-reported penicillin allergy in our PTA group was similar to that of the database population, although penicillin allergy did account for a greater percentage of all antibiotic allergies (84.6%) in our PTA group than in the larger population (62.8%). In our series, patients with PTA were more likely to have reported an allergy to penicillin than were patients without an abscess. Additionally, the prevalence of patient-reported antibiotic allergy is high at our institution. Although self-reported penicillin allergy may not represent a true hypersensitivity reaction, it can influence antibiotic selection and/or compliance. Prospective studies are needed to determine what influence allergic status and antibiotic choice has on abscess development.

Ultrasound-guided drainage of peritonsillar abscess by the emergency physician

The diagnosis of peritonsillar abscess (PTA) poses a challenge to emergency physicians (EPs). The decision to perform an invasive procedure with potential complications is based on clinical judgment that is often inaccurate. Although there is some mention of intraoral ultrasound in otolaryngology practice, there is none in the emergency medicine (EM) literature. However, this bedside emergency application of ultrasonography has the potential to be of considerable use in EM practice, and could allow EPs who previously deferred blind needle aspiration of a potential abscess to perform the procedure themselves. We report the cases of 6 patients who presented with probable PTA and were evaluated with intraoral ultrasound at the bedside by an EP. All 6 patients then underwent needle aspiration. As diagnosed on ultrasound, 3 of the patients had negative aspirations and were diagnosed with peritonsillar cellulitis. Three others were found to have PTA, with 2 requiring real-time ultrasound needle guidance to accomplish abscess drainage after multiple failures with the blind approach. (Am J Emerg Med 2003;21:155-158. Copyright 2003, Elsevier Science (USA). All rights reserved.)