Bilateral Intratonsillar Abscesses: A Deceiving Symmetrical Oral Bulging

Matityahou Ormianer*, Benjamin Z. Koplewitz, Ron Eliashar, Menachem Gross, Jeffrey M. Weinberger, Nir Hirshoren

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Unilateral intratonsillar abscess (ITA) is an urider-reported, 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. Objectives: To describe past cases and our experience, elaborating the diagnostic challenge and the surgical treatment for bilateral ITA. Methods: We 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. Results: We 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. Conclusions: Bilateral 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.

Original languageAmerican English
Pages (from-to)39-41
Number of pages3
JournalIsrael Medical Association Journal
Issue number1
StatePublished - Jan 2023

Bibliographical note

Publisher Copyright:
© 2023 Israel Medical Association. All rights reserved.


  • computed tomography scan (CT scan)
  • intratonsillar abscess (ITA)
  • peritonsillar abscess
  • tonsillar abscess
  • ultrasound


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