Peritonsillar abscess often arrives without a preceding sore throat

Design

Population-based registry study

Population

607 peritonsillitis episodes in 555 patients, Region Kronoberg, Sweden, 2012-2016

Primary outcome

Patient characteristics, preceding pharyngotonsillitis and care pathways

Effect

23% had pharyngotonsillitis in prior 30 days; 85% first managed in primary care

A population-based registry study in BMC Primary Care (August 2026) identified all 607 episodes of peritonsillitis — peritonsillar abscess or cellulitis — in 555 patients in one Swedish region between 2012 and 2016.

Incidence peaked in late adolescence and young adulthood and was low in children and older adults. Only 23% of episodes had a recorded pharyngotonsillitis in the preceding 30 days (29% in ENT-confirmed cases). Three-quarters were first diagnosed in primary care, and 85% of all episodes involved primary care at the start; 71% of those diagnosed in primary care went on to ENT.

The data are from 2012-2016 and one region, and 'no recorded sore throat' may mean the patient did not consult rather than had none. The practical message stands: do not rule out peritonsillar abscess because there was no recent tonsillitis.

• Consider peritonsillar abscess in any adolescent or young adult with severe unilateral throat pain, trismus or a muffled voice
• Do not dismiss it because there was no recent sore throat or tonsillitis visit
• Look for uvular deviation and asymmetric swelling of the soft palate
• Refer the same day for drainage when abscess is suspected

Why it matters

It challenges the idea that peritonsillar abscess is mainly a complication of a treated or untreated tonsillitis that the GP would already know about.

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