Peritonsillar Abscess | AAFP

NICHOLAS J. GALIOTO, MD

Am Fam Physician. 2017;95(8):501-506

Author disclosure: No relevant financial affiliation.

Peritonsillar abscess is the most common deep infection of the head and neck, occurring primarily in young adults. Diagnosis is usually made on the basis of clinical presentation and examination. Symptoms and findings generally include fever, sore throat, dysphagia, trismus, and a “hot potato” voice. Drainage of the abscess, antibiotic therapy, and supportive therapy for maintaining hydration and pain control are the cornerstones of treatment. Most patients can be managed in the outpatient setting. Peritonsillar abscesses are polymicrobial infections, and antibiotics effective against group A streptococcus and oral anaerobes should be first-line therapy. Corticosteroids may be helpful in reducing symptoms and speeding recovery. Promptly recognizing the infection and initiating therapy are important to avoid potentially serious complications, such as airway obstruction, aspiration, or extension of infection into deep neck tissues. Patients with peritonsillar abscess are usually first encountered in the primary care outpatient setting or in the emergency department. Family physicians with appropriate training and experience can diagnose and treat most patients with peritonsillar abscess.

Peritonsillar abscess is the most common deep infection of the head and neck, with an annual incidence of 30 cases per 100,000 persons in the United States.^1–3 This infection can occur in all age groups, but the highest incidence occurs in adults 20 to 40 years of age. ^1,2 Peritonsillar abscess is most commonly a complication of streptococcal tonsillitis; however, a definitive correlation between the two conditions has not been documented.⁴

Clinical recommendation	Evidence rating	References
Some type of drainage procedure is appropriate treatment for most patients who present with a peritonsillar abscess.	C	6, 7, 13
Broad-spectrum antibiotics effective against group A streptococcus and oral anaerobes should be considered first line after drainage of the abscess, although some evidence suggests that penicillin alone may be sufficient.	C	9, 12, 17, 18
Corticosteroids may be useful in reducing symptoms and speeding recovery in patients with peritonsillar abscess.	B	3, 15, 26

Anatomy

The two palatine tonsils lie on the lateral walls of the oropharynx in the depression between the anterior tonsillar pillar (palatoglossal arch) and the posterior tonsillar pillar (palatopharyngeal arch). The tonsils are formed during the last months of gestation and grow irregularly, reaching their largest size by the time a child is six to seven years of age. The tonsils typically begin to involute gradually at puberty, and after 65 years of age, little tonsillar tissue remains.⁵ Each tonsil has a number of crypts on its surface and is surrounded by a capsule between it and the adjacent constrictor muscle through which blood vessels and nerves pass. Peritonsillar abscess is a localized infection where pus accumulates between the fibrous capsule of the tonsil and the superior pharyngeal constrictor muscle.^6,7

Etiology

Peritonsillar abscess has traditionally been regarded as the last stage of a continuum that begins as an acute exudative tonsillitis, which progresses to a cellulitis and eventually abscess formation. However, this assumes a close association between peritonsillar abscess and streptococcal tonsillitis. Because the occurrence of peritonsillar abscess is evenly distributed throughout the year and streptococcal tonsillitis is generally seasonal, the role of streptococcal tonsillitis in the etiology of peritonsillar abscess has been called into question.⁸

Abscess formation may not originate in the tonsils themselves. Some theories suggest that Weber glands contribute to the formation of peritonsillar abscesses.^4,9 This group of minor mucous salivary glands is located in the space just superior to the tonsil in the soft palate and is connected by a duct to the surface of the tonsil.⁹ These glands clear the tonsillar area of debris and assist with digesting food particles trapped in the tonsillar crypts. If Weber glands become inflamed, local cellulitis can develop. As the infection progresses, the duct to the surface of the tonsil becomes obstructed from surrounding inflammation. The resulting tissue necrosis and pus formation produces the classic signs and symptoms of peritonsillar abscess.^4,9 These abscesses are generally formed within the soft palate, just above the superior pole of the tonsil, which coincides with the typical location of a peritonsillar abscess.⁴ The lack of these abscesses in patients who have undergone tonsillectomy supports the theory that Weber glands may contribute to the pathogenesis of peritonsillar abscesses.⁴ Other clinical variables associated with the formation of peritonsillar abscesses include significant periodontal disease and smoking.¹⁰

Clinical Manifestations

Patients with peritonsillar abscess appear ill and report malaise, fever, progressively worsening throat pain, and dysphagia.⁷ The associated sore throat is markedly more severe on the affected side and is often referred to the ear on the ipsilateral side. Physical examination usually reveals trismus, with difficulty opening the mouth secondary to inflammation and spasm of masticator muscles. ¹¹ Swallowing can be difficult and painful.^11,12 The combination of odynophagia and dysphagia often leads to the pooling of saliva and subsequent drooling. Patients often speak in a muffled or “hot potato” voice. Marked tender cervical lymphadenitis may be palpated on the affected side. Inspection of the oropharynx reveals tense swelling and erythema of the anterior tonsillar pillar and soft palate overlying the infected tonsil. The tonsil is generally displaced inferiorly and medially with contralateral deviation of the uvula¹¹(Figure 1¹).

The most common history and physical examination findings in patients with peritonsillar abscess are summarized in Table 1.^4,7,11,12 Potential complications of peritonsillar abscess are outlined in Table 2.¹³ If it is inadequately treated, life-threatening complications can occur from upper airway obstruction, abscess rupture with aspiration of pus, or further extension of the infection into the deep tissues of the neck, putting neurologic and vascular structures at risk. ^7,13

Diagnosis

The diagnosis of peritonsillar abscess is usually based on clinical presentation and physical examination. Other conditions to consider in the differential diagnosis include peritonsillar cellulitis, retropharyngeal abscess, retromolar abscess, infectious mononucleosis, epiglottitis (especially in children), and neoplasm (lymphoma or carcinoma).^4,6,11,13 In several retrospective studies, infectious mononucleosis has been reported as a coinfection in 1.5% to 6% of peritonsillar abscess cases,¹³ making it a possible alternative diagnosis and comorbidity. This is particularly true in adolescents and young adults. Testing for infectious mononucleosis should be based on the patient history, examination findings (e.g., splenomegaly, lymphadenopathy, bilateral tonsillar infection), and clinical suspicion. If infectious mononucleosis is confirmed, amoxicillin use should be avoided secondary to the associated drug-induced rash.¹³

Patients with peritonsillar cellulitis often present with symptoms similar to peritonsillar abscess, making it difficult to differentiate between the conditions. In peritonsillar cellulitis, the area between the tonsil and its capsule is erythematous and edematous, without an obvious area of fluctuance or pus formation. Often, these two conditions are distinguished by the absence of pus on needle aspiration, which indicates cellulitis. If the presence of an abscess remains uncertain after needle aspiration, radiologic testing may be helpful. Computed tomography (CT) with contrast media enhancement can be used to demonstrate the presence and extent of an abscess (Figure 2¹). Alternatively, several small studies have shown that intraoral ultrasonography, if available, can accurately identify and distinguish abscess from cellulitis.^13,14

If there is suspicion that infection has spread beyond the peritonsillar space or if there are complications involving the lateral neck space, CT or magnetic resonance imaging (MRI) is required.¹³ Lateral neck infections should be suspected if there is swelling or induration below the angle of the mandible or medial bulging of the pharyngeal wall. Besides accurately diagnosing peritonsillar abscess, CT can detect potential airway compromise and demonstrate the spread of infection to the contiguous deep neck spaces. MRI is superior to CT for soft-tissue definition and is therefore better at detecting complications from deep neck infections, such as internal jugular vein thrombosis or erosion of the abscess into the carotid sheath.¹³ Disadvantages of MRI include longer scanning times, higher cost, and the potential for claustrophobia.¹³

Treatment

Drainage, antibiotic therapy, and supportive therapy for maintaining hydration and pain control are the cornerstones of treatment for peritonsillar abscess.¹⁵ Based on these cornerstones, key clinical questions include: (1) What is the best method for draining the abscess? (2) Which antibiotics should be prescribed following drainage? (3) Can the patient be treated as an outpatient? and (4) Given the swelling and inflammation associated with peritonsillar abscess, are adjuvant corticosteroids helpful? Figure 3 outlines the basic treatment approach to patients presenting with a peritonsillar abscess.

DRAINAGE

Some type of drainage procedure is appropriate for most patients who present with a peritonsillar abscess.^6,7,13 Exceptions include small abscesses (less than 1 cm) without muffled voice, drooling, or trismus. The main procedures include needle aspiration, incision and drainage, or immediate tonsillectomy (at time of presentation or shortly thereafter). Most studies comparing different surgical methods have found that all were equally effective for the treatment of peritonsillar abscess, and there were no statistically significant differences in patient outcomes.^6,13 The acute surgical management of peritonsillar abscess has evolved from immediate tonsillectomy to primarily incision and drainage or needle aspiration.⁶ Peritonsillar aspiration is a technique well suited for family physicians with proper training. Drainage or aspiration should be performed in a setting where possible airway complications can be managed and the patient can be observed for a few hours afterward to ensure adequate oral fluid intake. ¹Table 3 describes the technique for needle aspiration of a peritonsillar abscess.¹⁶ Physicians must be aware of important anatomic relationships when performing needle aspiration (Figure 4). If a physician is not comfortable aspirating the abscess, appropriate antibiotics and intravenous fluids should be administered while awaiting otolaryngology consultation.

Make sure the setting is suitable for managing airway complications.

Check that adequate lighting and suction are available.

Ask the patient to sit slightly forward and at eye level to the clinician.

Gently palpate soft palate to localize fluctuant area.

Apply topical anesthetic using Cetacaine spray.

Wait a few minutes for topical anesthetic to take effect, then draw up 6 to 10 mL of 1% to 2% lidocaine with epinephrine.

Use a 25-gauge 1 ½-inch needle to inject local anesthesia into the mucosa overlying the fluctuant area.

Retract the tongue using a tongue depressor.

Insert an 18-gauge spinal needle attached to a 10-mL syringe into area of maximum fluctuance and aspirate.

Do not insert the needle more than 8 mm.

If positive for pus, aspirate until no pus returns.

If negative for pus, withdraw needle and redirect slightly inferior; be aware that the carotid artery is 2 cm posterior and lateral to tonsillar pillar, and the risk of puncture increases the more inferior the needle is directed.

If aspiration is unsuccessful, perform imaging to confirm the presence of abscess; arrange otolaryngology consultation for possible incision and drainage as appropriate.

Although no longer routinely performed, immediate tonsillectomy should be considered in patients who have strong indications for it, especially those with a history of recurrent tonsillitis, because there is a recurrence rate up to 40% in these patients compared with 10% to 15% for the average patient.^6,7,13 Tonsillectomy may also be favored in children because they are likely to have recurrent episodes of tonsillitis and may be intolerant of drainage procedures under local anesthesia.^11,13

ANTIBIOTIC THERAPY

Peritonsillar abscesses are a polymicrobial mixture of aerobic and anaerobic bacteria. Group A streptococcus and Streptococcus milleri group (a subgroup of viridans streptococci) are the most commonly isolated aerobes recovered from culture, whereas Fusobacterium necrophorum is the predominant anaerobe.^1,9,17 Common organisms associated with peritonsillar abscess are listed in Table 4. ^8–10,17 Initial empiric antibiotic therapy should include antimicrobials effective against streptococcus and oral anaerobes.^12,13 There is almost universal sensitivity of streptococcus species to penicillin, and several studies show the clinical effectiveness of intravenous penicillin alone after adequate drainage of the abscess.¹⁸ However, there are growing concerns about the polymicrobial nature of peritonsillar abscesses. Culture reports demonstrate a greater than 50% penicillin-resistance rate among pathogens other than streptococcus found in peritonsillar abscess, which has led to the routine use of broad-spectrum antibiotics as first-line therapy.^12,13,18 Macrolides should be avoided secondary to Fusobacterium resistance.⁸Table 5 lists suggested antimicrobial regimens.^9,13,19–21

Aerobic bacteria
Corynebacterium
Group A streptococcus
Staphylococcus aureus
Streptococcus milleri group (S. intermedius, S. anginosus, S. constellatus)
Anaerobic bacteria
Bacteroides
Fusobacterium
Peptostreptococcus
Prevotella

Intravenous therapy

Penicillin G, 10 million units every 6 hours, plus metronidazole (Flagyl), 500 mg every 6 hours

Ampicillin/sulbactam (Unasyn), 3 g every 6 hours

Third-generation cephalosporin (e.g., ceftriaxone, 1 g every 12 hours) plus metronidazole, 500 mg every 6 hours

Piperacillin/tazobactam (Zosyn), 3.375 g every 6 hours (maximum daily dosage of 18 g)

If penicillin allergic, then clindamycin, 900 mg every 8 hours

If MRSA is a concern, then vancomycin, 1 g every 12 hours, plus metronidazole, 500 mg every 6 hours

Oral therapy

Penicillin VK, 500 mg every 6 hours, plus metronidazole, 500 mg every 6 hours

Amoxicillin/clavulanate (Augmentin), 875 mg every 12 hours

Third-generation cephalosporin (e. g., cefdinir [Omnicef], 300 mg every 12 hours) plus metronidazole, 500 mg every 6 hours

Clindamycin, 300 to 450 mg every 8 hours

If MRSA is a concern, then linezolid (Zyvox), 600 mg every 12 hours, plus metronidazole, 500 mg every 6 hours

INPATIENT VS. OUTPATIENT MANAGEMENT

Patients with a peritonsillar abscess can be treated as outpatients, but a small percentage may require hospitalization.^22,23 The most common reasons for admission are dehydration, inability to manage oral fluid intake, airway concerns (kissing tonsils), and failure of outpatient management.^13,15 Other comorbid conditions that warrant inpatient management include diabetes mellitus, immunosuppressive disease, chronic immunosuppressive medication use (including prolonged corticosteroid use), or signs of sepsis.^13,22,23 Complication rates are higher in patients 40 years or older compared with younger patients. ^24,25 Hospital stays averaged two to four days for all patients.^13,19 If the decision is made to pursue outpatient management, patients should be observed for a few hours after drainage of the abscess to ensure they can tolerate oral fluids, antibiotics, and pain medications. Patients should continue to be monitored closely, with a follow-up appointment scheduled within 24 to 36 hours.

ADJUVANT CORTICOSTEROID THERAPY

The acute symptoms of peritonsillar abscess result from inflammation and soft palate edema. Although corticosteroids have been used to treat edema and inflammation in other otolaryngologic diseases, their use as part of a treatment regimen for peritonsillar abscess has not been extensively studied. Two small studies investigated whether the addition of a single corticosteroid dose administered intramuscularly or intravenously (methylprednisolone, 2 to 3 mg per kg up to 250 mg, or dexamethasone, 10 mg) would speed recovery.^15,26,27 Patients who received the corticosteroids reported decreased pain and improved oral fluid intake within 12 to 24 hours compared with patients who did not receive corticosteroids. These differences seemed to disappear after 48 hours. The empiric use of corticosteroids for the treatment of peritonsillar abscess appears to speed recovery as demonstrated by shorter hospital stays and quicker resolution of pain. However, additional studies are needed before the routine use of corticosteroids is included in treatment protocols.^{3,13,15,26,27}

COMPLICATIONS

Peritonsillar abscess is usually first encountered in the primary care setting. Promptly recognizing the infection and initiating therapy are important to avoid potentially serious complications (Table 2).¹³ If the physician is inexperienced in treating peritonsillar abscess, or complications or questions arise during treatment, an otolaryngologist should be consulted.

This article updates previous articles on this topic by Galioto¹ and Steyer.²⁸

Data Sources: A PubMed search was completed in Clinical Queries using the key terms peritonsillar abscess, tonsillitis, diagnosis, treatment, management, microbiology, bacteriology, use of steroids in peritonsillar abscess, antibiotics for treatment of head and neck abscesses, and complications of peritonsillar abscess. The search included meta-analyses, randomized controlled trials, clinical trials, and systematic reviews. Also searched were the Agency for Healthcare Research and Quality evidence reports, Essential Evidence Plus, National Institute for Health and Care Excellence guidelines, American Academy of Otolaryngology–Head and Neck Surgery, UpToDate, and DynaMed. Search dates: November 2, 2015, and November 21, 2016.

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.

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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.

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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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Treatment of paratonsillar abscess – symptoms and causes

Article rating

4.27 (Votes: 15)

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

Peritonsillar abscess is characterized by impaired general health, 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 comes late for help, conservative methods are not enough, it is necessary to use surgical methods of treatment.

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 an abscess, an 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. It consists in diluting the edges of the wound, under local anesthesia, to remove the remnants of pathological contents. The audit can be carried out repeatedly, as needed.

Measures to prevent peritonsillar abscess

1. timely treatment of chronic foci of infection and adequate treatment of acute processes 0004 annual preventive visit to the otorhinolaryngologist and dentist.

In the conditions of the “ENT clinic plus 1”, otorhinolaryngologists will conduct a complete examination of the ENT organs using endoscopic techniques, make an accurate diagnosis and provide qualified assistance. According to indications, the patient will be hospitalized or an autopsy of the paratonsillar abscess will be performed and adequate treatment will be prescribed.

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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 valleys. The condition is dangerous and has a number of formidable complications and severe consequences for the patient.

Content

1. Causes and forms of the 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:

• anterior form, diagnosed in more than 70% of patients – the inflammatory focus is localized between the anterior palatine arch and the upper part of the tonsil, from where the infection enters the paratonsillar tissue;
• the posterior form is in second place in terms of prevalence – the focus of purulent inflammation is located between the tonsil and the posterior palatine arch;
• lower form – the focus of inflammation is located below the tonsil itself, is poorly visible during normal examination and is not accompanied by pronounced characteristic symptoms;
• 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, with 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.