With more and more ENT specialist resigning their hospital affiliations in favor of outpatient surgical centers it is getting harder and harder to find an oncall ENT to treat an ENT emergency. Peritonsillar abscesses and the need for drainage are a common reason to initiate a transfer. If you are unable to transfer your patient, here are some tips on how to do a needle aspiration safely.
The carotid artery lies lateral and posterior to the tonsil. Any attempts should be done anteriorly, and medial to the peritonsillar pillar.
The incision is made superior to the tonsil in the area of the soft palate. The abscess is normally located in the peritonsillar soft tissues of the soft palate.
Needle aspiration: Needle aspiration can be therapeutic in itself; in some studies, up to 85% of patients were effectively treated with outpatient needle aspiration and oral antibiotics.
Consider cutting the cap of the needle or scalpel so that once it is replaced only a portion of the needle /scalpel is exposed. This will help prevent you from inadvertently inserting the needle//scalpel to deeply.
A single high dose of steroid (decadron 10 mg) prior to antibiotic therapy dramatically improves symptoms of patients with PTAs postdrainage.
Streptococcus pyogenes (group A beta-hemolytic streptococcus) is the most common aerobic organism, and fusobacterium is the most common anaerobic organism. However, most abscesses contain a mixture of aerobic and anaerobic organisms. Consider Penicillin VK, Clindamycin, or Augmentin. If no response to Penicillin VK in 24 hours consider the addition of metronidazole
Disclaimer: Any and all procedures should only be done by properly trained and qualified individuals. These pearls do not meet the standard for proper training and/or qualification.
