Peritonsillar Abscess: A Cohort Study of an Unusual Imaging and Needle Guidance Approach

Objective: The purpose of this study was to establish a noninvasive, safe, and reliable sonographic technique for evaluating peritonsillar abscess and subsequent drainage. Also, of paramount interest to the emergency physicians was to determine whether this imaging technique could assist in localization and drainage of a tonsillar abscess, minimizing the risk of patient complications. Materials and Methods: This was a prospective nonrandomized study, conducted in a small urban community hospital. All sonographic examinations were performed by the staff sonographers. Imaging procedures were performed using a GE Logiq 9 or E9 ultrasound equipment system (GE Medical, Waukesha, Wisconsin). A broad-band curved linear array transducer (9L) was used to visualize the affected tonsil through a submandibular approach. An endocavity transducer (5 to 9 MHz) was used for all trans-oral cavity imaging. All aspirations were performed with an 18-G 20-cm Trocar needle (Cook Medical LLC. Bloomington, IN) inserted through a commercially available needle guide attachment (CIVCO Medical Solutions. Kalona, IA). Results: A total of 91 patients (N = 50 males and N = 41 females) are included in this cohort study. The patients ranged in age from 10 to 80 years of age and the average age was 34 years. In this patient cohort, 87 abscesses were found, and five patients had bilateral peritonsillar abscess. Of the remaining patients, one had inflammatory lymph nodes and four inflamed tonsils without abscess. All abscesses were successfully drained without complications. Conclusion: This level of evidence demonstrates a possible method is safer, which may be more effective than a nonimaging approach for needle aspiration. This technique is easily applied by both physician and sonographer with minimal training.