An evidence-based review of peritonsillar abscess.

OBJECTIVE OF REVIEW: We present the current literature surrounding peritonsillar abscess management highlighting areas of controversy. TYPE OF REVIEW AND SEARCH STRATEGY: Literature review using Medline and Embase databases (search terms 'peritonsillar abscess', 'peritonsillar infection' and 'quinsy') limited to articles published from 1991 to 2011 (English language).
RESULTS: (i) INVESTIGATIONS: Intraoral ultrasound has a sensitivity and specificity of between 89-95% and 79-100%, respectively, for correctly diagnosing peritonsillar abscess and is underutilised currently. (ii) Medical management: Steroids can effectively aid recovery, reducing hospitalisation time and improving symptom relief; however, further study is needed, especially related to risk and cost benefit. Penicillin and metronidazole are an effective combination in 98-99% of cases of peritonsillar abscess. (iii) Surgical management: Overall, there is no convincing evidence in favour of either aspiration or incision & drainage. Quinsy tonsillectomy is subject to great geographical variation, however, is a safe procedure and reduces overall recovery time when compared with interval tonsillectomy. (iv) Admission: peritonsillar abscess can be effectively managed as an outpatient in many cases. (v) Further management: Overall, the recurrence rate of peritonsillar abscess is poorly defined but estimated as 9-22% based on current evidence. Interval tonsillectomy may be indicated in selected groups of patients at high risk of recurrence.
CONCLUSIONS: Peritonsillar abscess is a common condition with increasing incidence. We demonstrate the potential for evidence-based modifications in clinical management. However, lack of national consensus may mean that this evidence base is not being adequately exploited in current practice. A national audit of peritonsillar abscess management, in particular looking at recurrence rates and patient experience with different management strategies, appears indicated.