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Bilateral Intratonsillar Abscesses: A Deceiving Symmetrical Oral Bulging
Matityahou Ormianer1, Benjamin Z Koplewitz2, Ron Eliashar1
1Department of Otolaryngology/Head, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
The Israel Medical Association Journal : IMAJ
|January 31, 2023
Summary
Bilateral intratonsillar abscess (ITA) is rare and challenging to diagnose due to symmetrical symptoms. Early suspicion and imaging are key for prompt treatment of this deceiving condition.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Infectious Diseases
Background:
- Unilateral intratonsillar abscess (ITA) is a known complication of acute tonsillitis, but bilateral ITA is extremely rare.
- The prevalence of unilateral ITA is significantly higher than bilateral ITA, with only four cases previously reported.
Purpose of the Study:
- To review existing literature on bilateral ITA and present a new case.
- To highlight the diagnostic challenges and surgical management of bilateral ITA.
Main Methods:
- A literature search was performed on PubMed using keywords related to tonsillar and peritonsillar abscesses.
- The search was limited to publications between 1980 and 2020.
Main Results:
- Only four cases of bilateral ITA were previously documented, all showing delayed diagnosis (median 10 days) due to symmetrical presentation.
- Symptoms included enlarged bilateral tonsils, and treatment involved surgical drainage or paracententesis, with respiratory compromise being a concern.
- The presented case, the fifth reported and first in a pediatric patient, was successfully treated with bilateral quinsy tonsillectomy.
Conclusions:
- Bilateral ITA is a rare and deceptive condition, often presenting with symmetrical oral bulging that delays diagnosis.
- A high index of suspicion and appropriate imaging are crucial for accurate diagnosis and timely treatment.
- This study contributes the fifth reported case and the first pediatric case, offering insights into pathogenesis and management.
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