Summary

Point-of-care ultrasound is an ideal tool for differentiating between peritonsillar cellulitis and peritonsillar abscess in the emergency department. A defined analgesic/anti-inflammatory “cocktail” will facilitate patient comfort and a thorough examination of the posterior pharynx. Finally, a clear scanning protocol that includes identifying the unaffected tonsil prior to the evaluation of the affected peritonsillar space will improve accuracy.

Question: Is the submandibular approach for identification of a peritonsillar abscess useful in the emergency department? If so, how is it performed?

Answer: The transcutaneous submandibular approach to peritonsillar abscess identification is performed with a high frequency linear probe. Place the probe below the mandible, aiming cephalad towards the peritonsillar region. Similar to the intraoral approach, we recommend trying to identify the contralateral/unaffected palatine tonsil. The transcutaneous approach is useful in patients with severe trismus, who are unable to open the mouth to tolerate an intraoral probe.^4,6

Bibliography

1. Clin Otolaryngol 2012 Apr;37(2):136–145.
2. Acad Emerg Med 2005 Jan;12(1):85–88.
3. Acad Emerg Med 2012 Jun;19(6):626–631.
4. Braz J Otorhinolaryngol 2006 Jun;72(3):377–381.
5. AJR Am J Roentgenol 2005 May;184(5):1691–1699.
6. Am J Emerg Med 2013 Jan;31(1):267.e1–3.

Dr. Miss is an emergency ultrasound fellow and attending physician in the Department of Emergency Medicine at Alameda County Medical Center, Highland General Hospital, Oakland, Calif.; Dr. Herring is an emergency ultrasound fellow and attending physician in the Department of Emergency Medicine, Alameda County Medical Center, Highland General Hospital, Oakland, Calif.; Dr. Mantuani is an attending physician

in the Department of Emergency Medicine, Alameda County Medical Center, Highland General Hospital, Oakland, Calif.; and Dr. Nagdev is the director of emergency ultrasound, Department of Emergency Medicine, Alameda County Medical Center, Highland General Hospital, Oakland, Calif.