What is a peritonsillar abscess. How does it develop. What are the common symptoms. How is it diagnosed. What treatment options are available. Can it be prevented. What is the prognosis for patients with peritonsillar abscess.

Understanding Peritonsillar Abscess: A Comprehensive Overview

A peritonsillar abscess, also known as quinsy, is a potentially serious complication of tonsillitis. It occurs when pus collects in the area surrounding the tonsils, typically affecting one side more than the other. This condition predominantly affects older children, adolescents, and young adults, though its incidence has decreased since the widespread use of antibiotics for tonsillitis.

The Anatomy Behind Peritonsillar Abscess

To understand peritonsillar abscesses, it’s crucial to be familiar with the anatomy of the throat. The tonsils are part of the lymphatic system, which plays a vital role in the body’s immune defense. They are located on either side of the throat, along with other structures such as the esophagus, trachea, and epiglottis.

When infection spreads beyond the tonsils to the surrounding tissue, it can lead to the formation of an abscess. This collection of pus can cause significant discomfort and, if left untreated, may lead to more severe complications.

Causes and Risk Factors of Peritonsillar Abscess

The primary cause of peritonsillar abscess is bacterial infection, most commonly by group A beta-hemolytic streptococcus. This is the same type of bacteria responsible for strep throat. However, other bacteria can also be involved in the development of the abscess.

Risk Factors for Developing Peritonsillar Abscess

• Recurrent or untreated tonsillitis
• Smoking
• Poor oral hygiene
• Weakened immune system
• Dehydration

Are certain individuals more susceptible to peritonsillar abscesses? While anyone can develop this condition, those with a history of frequent tonsillitis or who delay seeking treatment for throat infections may be at higher risk.

Recognizing the Symptoms of Peritonsillar Abscess

The symptoms of a peritonsillar abscess can be quite severe and often develop rapidly. Recognizing these signs early can lead to prompt treatment and prevent potential complications.

Common Symptoms to Watch For

1. Severe sore throat, typically worse on one side
2. Difficulty opening the mouth (trismus)
3. Pain when swallowing
4. Fever and chills
5. Swollen lymph nodes in the neck
6. Muffled or “hot potato” voice
7. Drooling or inability to swallow saliva
8. Ear pain on the affected side
9. Neck stiffness
10. Headache

Can peritonsillar abscesses cause breathing difficulties? In severe cases, the swelling associated with a peritonsillar abscess can indeed obstruct the airway, leading to breathing problems. This is considered a medical emergency and requires immediate attention.

Diagnostic Procedures for Peritonsillar Abscess

Accurate diagnosis of a peritonsillar abscess is crucial for appropriate treatment. Healthcare providers use a combination of physical examination and, when necessary, additional diagnostic tests to confirm the presence of an abscess.

Physical Examination

During a physical exam, the healthcare provider will look for:

• Swelling on one side of the throat
• Displacement of the uvula
• Redness and swelling of the neck and throat
• Difficulty opening the mouth

Additional Diagnostic Tests

In some cases, further tests may be necessary:

• Needle aspiration: This can both diagnose and treat the abscess
• CT scan: To visualize the extent of the abscess
• Fiber optic endoscopy: To assess potential airway obstruction

How accurate are these diagnostic methods? While physical examination by an experienced clinician can often diagnose a peritonsillar abscess, imaging studies like CT scans provide the most definitive diagnosis, especially in cases where the abscess is not easily visible or palpable.

Treatment Options for Peritonsillar Abscess

The treatment of peritonsillar abscesses aims to eliminate the infection, drain the abscess, and prevent complications. The approach may vary depending on the severity of the condition and the patient’s overall health.

Antibiotics

Antibiotic therapy is a crucial component of treatment. Broad-spectrum antibiotics are typically prescribed to combat the underlying bacterial infection. Common choices include:

• Penicillin or amoxicillin
• Clindamycin (for penicillin-allergic patients)
• Metronidazole (often used in combination with other antibiotics)

Drainage Procedures

Draining the abscess is often necessary for complete resolution. This can be done through:

• Needle aspiration: A minimally invasive procedure performed under local anesthesia
• Incision and drainage: A small incision is made to allow the abscess to drain

Tonsillectomy

In rare cases, particularly for recurrent or severe infections, tonsillectomy may be recommended. This involves surgically removing the tonsils, usually under general anesthesia.

Is immediate tonsillectomy necessary for all peritonsillar abscesses? While tonsillectomy was once considered standard treatment, current practice favors more conservative approaches like drainage and antibiotics, reserving tonsillectomy for recurrent cases or when other treatments have failed.

Potential Complications and Prognosis

While peritonsillar abscesses can be effectively treated in most cases, they do carry the risk of complications if left untreated or if treatment is delayed.

Possible Complications

• Airway obstruction
• Spread of infection to nearby tissues (parapharyngeal or retropharyngeal space)
• Aspiration pneumonia if the abscess ruptures
• Sepsis in severe cases

What is the long-term outlook for patients with peritonsillar abscesses? With prompt and appropriate treatment, most patients recover fully from peritonsillar abscesses. However, there is a risk of recurrence, especially in individuals prone to tonsillitis or those who have had previous abscesses.

Prevention Strategies and Lifestyle Modifications

While it’s not always possible to prevent peritonsillar abscesses, certain measures can reduce the risk of developing this condition.

Preventive Measures

• Practicing good oral hygiene
• Seeking prompt treatment for throat infections
• Completing full courses of prescribed antibiotics
• Avoiding smoking and secondhand smoke
• Maintaining a healthy lifestyle to support immune function

Can dietary changes help prevent peritonsillar abscesses? While no specific diet has been proven to prevent these abscesses, maintaining a balanced diet rich in nutrients that support immune function may help reduce the risk of infections in general.

Recent Advances in Peritonsillar Abscess Management

Medical research continues to improve our understanding and management of peritonsillar abscesses. Recent advances have focused on optimizing treatment protocols and exploring new diagnostic techniques.

Emerging Trends in Treatment

• Use of ultrasound-guided drainage for more precise abscess localization
• Development of novel antibiotic formulations for more effective treatment
• Exploration of minimally invasive surgical techniques for recurrent cases

How might these advances impact patient care in the future? These developments hold the promise of more accurate diagnosis, less invasive treatments, and potentially reduced recovery times for patients with peritonsillar abscesses.

Peritonsillar abscesses, while potentially serious, are treatable conditions. Early recognition of symptoms, prompt medical attention, and adherence to prescribed treatments are key to successful outcomes. As research continues, we can expect further improvements in the diagnosis and management of this condition, ultimately leading to better patient care and reduced complications.

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.

Symptoms and images of abscesses around the tonsils

This is an automatically translated article.

Peritonsillar abscess and peritonsillar inflammation are the most common acute pharyngeal infections in adolescents and adults. Symptoms of peritonsillar abscess include severe sore throat, hoarse voice, tightness in the jaw, and displacement of the uvula. If not treated in time, the abscess around the tonsils can lead to dangerous complications.

1. What is an abscess around the tonsils?

Abscesses around the tonsils are often a complication of tonsillitis or strep throat. This is a bacterial infection with a pus-filled sac near one of the tonsils.
Abscesses around the tonsils are common in children, adolescents, and young adults. However, this condition is quite rare because patients are usually treated completely with antibiotics, avoiding complications of abscesses.

2. Symptoms of abscess around the tonsils

Peritonsillar abscess is a complication of tonsillitis or strep throat, so the symptoms will be similar to these two conditions. Manifestations of peritonsillar abscess include:
Infection occurs in one or both tonsils. Fever with or without chills. Difficulty opening the mouth wide. Difficulty chewing food. Difficulty swallowing saliva. Swelling of the face or neck. Headache. The voice was muffled. A sore throat is usually worse on one side. Swollen lymph nodes in the neck or jaw that are often painful to the touch. Ear pain on the same side as sore throat. Halitosis. In addition, abscesses around the tonsils can cause serious complications, such as:
Lung infections. Airway obstruction. The infection spreads to the throat, mouth, neck, and chest. Abscess abscess. If left untreated, an abscess around the tonsils can cause infections throughout the body and even block the airways.

Hạch xuất hiện ở vùng cổ do áp xe quanh amidan gây ra

3. Abscess around the tonsils when to see a doctor?

If you have a sore throat accompanied by fever or other symptoms, see your doctor promptly for an accurate diagnosis.
In addition, if you have a sore throat and difficulty swallowing, difficulty breathing, difficulty speaking or signs of airway obstruction, you should quickly go to the hospital to avoid life-threatening.

4. Causes of abscess around tonsils

As mentioned above, a peritonsillar abscess is a complication of tonsillitis. When the infection spreads to the area around the tonsils and forms an abscess.
Infectious mononucleosis as well as tooth and gum infections can also cause abscesses around the tonsils. In rare cases, an abscess around the tonsils may be caused not by an infection but by inflammation of the salivary glands.

5. What methods help diagnose abscess around tonsils?

First, to diagnose a peritonsillar abscess, your doctor will examine your throat and mouth. Your doctor may then ask you to do a blood test or take a sample of your throat to confirm the diagnosis. Signs that help diagnose a peritonsillar abscess include:
Swelling on one side of the throat. Swelling on the roof of the mouth. Redness and swelling in the throat. Enlarged lymph nodes on one side of the neck. In addition, your doctor may also recommend that you have a CT or MRI scan to get a better look at the abscess. The doctor also takes a sample of the abscess fluid with a needle to determine if there is an infection.

6. Methods of treating abscesses around the tonsils

Usually, the doctor will prescribe antibiotics to treat abscesses around the tonsils. In addition, the doctor may also drain the abscess to speed healing. Depending on the stage and symptoms, the doctor will give different treatment methods:
The stage of peritonsillar inflammation is an intermediate stage between acute tonsillitis and peritonsillar abscess. During this period, it is only necessary to use antibiotics in combination with anti-inflammatory, antipyretic and pain relievers according to the dose prescribed by the doctor. When the abscess around the tonsil has pus, the treatment method is to make an incision in the abscess to drain the pus, keep the incision open for about 3 days; combined with medical treatment with intravenous antibiotics or intravenous infusion, using drugs against both aerobic and anaerobic bacteria; along with that is taking anti-inflammatory, pain-relieving, fever-reducing drugs,. .. If you can’t eat or drink, your doctor can give you fluids. If your throat is very sore, your doctor may give you a pain reliever. Your doctor will ask you to have your tonsils removed if the abscess recurs to avoid possible more serious complications.

Chích rạch khối áp xe quanh amidan

7. How dangerous is an abscess around the tonsils?

Abscesses around the tonsils usually clear up and cause no complications with proper treatment. However, if left untreated or improperly treated, an abscess can lead to serious complications such as:
Obstruction of the airways. Loss of water. Infection in the jaw, neck, or chest. Sepsis . Pneumonia . Meningitis . Endocarditis.

8. Prevention of abscesses around the tonsils

The simplest and most effective method to prevent abscesses around the tonsils is to limit the risk of tonsillitis and pharyngitis such as: Don’t smoke, maintain good oral hygiene and treat oral infections properly. way.
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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 peritonsillar 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.

Treatment of peritonsillar abscess – symptoms and causes

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Contents

• Symptoms of paratonsillar abscess

• Treatment of paratonsillar abscess

• Measures to prevent paratonsillar abscess

Peritonsillar abscess is an inflammatory process that occurs in the tissue around the palatine tonsil, which leads to the formation of a purulent cavity and the development of an extensive inflammatory process.

The cause of this disease may be pathogenic microorganisms. Most often it is streptococci, but there may be other pathogens. Often paratonsillar abscess is the result of chronic tonsillitis or tonsillitis, sometimes the pathology appears after dental caries.

Symptoms of paratonsillar abscess

Paratonsillar abscess is characterized by a violation of general well-being, weakness, headache, fever, sometimes up to 40*C. In the throat, on the side of inflammation, pronounced pain occurs, a person experiences severe discomfort when swallowing and difficulty opening the mouth. There may be pain in the ear on the side of the inflammation. In the throat, swelling of the tissues is noted and asymmetry, bulging in the area of ​​\u200b\u200bthe inflammatory process occurs.

If these signs appear, you should immediately consult an otorhinolaryngologist.

Treatment of peritonsillar abscess

Treatment of peritonsillar abscess is carried out by three main methods

• conservative;

• surgical;

• integrated.

Conservative treatment of peritonsillar abscess is effective only in the initial stage. This is a general antibacterial therapy, rinsing with the use of antiseptic and local antibacterial agents.

If the patient seeks help late, conservative methods are not enough, surgical methods of treatment must be used.

In this case, the patient is hospitalized for opening the abscess and further treatment, but in exceptional cases, the opening is performed on an outpatient basis.

Before opening the abscess, the otorhinolaryngologist performs local application anesthesia at the site of inflammation. Then, using a scalpel, the doctor opens the abscess and evacuates the accumulated purulent discharge, after which he rinses the cavity with disinfectant solutions. As a rule, the patient feels relief after a few hours. Be sure, even after the opening of the abscess, general and local antibiotic therapy is prescribed. The next day after the intervention, the patient comes to the appointment to carry out an audit of the site of the autopsy.