What is the best way to differentiate tonsillopharyngitis from a peritonsillar abscess? — Any Rozelle, NP, St. Petersburg, Fla.

Tonsillopharyngitis can be caused by viral infections or by bacterial infections, the most common of which is group A beta-hemolytic streptococci (GABHS). The typical presenting symptoms of GABHS tonsillopharyngitis are sudden onset of sore throat, pain on swallowing, fever and the absence of cough or rhinorrhea. Physical exam findings include tonsillopharyngeal erythema, with or without tonsillar exudate and swollen, tender anterior cervical nodes.

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A peritonsillar abscess is a suppurative complication of bacterial tonsillitis, usually caused by GABHS, and involves extension of the infection through the tonsillar fibrous capsule into the peritonsillar space. Presenting symptoms of peritonsillar abscess include fever, malaise, sore throat, odynophagia, dysphagia, trismus and voice change (often referred to as “hot potato voice”).

Physical exam may reveal asymmetric edema of the palate, contralateral deflection of a swollen uvula, fluctuant peritonsillar fullness, drooling, and cervical adenopathy. This infection requires immediate attention. Needle aspiration of the peritonsillar space is recommended and is most accurately done by an experienced otolaryngologist. — Eileen F. Campbell, MSN, CRNP (155-10)