Inferior pole peritonsillar abscess is uncommon and easily overlooked because it has no obvious physical appearance and there is a low index of suspicion by clinicians. In this report, we present four patients with inferior pole peritonsillar abscess who all had severe symptoms (fever, sore throat, muffled voice, trismus and painful neck) but had no obvious distortion of the peritonsillar structure. Careful oropharyngeal examination and a high index of suspicion are critical to make the diagnosis at an early disease stage, when the abscess can be treated with antibiotics without immediate tonsillectomy. This treatment strategy can be used if a patient is immunocompetent and the initial treatment response is good.