Peritonsillar abscess Information | Mount Sinai

Quinsy; Abscess – peritonsillar; Tonsillitis – abscess

Peritonsillar abscess is a collection of infected material in the area around the tonsils.

The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).

Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

Causes

Peritonsillar abscess is a complication of tonsillitis. It is most often caused by a type of bacteria called group A beta-hemolytic streptococcus.

Peritonsillar abscess most often occurs in older children, adolescents, and young adults. The condition is rare now that antibiotics are used to treat tonsillitis.

Symptoms

One or both tonsils become infected. The infection may spread to the area around the tonsil. It can then spread down into the neck and chest. Swollen tissues can block the airway. This is a life-threatening medical emergency.

The abscess can break open (rupture) into the throat. The contents of the abscess can travel into the lungs and cause pneumonia.

Symptoms of peritonsillar abscess include:

• Fever and chills
• Severe throat pain that is usually on one side
• Ear pain on the side of the abscess
• Difficulty opening the mouth, and pain with opening the mouth
• Swallowing problems
• Drooling or inability to swallow saliva
• Facial or neck swelling
• Fever
• Headache
• Muffled voice
• Tender glands of the jaw and throat
• Neck stiffness

Exams and Tests

An exam of the throat often shows swelling on one side and on the roof of the mouth.

The uvula in the back of the throat may be shifted away from the swelling. The neck and throat may be red and swollen on one or both sides.

The following tests may be done:

• Aspiration of the abscess using a needle
• CT scan
• Fiber optic endoscopy to check if the airway is blocked

Treatment

The infection can be treated with antibiotics if it is caught early. If an abscess has developed, it will need to be drained with a needle or by cutting it open. You will be given pain medicine before this is done.

If the infection is very severe, the tonsils will be removed at the same time the abscess is drained, but this is rare. In this case, you will have general anesthesia so you will be asleep and pain-free. 

Outlook (Prognosis)

In most cases, peritonsillar abscess goes away with treatment. The infection may return in the future.

Possible Complications

Complications may include:

• Airway obstruction
• Cellulitis of the jaw, neck, or chest
• Endocarditis (rare)
• Fluid around the lungs (pleural effusion)
• Inflammation around the heart (pericarditis)
• Pneumonia
• Sepsis (infection in the blood)

When to Contact a Medical Professional

Contact your health care provider right away if you have had tonsillitis and you develop symptoms of peritonsillar abscess.

Contact your provider if you have:

• Breathing problems
• Trouble swallowing
• Pain in the chest
• Persistent fever
• Symptoms that get worse

Prevention

Quick treatment of tonsillitis, especially if it is caused by bacteria, may help prevent this condition.

Pappas DE, Hendley JO. Retropharyngeal abscess, lateral pharyngeal (parapharyngeal) abscess, and peritonsillar cellulitis/abscess. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 410.

Roginski MA, Atchinson PR. Upper respiratory tract infections. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 61.

Waage RK. Peritonsillar abscess drainage. In: Fowler GC, ed. Pfenninger and Fowler’s Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 206.

Last reviewed on: 11/29/2022

Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Peritonsillar Abscess | Saint Luke’s Health System

A peritonsillar abscess is a
collection of pus that forms near the tonsils. It is a complication of a bacterial
infection of the tonsils (tonsillitis). The abscess causes one or both tonsils to
swell.
The infection and swelling may spread to nearby tissues. If tissues swell enough to
block
the throat, the condition can become life-threatening. It is also dangerous if the
abscess
bursts and the infection spreads or is breathed into the lungs. The goal is to treat
a
peritonsillar abscess before it gets worse and threatens your health.

Signs and symptoms of peritonsillar
abscess

• Severe sore throat (often
  worse on one side)

• Swollen and enlarged
  tonsils

• Fever and chills

• Pain when swallowing or
  trouble opening the jaws of the mouth. This is also known as lockjaw or
  trismus.

• Voice changes 

• Drooling

• Swollen or tender glands in
  the neck

Diagnosing peritonsillar abscess

Your healthcare provider will
examine you and look inside your mouth and throat. You will be asked about your symptoms
and health history. Tests or procedures may be done as well, including those listed
below:

• Throat swab. This test
  checks for infection. It is done by wiping a sterile cotton swab in the back of
  the throat. The swab can be used for an immediate result. It can also be sent to a
  lab for a culture if needed.

• Blood tests. These
  might be done to check how your body is responding to the infection.

• Ultrasound or CT scans.

  These tests provide images of the abscess. They also help rule out other
  problems.

• Needle aspiration.

  This procedure removes a sample of pus from the abscess with a needle. The
  sample is then sent to a lab to check for infection. Whenever possible, all the
  pus is removed from the abscess.

Treating peritonsillar abscess

The abscess itself can be treated.
Treatment of the underlying infection is also needed. Common treatments are listed
below.

• Medicines. Antibiotics
  are needed to treat the underlying infection. These may be taken by mouth or given
  by IV. Pain relievers may also be given, if needed. Follow your healthcare
  provider’s directions for taking these medicines.

• Abscess d
  rainage. A
  procedure may be needed to drain the pus from the abscess. Pus may be removed from
  the abscess with a needle (needle aspiration). Or a small incision is made in the
  abscess. The pus is then drained and suctioned from the throat and mouth. This is
  called incision and drainage.

• Tonsillectomy. This is
  surgery to remove the tonsils. It may be done if the abscess does not improve with
  medicines. It may also be done if you have frequent tonsil infections or
  abscesses.

Recovery and follow-up

Treating the bacterial infection
generally relieves the problem. Once the infection goes away, you should recover
completely. Follow up with your healthcare provider as directed. And if you develop
another throat infection, see your healthcare provider right away.

Peritonsillar abscess: causes, methods of treatment, principles of prevention

Peritonsillar abscess is an inflammatory disease of the soft tissues surrounding the palatine tonsils. The condition is dangerous and has a number of formidable complications and severe consequences for the patient.

Contents

1. Causes and forms of disease
2. Clinical picture
3. Methods of treatment of paratonsillar abscess
4. Principles of disease prevention

Causes and forms of paratonsillar abscess

As mentioned earlier, paratonsillar abscess is an acute inflammatory disease of peritonsillar tissue, in which an area of ​​inflammation is formed, where purulent contents begin to accumulate over time.

In the vast majority of cases (more than 80% of patients), paratonsillar abscess develops against the background of a chronic inflammatory process in the palatine tonsils. The largest number of cases are recorded in the age range from 15 to 30 years. At the same time, men and women are equally often faced with this disease. It is noteworthy that approximately 15% of people experience relapses of this pathology.

Peritonsillar abscess is extremely dangerous due to its complications. If untimely seeking medical help, it can lead to secondary inflammation of the cellular spaces of the neck or mediastinum. Somewhat less often, this pathology causes sepsis, inflammatory lesions of the brain, and erosive bleeding. However, in general, with the right treatment tactics, the prognosis is favorable.

This pathological process is based on the influence of bacterial flora. In the vast majority of cases, pyogenic streptococci, Staphylococcus aureus act as the causative agent, less often Haemophilus influenzae or E. coli, pneumococcal flora, etc. The most important predisposing factor in this case is the existing infectious and inflammatory foci in the oral cavity or pharynx.

As predisposing factors, a decrease in the level of immune protection, for example, due to hypothermia, systematic smoking, and so on, can be considered.

Depending on the location of the abscess, it is customary to distinguish several forms, namely:

the lateral form of paratonsillar abscess is the rarest and at the same time the most severe – the abscess is located behind the lower third of the palatine arch between the palatine and lingual tonsils.

Clinical picture in paratonsillar abscess

The main clinical manifestation is an extremely severe sore throat, most often determined on one side. It is worth noting that in some cases, patients have bilateral localization of the inflammatory process. The pain syndrome intensifies when swallowing saliva, gradually it begins to radiate to the region of the lower jaw and ear.

General intoxication syndrome is mandatory. It is characterized by febrile fever, chills, weakness, malaise, decreased appetite, etc. Also, the clinical picture is supplemented by an increase in regional lymph nodes, an increase in the amount of saliva, and bad breath.

Another specific symptom is a tonic spasm of the masticatory muscle group. The patient is forced to limit the movements of the neck, as they are accompanied by severe pain.

In a fairly large number of people, after a few days, an independent opening of the abscess is observed – this is manifested in the patient’s well-being by a decrease in pain, a decrease in body temperature, and some relief of the condition. However, it is worth noting that quite often the focus of purulent inflammation is not fully opened and arbitrary recovery does not occur, and the abscess may not open on its own, which is fraught with a progressive deterioration in the patient’s condition.

Stages of development of paratonsillar abscess:

Stage I – there is swelling of the peritonsillar tissue, there is discomfort in the throat, but the general condition of the patient often does not suffer;

Stage II – infiltration – the period when, instead of soft tissue edema, inflammatory elements of the blood begin to accumulate in the paratonsillar tissue, all the processes inherent in inflammation begin to unfold and grow; it is during this period that the symptom characteristic of paratonsillar abscess begins to appear;

Stage III – abscessing – this is the stage when the focus of purulent inflammation.

It is installed when the purulent cavity itself has formed.

The essence of this pathology lies in the formation of a purulent cavity in the area of ​​peri-almond tissue. The main clinical manifestation in such a pathological process is an extremely pronounced sore throat, complemented by a general intoxication of the body. In this article we will talk about what is a paratonsillar abscess and what does it threaten?

Methods of diagnosis and treatment

Diagnosis of paratonsillar abscess consists of an objective examination, supplemented by pharyngoscopy. It is pharyngoscopy that allows you to detect an abscess and assess its localization. Additionally, a general blood test, bacteriological culture to determine the pathogen are shown. Complications can be excluded using various instrumental methods, for example, ultrasound.

First of all, in such a disease, it is necessary to prescribe antibacterial drugs, selected on the basis of the sensitivity of the isolated flora. To relieve symptoms, drugs with analgesic and antipyretic effects are used, and detoxification measures are taken. Local therapy is reduced to gargling with antiseptic solutions. In the event that a purulent cavity has already formed, it is recommended to surgically open it with subsequent drainage.

Treatment for this disease may include not only conservative, but also surgical methods. The choice of tactics will depend on the timeliness of seeking medical help.

Principles of prevention

To prevent the development of this disease, it is necessary to sanitize existing infectious foci in the oropharynx in a timely manner, increase the level of immune protection, and so on.

What is an abscess? Why open up? Can an abscess be treated at home?

When harmful bacteria enter the body, it responds with a universal defense reaction – inflammation. Under certain circumstances, inflammation can become purulent. Pus is formed – a thick liquid that contains a lot of protein, dead leukocytes and microbial cells. If enough pus accumulates in one place, an abscess occurs, or, in simple words, an abscess.

Abscesses can appear in any part of the body, even in the bones. Most often, they form under the skin, in the armpit, groin, genitals, anus, and in other places. There are ulcers under the mucous membrane (for example, on the gums, if a carious tooth is not treated for a long time, or a pharyngeal abscess – inflammation of fatty tissue behind the pharynx), in internal organs: in the liver, spleen, kidneys, lungs, etc.

Most often, surgeons have to deal with subcutaneous abscesses. We will talk about their treatment below.

Can you deal with an abscess on your own?

In principle, if the abscess is less than 1 cm in diameter and does not cause much concern, you can try to deal with it yourself. Warm compresses for 30 minutes 4 times a day help.

Under no circumstances should an abscess be squeezed out. By pressing on the cavity with pus, you create increased tension in it, which contributes to the spread of infection. You can not pierce the abscess with a needle. The sharp tip of the needle can damage the healthy tissue or blood vessel under the pus. Malicious microbes will not fail to take advantage of this opportunity and rush to develop new “territories”.

If something resembling an abscess appears on your skin, it is better not to hesitate with a visit to the surgeon. Especially if:

• the abscess is very large or there are several;
• you feel unwell, your body temperature has risen to 38°C or more;
• an ulcer appeared on the skin;
• a red line “went” across the skin from the abscess – this indicates that the infection has spread to the lymphatic vessel, and lymphangitis has developed.

Can an abscess be cured without opening?

Even the ancient Greek physician Hippocrates liked to say: “where there is an abscess, there is an incision”. Since then, little has changed in the principles of abscess treatment.

Why must an abscess be opened? The human body is arranged very wisely, usually it gets rid of everything superfluous. If pus has accumulated somewhere, this indicates that the natural mechanisms have been ineffective. The body does not know how to bring it out. At the same time, the cavity with pus becomes like a time bomb. Pathogenic microbes can spread beyond the abscess, sometimes this leads to severe complications, up to sepsis.

The best solution in this situation is to drain the pus through the incision. As a rule, after this, improvement quickly occurs, the healing process begins.

After opening the abscess, the surgeon may prescribe antibiotics, but not all patients need them.

How is an abscess opened?

The operation is usually performed under local anesthesia. You will practically not feel pain. The doctor will make an incision and clean the wound from pus – using a special suction, or manually, armed with a gauze napkin.

Once the wound has been cleaned, the surgeon will insert a finger or a surgical forceps into the wound to check for pockets filled with pus. Sometimes there are partitions inside the abscess that divide it into two, three or more “rooms”. All partitions must be destroyed and all pus must be released.

Wash the wound with an antiseptic solution. But they are not in a hurry to sew it in. Pus may accumulate under the stitches again. The cavity must be left open so that it cleans better and heals faster. To drain excess fluid, a drain is left in it – a strip of latex, one end of which is let out. Subsequently, dressings are carried out with antiseptic solutions, healing and antibacterial ointments.

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How quickly will the healing take place?

The further scenario of the development of events after the opening of the abscess usually looks like this:

• As a rule, immediately after the pus is released, the pain subsides and the general condition improves.
• After 2 days, liquid discharge from the wound almost completely stops.
• Within 7-10 days, you will have to periodically see a doctor and do dressings.