A Novel Technique for Intraoral Ultrasound-Guided Aspiration of Peritonsillar Abscess

Abstract

Peritonsillar abscess (PTA) is a common complication to acute tonsillitis. The treatment is drainage of the abscess, but many needle aspirations are unsuccessful due to a low diagnostic accuracy based on oral examination only. In this article, we describe how intraoral ultrasound can be added to improve the diagnostic work-up of PTA and present a novel technique for ultrasound-guided aspiration of PTA, using a small pencil-shaped transducer. We present our first clinical experiences with this technique and describe how it could be integrated in a clinical setting to guide safe and successful needle aspirations of PTA.

Ultrasound-Guided Needle Aspiration of Peritonsillar Abscesses: Utility of Transoral Pharyngeal Ultrasonography

“…The advantage of TOPU over the Blaivas technique is that the operator can insert the needle parallel to the probe through the biopsy attachment in TOPU, which might be useful for inexperienced operators. The utility of transoral ultrasonography for the drainage of peritonsillar abscesses using a pencil-shaped Burr-Hole transducer and a 10-MHz small linear probe (hockey stick probe) has been demonstrated in other reports [13,14]. The attachment of a needle guide similar to the present TOPU method was used in the report of the pencil-shaped Burr-Hole transducer method [13].…”

“…The utility of transoral ultrasonography for the drainage of peritonsillar abscesses using a pencil-shaped Burr-Hole transducer and a 10-MHz small linear probe (hockey stick probe) has been demonstrated in other reports [13,14]. The attachment of a needle guide similar to the present TOPU method was used in the report of the pencil-shaped Burr-Hole transducer method [13]. These methods might have difficulty visualizing deep structures due to the narrow field of view in the image.…”

Impact of Bedside Ultrasound on Emergency Department Length of Stay and Admission in Patients With a Suspected Peritonsillar Abscess

“…Anatomically, the area of infection forms in the potential space between the palatine tonsils and capsule formed by the intrapharyngeal aponeurosis [11]. Presentation of PTA classically involves odynophagia, a 'hot potato' voice, trismus, erythema, edema, and contralateral soft palate deviation [1,13]. Diagnosing PTA on clinical signs alone can be erroneous, as the classic presentation mimics other infections, such as peritonsillar cellulitis [4,[6][7][8]14].…”

Surgeon‐performed Transoral Ultrasound‐Guided Aspiration of Peritonsillar Abscess

“…4 Therefore, we have improved the transoral technique using a small transducer to perform ultrasound-guided needle aspiration of patients with peritonsillar abscess. 5 In this article, we will describe the method and present our initial results.…”

“…Previously described transoral ultrasound techniques have limitations in clinical implementation due to transducer size and lack of real‐time guidance of the needle 4 . Therefore, we have improved the transoral technique using a small transducer to perform ultrasound‐guided needle aspiration of patients with peritonsillar abscess 5 . In this article, we will describe the method and present our initial results.…”