How is aspiration performed in the treatment of peritonsillar abscess (PTA)?

Updated: Apr 06, 2020
  • Author: Udayan K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

An 18-gauge needle on a 1 mL tuberculin syringe is placed into the pointing area, taking care not to penetrate the pharyngeal mucosa more than 1 inch in order to prevent injury to the vessels and nerves of the parapharyngeal space. Bending a sheathed needle at 2 points may prevent deeper injury during aspiration. [31] If attempt at aspiration from 3 different peritonsillar sites does not locate the abscess, the patient should be treated with oral or IV antibiotics. If symptoms persist after 24-48 hours of therapy, CT scanning with contrast may be performed.

Once purulence is detected, complete aspiration may be attempted. Sufficient material should be available for Gram stain and cultures with antibiotic sensitivities. Not all patients need microbiologic evaluation. For those who are immunosuppressed or who have developed a PTA after several days of appropriate antibiotic therapy, aspirated material should be sent for Gram stain, culture, and sensitivity tests.


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