Intratonsillar abscesses, or simply tonsillar abscesses, are uncommon complications of tonsillitis in which pus accumulates focally in the parenchyma of the tonsil (within the capsule).
They can occur in both children and adults, but their incidence is not well-defined. In a recent series from one institution, intratonsillar abscesses were 7-9% of identified cases of intratonsillar or peritonsillar abscesses 1,3.
Patients present with sore throat and fever for several days 2,3,11. Compared to patients who have peritonsillar abscess, those with intratonsillar abscess are less likely to have otalgia, trismus, or voice changes 1,3,11.
It is postulated that with swelling of the tonsil and alterations in lymphatic flow, the crypts are obstructed, accumulate inflammatory debris, and form an abscess 2,4.
Contrast-enhanced CT demonstrates an enlarged palatine tonsil with a central area of hypoattenuation and surrounding rim enhancement 1,2,4-9. There is tonsillar tissue surrounding the abscess, distinguishing this from peritonsillar abscess, but the two entities can coexist 3.
MRI demonstrates a rounded lesion in the tonsil with the following appearance 10:
- T2: central hyperintensity and hypointense rim
- T1 FS C+: central non-enhancement and rim enhancement
The peritonsillar tissues also have high signal on T2 weighted images and T1 fat suppressed postcontrast images, consistent with tonsillitis/peritonsillitis.
Treatment and prognosis
Compared to peritonsillar abscess, incision and drainage or needle aspiration of intratonsillar abscess is less likely to be successful if attempted 1. Moreover, recurrence after antibiotic therapy is less common with intratonsillar than peritonsillar abscesses 1,2. Thus, many otolaryngologists prefer medical management over procedural drainage for intratonsillar abscess 1,2,5, while some attempt drainage in some scenarios 6-9.
- 1. Ahmed Ali S, Kovatch KJ, Smith J, Bellile EL, Hanks JE, Truesdale CM, Hoff PT. Predictors of intratonsillar abscess versus peritonsillar abscess in the pediatric patient. (2018) International journal of pediatric otorhinolaryngology. 114: 143-146. doi:10.1016/j.ijporl.2018.08.042 - Pubmed
- 2. Giurintano JP, Kortebein S, Sebelik M, Thompson J, McLevy-Bazzanella J. Intratonsillar abscess: A not-so-rare clinical entity. (2019) International journal of pediatric otorhinolaryngology. 119: 38-40. doi:10.1016/j.ijporl.2018.12.039 - Pubmed
- 3. Ali SA, Kovatch KJ, Smith J, Bellile EL, Hanks JE, Truesdale CM, Hoff PT. Predictors of intratonsillar versus peritonsillar abscess: A case-control series. (2019) The Laryngoscope. 129 (6): 1354-1359. doi:10.1002/lary.27615 - Pubmed
- 4. Blair AB, Booth R, Baugh R. A unifying theory of tonsillitis, intratonsillar abscess and peritonsillar abscess. (2015) American journal of otolaryngology. 36 (4): 517-20. doi:10.1016/j.amjoto.2015.03.002 - Pubmed
- 5. Ulualp SO, Koral K, Margraf L, Deskin R. Management of intratonsillar abscess in children. (2013) Pediatrics international : official journal of the Japan Pediatric Society. 55 (4): 455-60. doi:10.1111/ped.12141 - Pubmed
- 6. Hsu CH, Lin YS, Lee JC. Intratonsillar abscess. (2008) Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 139 (6): 861-2. doi:10.1016/j.otohns.2008.09.010 - Pubmed
- 7. Singh GB, Kumar D, Arora R, Garg S, Ranjan S. A Rare Case of Intratonsillar Abscess in an Adult. (2015) Clinics and practice. 5 (4): 804. doi:10.4081/cp.2015.804 - Pubmed
- 8. Wang AS, Stater BJ, Kacker A. Intratonsillar abscess: 3 case reports and a review of the literature. (2013) International journal of pediatric otorhinolaryngology. 77 (4): 605-7. doi:10.1016/j.ijporl.2012.12.034 - Pubmed
- 9. Gan EC, Ng YH, Hwang SY, Lu PK. Intratonsillar abscess: a rare cause for a common clinical presentation. (2008) Ear, nose, & throat journal. 87 (12): E9. Pubmed
- 10. Añaguari BN, Rebollo J, Montes C. Intratonsillar abscess, a rare cause of odynophagia. (2017) Acta otorrinolaringologica espanola. 68 (4): 246-247. doi:10.1016/j.otorri.2016.05.004 - Pubmed
- 11. Childs EW, Baugh RF, Diaz JA. Tonsillar abscess. (1991) Journal of the National Medical Association. 83 (4): 333-6. Pubmed