Retropharyngeal Abscess Research Articles

The Public Health Impact of Pediatric Deep Neck Space Infections.

There is little consensus about the best management of pediatric deep neck space infections (DNSIs) and limited information about the national disease burden. The purpose of this study is to examine the health care burden, management, and complications of DNSIs from a national perspective. Retrospective administrative data set review. National pediatric admission database. Pediatric patients diagnosed with a parapharyngeal space and/or retropharyngeal abscess were identified from the 2009 KIDS' Inpatient Database. Patient demographic, hospital, and clinical characteristics were compared between patients who received surgical and nonsurgical management. All results for the analyses were weighted, clustered, and stratified appropriately according to the sampling design of the KIDS' Inpatient Database. The prevalence of DNSIs was 3444 in 2009, and the estimated incidence was 4.6 per 100,000 children. The total hospital charges were >$75 million. The patients who were drained surgically had a 22% longer length of stay (mean = 4.19 days) than that of those who were managed without surgery (mean = 3.44 days). Mean hospital charges for patients who were drained surgically were almost twice those of patients who were managed medically ($28,969 vs $17,022); 165 patients (4.8%) had a complication. There are >3400 admissions for pediatric DNSIs annually, and they account for a significant number of inpatient days and hospital charges. A randomized controlled trial of management may be indicated from a public health perspective.

Infectious arteritis of the internal carotid artery complicating retropharyngeal abscess

IntroductionRetropharyngeal abscess is a well-known entity in children, but can also occur in adults. The two main vascular complications are vascular compression and pseudoaneurysm, while infectious arteritis of the internal carotid artery is exceptional. Case reportThe authors describe a case of a retropharyngeal abscess in an adult woman complicated by infectious arteritis of the internal carotid artery. This rare complication was treated by endovascular occlusion of the internal carotid artery and incision and drainage of the abscess in combination with antibiotic and anticoagulant therapy. The patient did not present any neurological sequelae and follow-up MRI did not reveal any signs of vascular or neurological complications. DiscussionThis case highlights the importance of thorough examination of imaging performed in the context of deep neck space abscess to detect signs of vascular involvement. Treatment must be aggressive in view of the life-threatening risk of arterial rupture or septic embolism. This is the first reported case of infectious arteritis involving the internal carotid artery complicating retropharyngeal abscess.

Deep neck infection: clinical analyses of 95 cases

To review the recent diagnosis and treatment experience with deep neck infection and emphasize the importance of radiologic evaluation, microbiology and appropriate treatment selection in these patients. A respective review was conducted in 95 cases who were diagnosed as having deep neck from Jan. 2006 to March 2015. The primary diseases in 95 patients with deep neck infection were acute tonsillitis or acute laryngitis (27 cases), infection of upper respiratory tract (23 cases), odontogenic infection or oral inflammation (16 cases), foreign bodies in esophagus (9 cases), acute cervical lymphadenitis (5 cases) and cause uncertain (15 cases). Computed tomography was performed in all of patients to identify the location, extent, and character (cellulitis in 47 cases or abscesses in 48 cases) of the infections. The locations of abscess were parapharyngeal abscess (25 cases), retropharyngeal abscess (9 cases), submaxillary space abscess (6 cases), pretracheal space abscess (5 cases) and esophageal abscess (3 cases). mediastinitis (2 cases), pericarditis (1 case), bilateral pneumothorax (2 cases), and upper digestive tract (1 case). Bacterial cultivation performed in 35 patients and positive results were detected in 21. All patients were given intravenous antibiotic therapy. Tracheotomy was performed in 4 cases. Preoperative contrast enhanced CT was performed in 42 patients and indicated the formation of abscess. Three cases with the symptoms of septic shock were transferred to ICU and one was cured. All the patients were cured except two who died of massive hemorrhage of upper digestive tract and septic shock. The airway patency in patients with deep neck infections must be ensured. Drainage may be mandatory in selected cases at presentation or in cases who fail to respond to parenteral antibiotics within the first 24-48 hours. Imaging evaluation plays a significant role in the diagnosis and rational therapeutic management in deep neck infection. Bacterial cultivation can help to make the effective treatment and provide reliable evidence for the etiopathogenisis.

Stepwise Therapy for Treating Tuberculosis of the Upper Cervical Spine: A Retrospective Study of 11 Patients

Aims: Tuberculosis of the upper cervical spine is a rare occurrence with serious consequence, and its optimal treatment protocol remains inconclusive. This study aims at investigating the clinical characteristics and management outcomes of the stepwise therapy for different stages of tuberculosis of the upper cervical spine. Methods: We conducted a retrospective analysis of 11 patients with tuberculosis of the upper cervical spine who received anti-tuberculosis chemotherapy for 15 months. Two infants were treated by individualized chemotherapy, while 9 patients with retropharyngeal abscess were first treated with CT-guided percutaneous puncture, and the catheter was used to administer local chemotherapy. Two of these 9 patients continued to receive posterior instrumentation due to atlantoaxial subluxation. Patients were followed up clinically and radiologically for an average period of 60 months. Results: Two patients underwent catheter change due to catheter falling off and blockage, 2 patients had gastrointestinal side effects, and 2 patients had drug-induced hepatitis derived from the chemotherapy. Mean erythrocyte sedimentation rate was 10.27 mm/h (range 4-16 mm/h) and average visual analogue scale score was 2.55. A total of 11 cases underwent routine anti-tuberculosis chemotherapy for 15 months. 9 of 11 cases received supplementary surgical therapy, and all patients were cured at the final follow-up. Conclusion: Standard anti-tuberculosis chemotherapy is the cornerstone of stepwise therapy for tuberculosis of the upper cervical spine. Local chemotherapy is effective and minimally invasive for patients with severe local symptoms without spinal cord compression. Just as in patients with atlantoaxial instability, open fixation and bone grafting are necessary.

Retropharyngeal Abscess related to Hematogenous Dissemination

ABSTRACT A retropharyngeal abscess is an infection in the deep space of the neck and it is a potentially life-threatening condition, because of severe complications. Today, it is rare in adults, but it is still present in immunosuppressed patients or after local trauma by foreign body. Diagnosis is challenging due to the variety of the symptoms and a computed tomography (CT) scan of the area is required. Its management requires highly specialized care, based on antibiotic therapy and surgical drainage of the abscess. We report a case of a retropharyngeal abscess in a diabetic patient, with renal nephropathy and end-stage renal failure. Interestingly, the abscess was inside the thoracic cavity and surgical procedure included also thoracotomy. How to cite this article Chalkiadakis V, Roukis G, Karatzias G, Androulakis M. Retropharyngeal Abscess related to Hematogenous Dissemination. Int J Otorhinolaryngol Clin 2015;7(2):85-87

Adult Retropharyngeal Abscess: A Retrospective Case Series

ABSTRACTIntroductionRetropharyngeal abscess (RPA), is a deep tissue neck infection. It is a serious and occasionally life-threatening infection due to the anatomic location and the potential for obstruction of the upper airway. The retropharyngeal space is found posterior to the esophageal wall and anterior to the prevertebral fascia. Lymph nodes found in this space drain the nasopharynx, paranasal sinuses and middle ear. Often infections of these areas will lead to infection in the retropharyngeal space. Atrophy of these lymph nodes at or before puberty has been found as an explanation of the predominance of RPAs in young children. In fact, some believe that they atrophy after 4 years of age. Once almost exclusively a disease of children, is observed with increasing frequency in adults. Retropharyngeal abscess poses a diagnostic challenge for the ENT surgeon because of its infrequent occurrence and variable presentation.Materials and methodsTen cases of adult retropharyngeal abscess were reviewed. The diagnostic criteria were radiological evidence of widening of pre-vertebral soft tissue shadow and presence of pus in the swelling.ResultsSore throat, fever, muffled speech, painful swallow and stiffness of the neck were common presenting symptoms. Lateral X-ray of the neck was diagnostic. Commonest organism isolated wasStreptococcus pyogenes. Airway obstruction was the commonest complication.DiscussionMost of the patients had history of trauma prior to the development of RPA. Computed tomography (CT) scan of neck and thorax has an important role in planning the management in addition to lateral X-ray of the neck. Transoral surgical drainage in association with antibiotics is the treatment of choice in abscesses confined to the retropharyngeal space.ConclusionTuberculosis is no longer the commonest cause of adult retropharyngeal abscess. Sore throat or dysphagia, disproportionate to clinical findings in the throat should arouse suspicion of RPA. Early intervention with antibiotics reduces the chances of the development of complications.How to cite this articleKumar N. Adult Retropharyngeal Abscess: A Retrospective Case Series. Int J Otorhinolaryngol Clin 2015;7(2):100-103.

Nonsurgical management of mediastinal abscess and Lemierre syndrome in an infant

Non-surgical management of descending necrotizing mediastinitis secondary to a retropharyngeal abscess is a viable management option in children in contrast to the adult experience. We describe a pediatric case that underwent incision and drainage of a retropharyngeal abscess but did not require surgical drainage of a subsequent mediastinal abscess because of excellent clinical and radiologic response to intravenous antibiotics. The patient also had a co-existing Lemierre syndrome. Methicillin-resistant Staphylococcus aureus was recovered from the purulent drainage of the retropharyngeal abscess.

Anaerobic bacteria in upper respiratory tract and head and neck infections in children: Microbiology and management

Anaerobes are the predominant components of oropharyngeal mucous membranes bacterial flora, and are therefore a common cause of bacterial infections of endogenous origin of upper respiratory tract and head and neck in children. This review summarizes the aerobic and anaerobic microbiology and antimicrobial therapy of acute and chronic upper respiratory tract infection and other head and neck infections. These infections include acute and chronic otitis media, mastoiditis and sinusitis, pharyngo-tonsillitis, peritonsillar, retropharyngeal and parapharyngeal abscesses, suppurative thyroiditis, cervical lymphadenitis, parotitis, siliadenitis, and deep neck infections including Lemierre syndrome. The recovery from these infections depends on prompt and proper medical and when indicated also surgical management.

Predictive value of the neutrophil-to-lymphocyte ratio in patients with deep neck space infection secondary to acute bacterial tonsillitis

ObjectiveThe aim of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) can be used as a predictor for deep neck space infections (DNSIs) that occur as a complication of acute bacterial tonsillitis in the pediatric population. Materials and methodsWe evaluated the NLR values of 180 pediatric patients diagnosed with acute bacterial tonsillitis with or without DNSI who presented to the Otolaryngology Department of Marmara University Hospital between 2010 and 2013. In cases in which DNSI was suspected, the patients underwent complete otolaryngological examination and radiological imaging including CT and MRI. NLR was calculated in all the subjects and was compared between the patients with acute bacterial tonsillitis without DNSI and those with DNSI. ResultsWith regard to the tonsillitis-related complications, 17 patients had peritonsillar abscess (9.4%); five, parapharyngeal abscess (2.8%); and two, retropharyngeal abscess (1.1%). The mean NLR was significantly higher in the patients of acute bacterial tonsillitis with DNSI (P<0.05). The optimum cut-off value of NLR was determined to be 5.4. ConclusionThis study is the first to investigate the relationship between NLR and DNSI as a complication of acute bacterial tonsillitis. The results demonstrated that the NLR value could be a potential laboratory parameter for diagnosing DNSIs.

Surgical treatment of a retropharyngeal abscess in a bull

A 12-month-old bull with chronic respiratory stridor and dysphagia was presented. Endoscopic evaluation of the upper airway revealed a large swelling of the dorsal pharynx, partially obstructing the airway. The...

Acute Mediastinitis as a Complication of Epstein-Barr Virus

Acute mediastinitis is a rare, potentially life-threatening condition that is most commonly seen as a complication of esophageal perforations or cardiac surgery. The term "descending necrotizing mediastinitis" (DNM) is used to describe oropharyngeal infections that spread to the mediastinum, most commonly following odontogenic infections, peritonsillar or retropharyngeal abscesses, cervical lymphadenitis, trauma, or endotracheal intubation. Infectious mononucleosis is another rare cause of DNM. The mortality of acute mediastinitis is high, while the mortality for DNM is even higher. Major determinants of mortality are delayed diagnosis and/or treatment. While DNM is seen infrequently, its severe nature makes it essential that emergency physicians consider the diagnosis in patients presenting with upper respiratory infections, chest pain, and systemic symptoms, and also in patients with a recent diagnosis of EBV, in order to mitigate a high rate of morbidity and mortality.

Osteomyelitis and Destruction of the Atlas and Axis in a 4-Week-Old Infant: 4-Year Follow-Up

Introduction Neonatal vertebral osteomyelitis is not an uncommon condition, but osteomyelitis simultaneously involving the atlas and the axis is distinctly unusual and no other infant case has been published so far in the literature. We present the case of an infant with retropharyngeal abscess, which led to the destruction of the C1–C2 vertebrae. Materials and Methods MRI examination revealed a multilocular abscess in the right mastoidal area penetrating to the cervical region and causing destruction of the C1 and C2 vertebrae, and an epidural abscess with signs of spinal cord compression at the level of the Th5–Th7 vertebrae. The retropharyngeal and thoracic abscesses were surgically removed and the therapy was completed with antibiotics. The child was placed in a custom-made fixation device for 8 weeks. Follow-up was performed with MRI, CT scans, and functional X-ray diagnostics. Results CT scans with 3D reconstruction demonstrated the absence of normal osseous structures at the craniospinal region, but undamaged ossification centers in the C3 vertebra and below. Functional X-ray diagnostics, performed in general anesthesia showed no significant instability of the cervical spine. Normal motor development and independent walking were allowed. During a 4-year long follow-up period, no signs of neurological impairment were observed, neck movements were limited but painless. It is assumed that the remnants of the bony elements of C1–C2 vertebrae and the massive interconnecting postinflammatory scar tissue make some degree of neck movements possible. His development was undisturbed, similar to his age group. Conclusion C1–C2 osteomyelitis is a very rare entity even in children. There is limited experience with treatment and rehabilitation, but the temporary immobilization of the neck, surgical debridement, antibiotic treatment, and continuous physiotherapy can be recommended. Close follow-up is required to check the reconstitution of affected bones and ligaments, any development of instability, and the necessity of surgical stabilization.

Carotid artery occlusion secondary to retropharyngeal abscess treated with endovascular carotid sacrifice

Introduction: Carotid occlusion is a rare but serious complication of retropharyngeal abscess (RPA). Management questions that must be addressed include the choice between reconstruction and occlusion in the setting of an active infectious process. Case Report: A 4 year old female presented with hoarseness, shortness of breath, and a right-sided Horner’s syndrome. A CT scan confirmed the diagnosis of RPA, and contrast studies showed no filling in the right internal carotid artery (ICA). Surgical exploration of the abscess disrupted the occluded artery, causing deep, uncontrolled bleeding. Emergent angiographic evaluation was completed, and the decision was made to sacrifice the ICA. The patient recovered on antibiotics, but the Horner’s syndrome persisted. Discussion: The presence of a carotid artery occlusion must be ruled out in the setting of a RPA. When suspected, it should be investigated further. Therapeutic decisions regarding sacrifice or reconstruction of the carotid artery are burdened by risks associated with the setting of an infection, notably infection and systemic dissemination. Conclusion: The presence of a carotid occlusion is a serious complication resulting from a RPA that can lead to permanent neurological deficit. Endovascular vessel sacrifice is a viable treatment option for carotid occlusion in the setting of a retropharyngeal abscess, but must be considered on a case-by-case basis.

Calcific Tendinitis Of The Longus Colli Muscle

HISTORY: A 43 year old Arabic speaking female with history of chronic headaches presented to the Emergency Department with a 2 day history of left sided neck pain, odynophagia and urinary symptoms. She was diagnosed with strep pharyngitis and a UTI and treated with Amoxicillin, Ciprofloxacin, Phenazopyridine, and mouthwash. While on antibiotic therapy, she noted an improvement in her urinary symptoms but her head, neck and throat pain and fevers continued to worsen. Ibuprofen caused mild improvement in her symptoms. She was seen in our clinic two days after her Emergency Department visit. PHYSICAL EXAMINATION: Pharynx non-erythematous, no tonsil hypertrophy, no cervical lymphadenopathy. Head tilted to right, unable to open mouth widely or turn head/neck due to pain. Tenderness to palpation over mastoid as well as entire left side of neck. Increased tone to left side of head/neck musculature. DIFFERENTIAL DIAGNOSIS: 1. Infectious spondylitis 2. Mastoiditis 3. Retropharyngeal abscess 4. Torticollis 4. Calcific tendinitis TEST AND RESULTS: Neck Soft Tissue Computerized Tomography with and without contrast — No abscess/signs of pharyngitis, visible fluid collection, or inflammation. — C1-C2 calcification of the longus colli tendon. — Multiple indeterminate lymph nodes FINAL/WORKING DIAGNOSIS: Calcific tendinitis of the longus colli muscle TREATMENT AND OUTCOMES: 1. Conservative management was started with anti-inflammatory medications 2. Patient returned 3 weeks later and was symptom free 3. If symptoms are severe, a course of oral corticosteroids can be considered

Adult retropharyngeal abscess

ABSTRACTIntroductionThe proportion of adults suffering from retropharyngeal abscess (RPA) has increased in comparison to children.Materials and methodsEight cases of adult retropharyngeal abscess were reviewed. The diagnostic criteria were radiological evidence of widening of pre-vertebral soft tissue shadow and presence of pus in the swelling.ResultsSore throat, fever, muffled speech, painful swallow and stiffness of the neck were common presenting symptoms. Lateral X-ray of the neck was diagnostic. Commonest organism isolated was Streptococcus pyogenes. Airway obstruction was the commonest complication.DiscussionMost of the patients had history of trauma prior to the development of RPA. CT scan has an important role in planning the management in addition to lateral X-ray of the neck. Transoral surgical drainage in association with antibiotics is the treatment of choice in abscesses confined to the retropharyngeal space.ConclusionTuberculosis is no longer the commonest cause of adult retropharyngeal abscess. Sore throat or dysphagia, disproportionate to clinical findings in the throat should arouse suspicion of RPA. Early intervention with antibiotics reduces the chances of the development of complications.

Eighty-year-old man with 10 years dysphagia

AbstractDysphagia is a sensation of food being "stuck" up in its passage from the mouth to stomach. It is of two main types, oropharyngeal dysphagia, and esophageal dysphagia. In oropharyngeal dysphagia, there is difficulty in transferring the food from the mouth to upper esophagus. Thus, this dysphagia is also called as transfer dysphagia. It occurs within 1 st 1-2 s of the swallow. We also call this dysphagia as instant dysphagia. It is almost always associated with sinobronchial symptoms. The second type of dysphagia is esophageal dysphagia in which there is difficulty in passing the food from upper esophagus to the stomach. The two main mechanisms responsible for dysphagia are either a problem with the motor function of oropharynx or esophagus (neuromuscular causes) or mechanical narrowing of oropharynx or esophagus (mechanical dysphagia). As this dysphagia occurs a little later in the act of swallowing, we can call it delayed dysphagia. The mechanical cause of dysphagia includes benign strictures, malignancies, webs and rings, retropharyngeal abscesses, Zenker′s diverticulum, cricopharyngeal bar, and some vascular causes. We report an 80-year-old male with vascular dysphagia.

Retropharyngeal and Parapharyngeal Abscesses Among Children and Adolescents in the United States: Epidemiology and Management Trends, 2003-2012.

The epidemiology and hospital course of children with retropharyngeal abscess (RPA) or parapharyngeal abscess (PPA) have not been fully described at the national level in the United States. Pediatric discharges for PPA and RPA were evaluated by using the Kids' Inpatient Database from 2003, 2006, 2009, and 2012. Cases were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes 478.22 and 478.24 for PPA and RPA, respectively. Nationally representative incidence data were calculated by using weighted case estimates and US census data. Demographic and cost analyses were conducted by using unweighted analyses. There were 2685 hospital discharges for PPA and 6233 hospital discharges for RPA during the 4 study years combined. The incidence of RPA increased from 2.98 per 100 000 population among children <20 years old in 2003 to 4.10 per 100 000 in 2012. The incidence of PPA peaked at 1.49 per 100 000 in 2006. Incidences were highest among children <5 years old and boys in all age groups for PPA and RPA. Winter-to-spring seasonality also was evident for both. PPA was managed surgically in 58.1% of the cases, and RPA was managed surgically in 46.7%. Surgery was performed most often on the day of admission or the following day, was more frequent at teaching hospitals, and was associated with higher hospital charges. The mean hospital length of stay was longer for children who had surgery versus those who did not (4.4 vs 3.1 days [for PPA] and 4.8 vs 3.2 days [for RPA], respectively; both P < .001). The median charges for RPA and PPA were similar. The proportions of children with RPA or PPA covered by Medicaid increased during the study period. PPA and RPA represent relatively common male-predominant childhood infections with similar epidemiologies. The incidence of hospital discharges with a diagnosis of RPA increased during the study period. Substantial proportions of children with PPA or RPA are now managed without surgery. Surgical drainage was associated with higher hospital charges and longer lengths of stay.

Imaging appearance of dextranomer/hyaluronic acid copolymer implant injections for treatment of velopharyngeal insufficiency.

Dextranomer/hyaluronic acid copolymer implants are used in treating velopharyngeal insufficiency. These posterior nasopharyngeal implants can be mistaken for pathologic conditions such as retropharyngeal abscess on imaging. We studied the imaging appearance of dextranomer/hyaluronic acid copolymer implants in patients treated for velopharyngeal insufficiency. A consecutive series of patients with velopharyngeal insufficiency treated with dextranomer/hyaluronic acid copolymer were included in this study. Data on patient characteristics and volume of dextranomer/hyaluronic acid copolymer injected were obtained. Postoperative imaging characteristics on plain radiography, CT, and MR imaging were assessed. The imaging appearance of postoperative complications was determined. Sixteen patients were included in this study. Seven patients underwent postoperative plain radiographs, 5 patients underwent CT, and 9 patients underwent MR imaging. Plain radiographs demonstrated soft-tissue swelling in the retropharyngeal space, which resolved at 1 month. On CT, dextranomer/hyaluronic acid copolymer implants appeared as bilateral nasopharyngeal soft-tissue masses isoattenuated to hypoattenuated relative to muscle in 80% (4/5) of patients. On MR imaging, dextranomer/hyaluronic acid copolymer implants appeared as bilateral nasopharyngeal soft-tissue masses that were isointense to muscle on T1 (8/9, 88.9%) and hyperintense to muscle on T2 (8/9, 88.9%) and demonstrated no restricted diffusion (4/4, 100.0%) or peripheral enhancement (7/7, 100.0%). The normal postoperative findings of posterior nasopharyngeal dextranomer/hyaluronic acid copolymer injection on MR imaging is characterized by the presence of bilateral nasopharyngeal soft-tissue masses that are isointense to muscle on T1 and hyperintense on T2, with no restricted diffusion or peripheral enhancement. Velopharyngeal dextranomer/hyaluronic acid copolymer implants are iso- to hypoattenuated to muscle on CT and are not visible radiographically once associated implantation-related swelling has resolved.

National trends in retropharyngeal abscess among adult inpatients with peritonsillar abscess.

To describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA) and to determine factors associated with RPA in patients with PTA. Cross-sectional analysis. Nationwide Inpatient Sample, 2003-2010. PTA patients ≥18 years old, with or without RPA, were extracted according to ICD-9-CM codes. The cohort was analyzed with descriptive statistics and multivariate regression modeling to identify factors associated with RPA. Of the 91,647 (95% CI: 86,433-95,449) patients identified with PTA, 885 (1.0%) also had a concurrently coded RPA. The annual rate of concomitant RPA increased from 0.5% (95% CI: 0.3%-0.8%) to 1.4% (95% CI: 1.0%-2.0%) between 2003 and 2010 (P < .001). PTA patients with RPA more frequently underwent tonsillectomy (23.5% vs 11.1%), endotracheal intubation (7.1% vs 1.5%), and mechanical ventilation (13.2% vs 2.0%) than those without RPA (all P < .001). PTA patients with RPA were significantly older (41 vs 34 years old), had a longer hospital stay (6.4 vs 2.5 days), and had more procedures (2.5 vs 0.9) when compared to patients without RPA (all P < .001). Upon multivariate regression analysis, factors associated with RPA included the age groups of 40 to 64 years (odds ratio, 2.256; P < .001) and 65 and older (odds ratio, 2.086; P = .045). Median total charges for PTA inpatients with concomitant RPA were approximately $8700 greater (P < .001) when compared to patients with PTA alone. The incidence of RPA among adult inpatients with PTA is increasing, and patients with RPA have higher in-hospital resource utilization. Further studies may help validate factors predictive of RPA to enable prevention or earlier identification.

Retropharyngeal Abscess in Adults – Varied Etiology

Objective: We present a series of three different cases of Retropharyngeal Abscess with different presentation, etiology and treatment. Method: We reviewed the data of adult patients with retropharyngeal abscess treated in the department of Otorhinolaryngology with three different etiology and presentation. Results: Retropharyngeal abscess can have different presentation dependent upon the varied etiology. xray of neck was useful in diagnosis of all the cases. Culture of the causative organism is necessary for appropriate treatment. Conclusion: Retropharyngeal abscess are rare in adults and a high index of suspicion is required for correct and early diagnosis and institution of treatment. The therapy depends upon the etiology and causative organism.