PTA or cellulitis is usually secondary to local spread from pharyngeal infections The palatine tonsils are located between the palatoglossal and palatopharyngeal arches The tonsils are surrounded by a capsule which covers part of the tonsil and is responsible for housing neurovascular structures PTAs develop in the potential space between the capsule and the constrictor muscles (tonsil bed) An infection within the tonsil capsule is an intratonsillar abscess Clinical differentiation can be difficult PTA develops in the potential space between the capsule and the constrictor muscles (tonsil bed) An infection within the tonsil capsule is an intratonsillar abscess If untreated, infection or inflammation may spread from that abscess to contiguous structures such as the masseter or pterygoid muscles PTAs are more commonly seen in adolescents and young adults, though they can present in younger children as well Infections in the peritonsillar space are usually polymicrobial, including bacteria such as group A streptococci, anaerobic bacteria, and potentially S aureus Clinical Considerations Clinical Recognition Patients with tonsillitis often present with fever, sore throat, and lymphadenopathy Patients are usually able to open their mouths fully, and have diffuse erythema and often exudate present on examination The symptoms and examination findings are typically bilateral When patients present with associated URI symptoms such as cough and rhinorrhea, bacterial etiologies are less common (see Chapter 74 Sore Throat ) Peritonsillar cellulitis and abscess also often present with fever and sore throat PTA often presents with difficulty opening the mouth, or trismus, which can help the provider differentiate from simple tonsillitis or cellulitis Additionally, the patients may have difficulty handling their secretions, asymmetric palate swelling and erythema, and have voice changes including sounding “muffled” or speaking with a “hot-potato” voice Triage Considerations Immediate assessment of the airway is paramount in patients with tonsillar infections If patients have evidence of stridor or pooling secretions, alternative diagnoses such as supraglottitis, and, more rarely, epiglottitis should be considered If the airway is in jeopardy, the patient should ideally have all airway interventions performed in the operating room with an anesthesiologist and otolaryngologist present If the patient is stable without evidence of airway