Peritonsillar abscess physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

On physical examination, patients are usually acutely ill-looking and may have high temperature, muffled voice (also called “hot potato voice”), contralateral deflection of the uvula, the tonsil is generally displaced inferiorly and medially, facial swelling, tonsillar hypertrophy, trismus, drooling, tenderness of anterior neck and tender submandibular and anterior cervical lymph nodes^[1][2][3][4]

Physical examination findings suggestive of peritonsillar abscess include the following:^[1][5][3][4]

• They are usually acutely ill-looking.

• High temperature

• Muffled voice (also called “hot potato voice”)
• Contralateral deflection of the uvula (see image below)
• The tonsil is generally displaced inferiorly and medially
• Facial swelling
• Tonsillar hypertrophy with likely peritonsillar edema (see image below)
• Trismus
• Drooling
• Rancid or fetor breath

The image below shows edematous and inflamed tonsil on the right with contralateral uvula deviation:^[6]

• Tenderness of anterior neck
• Tender submandibular and anterior cervical lymph nodes

• May be in obvious respiratory distress with flaring of ala nasi, subcostal and intercostal recessions.
• Increased respiratory rate in both children and adults
• Decreased air-entry depending on degree of airway obstruction

• Cyanosis

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