• Matityahou Ormianer, Benjamin Z Koplewitz, Ron Eliashar, Menachem Gross, Jeffrey M Weinberger, and Nir Hirshoren.
• Department of Otolaryngology/Head, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
• Isr Med Assoc J. 2023 Jan 1; 25 (1): 394139-41.

BackgroundUnilateral intratonsillar abscess (ITA) is an underreported, well-known complication of acute tonsillitis. The prevalence of unilateral ITA compared to peritonsillar abscess (PTA) is 1:14. However, bilateral ITA is an extremely rare entity, with only four cases reported thus far.ObjectivesTo describe past cases and our experience, elaborating the diagnostic challenge and the surgical treatment for bilateral ITA.MethodsWe conducted a literature search in the PubMed database using the key words intra-tonsillar abscess, tonsillar abscess, bilateral tonsillar abscess, bilateral intra-tonsillar abscess and bilateral peritonsillar abscess. Our search was limited to the years 1980 to 2020.ResultsWe found that only four cases of bilateral ITA were previously published. All were characterized by a delay in diagnosis with a median of 10 days (4-14 days), symmetrical oral cavity appearance, enlarged bilateral kissing tonsils, and subsequent treatment by surgical drainage/paracentesis. Respiratory compromise was a concern in most cases. Our patient was treated with bilateral quinsy tonsillectomy and had a prompt recovery.ConclusionsBilateral ITA is a rare, deceiving entity, with a diagnosis delay attributed to the symmetrical oral bulging. We present the fifth case reported and the first ever reported in a pediatric patient. We describe the assumed pathogenesis and the main characteristics among all five patients, emphasizing the important role of a high index of suspicion and appropriate imaging, guiding to proper diagnosis and treatment.

10 keywords...

hide…