Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis

Infection around the tonsillar region does not always mean the presence of a peritonsillar abscess although the condition of peritonsillitis without abscess formation may clinically present similarly. It is, however, of therapeutic importance to distinguish between the two conditions. Treatment for abscess is surgical: aspiration, incision and drainage or immediate tonsillectomy. In contrast, phlegmonous peritonsillitis only requires antibiotics. In order to evaluate the diagnostic implications of preoperative ultrasonography in patients referred for treatment of peritonsillar abscess, 27 consecutive patients were subjected to bilateral ultrasound examination to visualize the tonsillar region. The transducer used was placed just below the mandibular angle, pointing posteriorly and cranially. The results of this study showed that it was possible to verify the presence of an abscess in approximately 90% of the cases. We suggest that this examination be performed whenever the normal clinical examination is insufficient due to trismus, lack of patient cooperation, etc.