In reality we find clinical assessment is relatively unreliable…
Tonsillar Ultrasound Technique
- Chose either a sterilised endocavity transducer or a hockey stick transducer for this procedure.
- Cover it with an unused condom.
- Explain the procedure to the patient, reassuring them it is not as bad as it looks!
- Spray the oropharynx with a local anaesthetic ENT spray. Now introduce the transducer carefully with the imaging plane transversely oriented.
- Gently push the transducer against the enlarged tonsil watching for any flow within the area of interest. Add colour Doppler. Record images measuring the size of any collection in both the transverse and longitudinal planes.
- Noting the depth from mucosal surface to collection, and from mucosal surface to carotid gives the proceduralist a sense of relative depths.
Uncomplicated Tonsillitis – Left Tonsillar fossa<
Peritonsillar Abscess – Right Tonsillar fossa
Differentiation between solid enlarged tonsil and peritonsillar abscess is made by close observation of the heterogenous predominantly hypoechoic material within the tonsillar area.
- If an abscess has formed subtle movement of the probe will cause the pus to flow within the collection.
- If the tonsillar enlargement remains solid, no such flow occurs.