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Hey Anand and Jan. Thanks for your info. Recently, we published a case series using an Endocavitary probe with needle guide to drain PTAs under direct visualization. The needle guide attached directly to the endocavitary probe so that visualization of the mucosal site was not necessary. One patient even closed his mouth entirely around the probe, but since we could see the needle on the US image we knew we were entering the abscess. We could even watch the pus being aspirated and the cavity shrinking in real time. If there was further abscess, a second or more attempts could be performed with the same direct visualization.
Use of Needle Guide for Dynamic Real-Time Ultrasound-Directed Aspiration of Peritonsillar Abscess in the Emergency Department: A Case SeriesThe Journal of Emergency Medicine15 March 2023
That's very interesting, especially for the larger PTA's that might still benefit from drainage. But just remember that because we CAN do something does not mean that we SHOULD. The lesson here is that the dogma of the old days that we need to drain these is questionable. And the "bad outcomes" of treatment "failure" are that the patient doesn't feel better, not septic, not airway obstruction, not death. I went to medical management for almost all of these that I have seen over the last 15yrs with no "known" bad outcomes. Admittedly anecdotal.
What you do matters.