Clinical Presentation:

• Sore Throat
• Voice Change
• Uvula deviation away from the abscess
• Fever/Chills
• Ipsilateral Ear pain/torticollis

Next Step:

Intra-Cavitary probe U/S:

• Evaluate efficacy of I&D
• Depth of abscess to measure needle guard
• Identify location of carotid artery relative to the abscess

Treatment:

I&D

• Nebulized lidocaine/Regional lidocaine injection for analgesia
• Use the needle guard
• Make small adjustments with the needle medially to avoid the carotid

Antibiotics (Polymicrobial Infections):

• IV: ampicillin/sulbactam or clindamycin
• Outpatient: Penicillin, clindamycin, and Amoxicillin/clavulanate

Steroids

• Single high-dose administration has been shown to provide symptomatic relief

References:

Mapelli E, Sabhaney V. "Stridor and Drooling in Infants and Children."Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, pg 800-801.