Effective triage leads to swift treatment.
- Peritonsillar abscesses typically develop after acute tonsilitis.
- They’re most common in adolescents.
- Rapid assessment and intervention are essential to prevent sepsis and airway compromise
WILLIAM JONES*, a 19-year-old with no significant past medical history, develops a sore throat that progressively worsens over 4 days. A change in his voice prompts an ED visit.
History and assessment
When William arrives in the ED, he tells Kara, a triage nurse, that he has right-sided throat pain with radiation to his right ear, subjective fever, and odynophagia. He’s been taking OTC ibuprofen every 8 hours without symptom improvement. Kara assesses William’s vital signs: temperature 38.8° C (101.8° F), HR 115 bpm, RR 22 breaths per minute, BP 106/54 mmHg, and O2 saturation 97% on room air.
Kara notes William’s “hot potato” muffled voice. She attempts to visualize his pharynx, but he can’t fully open his mouth. Concerned about a peritonsillar abscess, Kara secures a bed for William and notifies the nurse practitioner (NP) on duty.
Taking action
Kara places William on a cardiac monitor with continuous pulse oximetry monitoring. The NP’s assessment reveals halitosis, trismus, cervical lymphadenopathy (right greater than left), and right tonsil measuring grade +3 with swelling and deviation of the uvula to the left. The NP orders a STAT CBC, CRP, two sets of blood cultures, and a CMP.
The otolaryngologist’s bedside intraoral ultrasound reveals a 1.7 cm peritonsillar abscess. He anesthetizes the oral and laryngeal mucosa with 20% benzocaine spray before incising and draining the abscess. The purulent drainage is sent to the lab. The NP orders 0.9% normal saline infusion at 100 mL/hr and a 10 mg dose of I.V. dexamethasone.
Outcome
In the medical observation unit, nursing interventions include airway and bleeding monitoring, maintaining the head of bed at 45 degrees, and pain assessments. After ensuring William isn’t allergic to penicillin agents, his nurse starts 3 g I.V. ampicillin/sulbactam every 6 hours as well as oral analgesics and antipyretics as ordered. William is instructed to gargle with sodium chloride solution four times per day.
William’s trismus resolves over 24 hours. Culture and sensitivity results show Streptococcus pyogenes, susceptible to ampicillin/sulbactam. William is transitioned to amoxicillin/clavulanate potassium 875/125 mg twice daily for 14 days and discharged home with primary care and otolaryngology follow-up. Nursing education includes medication adherence, signs of recurrence, and when to seek emergency care.
Education and follow-up
Peritonsillar abscesses are localized collections of purulent fluid in the peritonsillar space between the superior constrictor muscle and tonsillar capsule. Although the exact pathophysiology of peritonsillar abscesses remains unknown, cultures frequently reveal Group A beta-hemolytic Streptococcus bacteria.
Symptoms include unilateral throat pain, earache from referred pain, odynophagia, poor oral hygiene and halitosis, neck pain from cervical lymphadenopathy, trismus from inflammation of the pterygoid muscles, muffled voice, fever, and chills. Physical examination typically reveals cervical lymphadenopathy; a tonsil pushed downward and medially; swollen, laterally displaced, and edematous uvula; and a bulge on the soft palate and anterior tonsillar pillar. Following diagnosis, antibiotic therapy is the mainstay of treatment. (See Peritonsillar abscess: Diagnosis and treatment)
Peritonsillar abscess: Diagnosis and treatment
In mild cases, the diagnosis of peritonsillar abscess may be made clinically. Many clinicians use intraoral ultrasonography to differentiate peritonsillitis from peritonsillar abscess.
Antibiotic therapy and supportive care remain the mainstay of treatment, with antibiotic therapy adjusted based on culture and sensitivity reports, as available. I.V. antibiotics should be transitioned to oral when patients can tolerate oral liquids.
Otolaryngology evaluation and management include ultrasonography, incision and drainage, and follow-up care.
Peritonsillar abscesses and associated complications, including sepsis and airway compromise, can be fatal, making timely diagnosis and definitive treatment critical. Kara’s triage assessment facilitated the swift implementation of an evidence-based treatment plan.
*Names are fictitious
Aaron Sebach is dean and professor in the College of Nursing and Health Sciences at Wilmington University in New Castle, Delaware, and a mobile integrated health nurse practitioner at TidalHealth in Salisbury, Maryland. Jessica Stoner is a mobile integrated health nurse practitioner at TidalHealth.
American Nurse Journal. 2026; 21(6). Doi: 10.51256/ANJ062656
References
Gibbons RC, Costantino TG. Evidence-based medicine improves the emergent management of peritonsillar abscesses using point-of-care ultrasound. J Emerg Med. 2020;59(5):693-8.doi:10.1016/j.jemermed.2020.06.030
Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob.2020;19:32. doi:10.1186/s12941-020-00375-x
Krishnaprasadh D, Hohman MH, McDowell RH. Peritonsillar abscess. StatPearls. 2026. ncbi.nlm.nih.gov/books/NBK519520/
Long B, Gottlieb M. Managing peritonsillar abscess. Ann Emerg Med. 2023;82(1):101-7.doi:10.1016/j.annemergmed.2022.10.023
Rebusi N, Paras ML, Barshak MB. Acute pharyngitis, tonsillitis, and peritonsillar abscess. In: Durand ML, Deschler DG (eds). Infections of the Ears, Nose, Throat, and Sinuses. Princeton, NJ: Springer; 2024.
Wu V, Kolarski MM, Kandel CE, Monteiro E, Chan Y. Current trend of antibiotic prescription and management for peritonsillar abscess: A cross-sectional study. LaryngoscopeInvestig Otolaryngol. 2021;6(2):183-7.doi:10.1002/lio2.538
Keywords: peritonsillar abscess, tonsilitis, triage
