Computed Tomographic and Clinical Findings Predictive of Successful Peritonsillar Abscess Drainage

Prompt diagnosis of a peritonsillar abscess (PTA) is critical to prevent complications such as airway compromise. Bedside drainage and medical therapy are the mainstays of treatment, but there is a lack of research into clinical and radiographic markers that are predictive of successful PTA drainage. In this study, we sought to identify those factors.

We retrospectively analyzed all patients who presented to our Emergency Department from January 2013 to December 2023 with PTA for whom a CT neck was obtained. Patient demographics, medical history, radiographic imaging, procedures performed, and clinical course were collected. A multivariable analysis was run to determine which factors were predictive of successful PTA drainage.

One hundred thirty-two patients met inclusion criteria. There were 72 males. The mean age was 41 years. Patients who had successful PTA drainage had larger abscesses (largest cross-sectional dimension 26.38 vs. 20.02 mm, p < 0.001). They were also more likely to have soft palate effacement (53.7% vs. 34.0%, p = 0.028) and continuous ring enhancement on CT (75.0% vs. 50.9%, p = 0.003), whereas patients who had unsuccessful drainage were more likely to have higher temperature (99.40°F vs. 98.67°F, p = 0.003).

Clinical and CT parameters were useful in predicting successful PTA drainage. Soft palate effacement, continuous ring enhancement, and size of abscess were statistically significant predictors and can be used to guide management.