Summary
Definition
History and exam
Key diagnostic factors
- spiking fever
- neck pain or torticollis
- odynophagia
- dysphagia
- neck swelling/mass/lymphadenopathy
- oropharyngeal swelling
- drooling
Other diagnostic factors
- decreased oral intake
- anorexia
- malaise
- irritability
- trismus
- dysphonia
- dyspnea
- fatigue
- sleep apnea
- stridor
- tonsillar swelling
- increased respiration rate
- decreased oxygen saturations
- cyanosis
- tachypnea
- tracheal tug
- intercostal recession
Risk factors
- foreign body ingestion
- trauma to posterior pharyngeal wall
- dental caries/infection
- diabetes mellitus
- male sex
- adenotonsillectomy
Diagnostic tests
1st tests to order
- CBC
- erythrocyte sedimentation rate
- CT neck with contrast
- x-ray of neck
- ultrasonography of neck
- examination under anesthetic (EUA)
- culture
Treatment algorithm
airway compromise
no airway compromise
Contributors
Authors
Carl Philpott, MB ChB, FRCS (ORL-HNS) DLO, MD, PGCME
Consultant in ENT & Rhinology
James Paget University Hospital
Great Yarmouth
UK
Disclosures
CP is an advisory board member for GSK, Sanofi, and Stryker. He has received grants from NIHR and is a trustee of Fifth Sense. CP is an author of a number of references cited in this topic.
Kala Kumaresan, MBBS, MRCS (ENT)
Clinical Research Fellow
Department of ENT
James Paget University Hospital
Norwich
UK
Disclosures
KK declares that she has no competing interests.
Acknowledgements
Professor Carl Philpott and Dr Kala Kumaresan would like to gratefully acknowledge Dr Kristian Hutson, Dr Lorna Langstaff, Dr Asad Qayyum, Dr Kevin Kulendra, Dr Cameron Davies-Husband, and Dr Marcos Martinez Del Pero, previous contributors to this topic.
Disclosures
KH, LL, AQ, KK, CDH, and MMDP declare that they have no competing interests.
Peer reviewers
Remco de Bree, MD, PhD
Otolaryngologist
Head and Neck Surgeon
VU University Medical Center
Amsterdam
The Netherlands
Disclosures
RdB declares that he has no competing interests.
Michael Johns, MD
Director
Assistant Professor
Emory University
Atlanta
GA
Disclosures
MJ declares that he has no competing interests.
Lynn Solomon, MD
Assistant Professor
Tufts University
Boston
MA
Disclosures
LS declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Philpott CM, Selvadurai D, Banerjee AR. Paediatric retropharyngeal abscess. J Laryngol Otol. 2004 Dec;118(12):919-26. Abstract
Bochner RE, Gangar M, Belamarich PF. A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscesses. Pediatr Rev. 2017 Feb;38(2):81-92. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Acute epiglottitis
- Laryngotracheobronchitis
- Meningitis
More DifferentialsGuidelines
- A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscesses
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Sore throat
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