Is there a consensus on peritonsillar abscess management?-an audit of a tertiary hospital in Australia

Background: Peritonsillar abscess is the most common deep space infection of the head and neck. It can have life threatening complications if inadequately treated. The study aimed to analyse the workup and management trends of peritonsillar abscess presentations in a tertiary Australian hospital. Methods: A retrospective electronic medical records review was undertaken on all patients who presented with peritonsillar abscess or peritonsillar cellulitis between July 1, 2016 and June 30, 2021, at Nepean Hospital, Sydney, Australia. Data on age, sex, Aboriginal and/or Torres Strait Islander background, length of stay, month of presentation, smoking and alcohol status, microbiology, utilisation of computed tomography (CT) scan, management (medical and/or surgical), tonsillectomy performed, and tonsillar malignancy were extracted and analysed. Results: A total of 291 patients were identified in this 5-year period. The mean age was 34 years with a male predominance (56%). Group A Streptococcus and Streptococcus milleri were the most common pathogens, although 29% of swabs grew normal respiratory flora or no growth at all. CT scans were performed for 26% of patients. Combination intravenous antibiotics and steroids were used as the preferred medical management for 97% of patients. Needle aspiration and incision and drainage as a combination surgical therapy was performed for 40% of cases. Conclusions: There is considerable heterogeneity within the workup and management of peritonsillar abscess presentations in this tertiary Australian hospital. The role of swabs is questionable given it did not change management. CT scans are not recommended routinely. Further studies are warranted to formulate a consensus for the workup and management of peritonsillar abscesses.