## Distinguishing Peritonsillar Abscess from Acute Tonsillitis ### Clinical Presentation Comparison | Feature | Acute Tonsillitis | Peritonsillar Abscess | |---------|-------------------|----------------------| | **Laterality** | Usually bilateral | Unilateral (>90% cases) | | **Uvular deviation** | Absent or minimal | Present (away from affected side) | | **Pharyngeal wall bulge** | No bulging | Lateral pharyngeal wall bulge | | **Trismus** | Mild or absent | Marked (often severe) | | **Dysphagia** | Present but mild | Severe, may have drooling | | **Onset** | Acute (1–2 days) | Follows tonsillitis (3–5 days) | | **Fluctuance** | Absent | May be present on palpation | **Key Point:** Uvular deviation and lateral pharyngeal wall bulge are pathognomonic for peritonsillar abscess and represent collection of pus in the peritonsillar space, pushing the soft palate and uvula medially. ### Why This Matters **Clinical Pearl:** The combination of unilateral tonsillar enlargement + uvular deviation + lateral pharyngeal bulge is the **single most reliable clinical discriminator** between simple tonsillitis and abscess formation. This triad indicates pus loculation and demands immediate drainage. **High-Yield:** Peritonsillar abscess is a **surgical emergency** requiring needle aspiration or incision and drainage (I&D), whereas acute tonsillitis is managed medically with antibiotics and supportive care. ### Mechanism Peritonsillar abscess develops when infection penetrates the tonsillar capsule and spreads into the peritonsillar space (between the capsule and superior pharyngeal constrictor muscle). The expanding collection displaces the lateral pharyngeal wall inward and pushes the soft palate/uvula toward the midline. [cite:Cummings Otolaryngology 6e Ch 24] 
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