What are the common causes of peritonsillar abscess. How is peritonsillar abscess diagnosed. What are the most effective treatment options for peritonsillar abscess. When should a patient with peritonsillar abscess seek emergency care. How can peritonsillar abscess be prevented.

Understanding Peritonsillar Abscess: A Common Deep Neck Infection

Peritonsillar abscess is the most prevalent deep infection of the head and neck region, affecting approximately 30 out of 100,000 individuals in the United States annually. This condition primarily impacts young adults between 20 and 40 years of age, although it can occur across all age groups. While often associated with streptococcal tonsillitis, the exact relationship between these two conditions remains unclear.

To grasp the nature of peritonsillar abscess, it’s crucial to understand the anatomy of the affected area. The palatine tonsils, located on the lateral walls of the oropharynx, are surrounded by a fibrous capsule. When an infection develops, pus accumulates between this capsule and the superior pharyngeal constrictor muscle, forming an abscess.

Etiology and Risk Factors of Peritonsillar Abscess

The development of peritonsillar abscess is not fully understood, but several theories exist:

• Progression from acute exudative tonsillitis to cellulitis and eventually abscess formation
• Involvement of Weber glands, minor mucous salivary glands located superior to the tonsils
• Obstruction of Weber gland ducts leading to tissue necrosis and pus formation

Is there a direct correlation between streptococcal tonsillitis and peritonsillar abscess? While traditionally believed to be closely linked, the year-round occurrence of peritonsillar abscesses compared to the seasonal nature of streptococcal tonsillitis has called this association into question.

Clinical Presentation and Diagnosis of Peritonsillar Abscess

Recognizing the symptoms of peritonsillar abscess is crucial for timely diagnosis and treatment. Common signs and symptoms include:

• Fever
• Severe sore throat
• Dysphagia (difficulty swallowing)
• Trismus (limited mouth opening)
• “Hot potato” voice
• Unilateral throat pain
• Swelling and redness of the affected tonsil

How is peritonsillar abscess diagnosed? The diagnosis is primarily based on clinical presentation and physical examination. In some cases, additional diagnostic tools may be employed:

• Needle aspiration to confirm the presence of pus
• Ultrasound or CT scan for complex cases or when the diagnosis is uncertain

Treatment Approaches for Peritonsillar Abscess

The management of peritonsillar abscess typically involves a combination of drainage, antibiotic therapy, and supportive care. What are the primary treatment options?

1. Drainage Procedures

Drainage is the cornerstone of treatment for most patients with peritonsillar abscess. Common drainage techniques include:

• Needle aspiration
• Incision and drainage
• Quinsy tonsillectomy (in rare cases)

2. Antibiotic Therapy

Broad-spectrum antibiotics effective against group A streptococcus and oral anaerobes are typically prescribed. Which antibiotics are most commonly used?

• Penicillin (some evidence suggests it may be sufficient alone)
• Amoxicillin-clavulanate
• Clindamycin
• Metronidazole (in combination with penicillin)

3. Supportive Care

Maintaining hydration and pain control are essential aspects of supportive care. What additional treatments might be beneficial?

• Corticosteroids to reduce symptoms and speed recovery
• Pain management with over-the-counter or prescription analgesics
• Oral rinses to alleviate discomfort

Potential Complications and When to Seek Emergency Care

While most cases of peritonsillar abscess can be managed in an outpatient setting, certain complications may require immediate medical attention. What are the potential serious complications?

• Airway obstruction
• Aspiration of abscess contents
• Extension of infection into deep neck tissues
• Sepsis

When should a patient with peritonsillar abscess seek emergency care? Immediate medical attention is necessary if any of the following occur:

• Difficulty breathing or swallowing
• Severe pain unrelieved by prescribed medications
• High fever unresponsive to treatment
• Spreading of swelling to the neck or face

Prevention Strategies for Peritonsillar Abscess

While it may not always be possible to prevent peritonsillar abscess, certain measures can reduce the risk of developing this condition. What are some effective prevention strategies?

• Prompt treatment of streptococcal throat infections
• Maintaining good oral hygiene
• Avoiding smoking and excessive alcohol consumption
• Staying hydrated and getting adequate rest when ill

Is tonsillectomy a viable preventive measure? For patients with recurrent peritonsillar abscesses or frequent tonsillitis, tonsillectomy may be considered as a preventive option. However, this decision should be made in consultation with an otolaryngologist, weighing the potential benefits against the risks of surgery.

Role of Family Physicians in Managing Peritonsillar Abscess

Family physicians play a crucial role in the diagnosis and management of peritonsillar abscess. With appropriate training and experience, they can effectively handle most cases in the primary care setting. What specific responsibilities do family physicians have in managing this condition?

• Recognizing the signs and symptoms of peritonsillar abscess
• Performing initial diagnostic evaluations
• Initiating appropriate treatment, including drainage procedures when indicated
• Prescribing antibiotics and supportive care
• Monitoring patients for potential complications
• Referring complex cases to specialists when necessary

How can family physicians enhance their skills in managing peritonsillar abscess? Continuing medical education courses, workshops, and hands-on training sessions can help family physicians stay up-to-date with the latest diagnostic and treatment approaches for this condition.

Emerging Research and Future Directions in Peritonsillar Abscess Management

As medical knowledge advances, new insights into the management of peritonsillar abscess continue to emerge. What are some areas of ongoing research and potential future developments?

• Improved diagnostic techniques, such as point-of-care ultrasound
• Novel antibiotic therapies targeting specific pathogens
• Minimally invasive drainage techniques
• Immunomodulatory treatments to enhance recovery
• Personalized treatment approaches based on genetic factors

How might these advancements impact patient care? As research progresses, we may see more targeted and effective treatments, reduced complication rates, and improved outcomes for patients with peritonsillar abscess.

The Role of Biofilms in Peritonsillar Abscess Formation

Recent studies have highlighted the potential role of biofilms in the development of peritonsillar abscesses. What are biofilms, and how do they contribute to this condition?

Biofilms are communities of microorganisms that adhere to surfaces and are encased in a self-produced extracellular matrix. In the context of peritonsillar abscesses, biofilms may:

• Provide a protective environment for bacteria, making them more resistant to antibiotics
• Facilitate the persistence of infection
• Contribute to the recurrence of peritonsillar abscesses in some patients

How does the presence of biofilms impact treatment strategies? Understanding the role of biofilms may lead to the development of new therapeutic approaches, such as:

• Anti-biofilm agents to disrupt the protective matrix
• Combination therapies targeting both planktonic bacteria and biofilm-associated organisms
• Novel drug delivery systems to enhance antibiotic penetration into biofilms

The Gut-Throat Axis: A New Perspective on Peritonsillar Abscess

Emerging research suggests a potential link between gut health and the development of upper respiratory tract infections, including peritonsillar abscesses. What is the gut-throat axis, and how might it influence peritonsillar abscess formation?

The gut-throat axis refers to the bidirectional communication between the gastrointestinal tract and the upper respiratory system. This connection may impact peritonsillar abscess development through:

• Modulation of the immune response
• Alterations in the microbiome of the oral and pharyngeal regions
• Influence on systemic inflammation

Could probiotics play a role in preventing or managing peritonsillar abscesses? While more research is needed, some studies suggest that certain probiotic strains may:

• Enhance immune function in the upper respiratory tract
• Compete with pathogenic bacteria for colonization
• Produce antimicrobial substances that inhibit the growth of harmful bacteria

Genetic Factors and Peritonsillar Abscess Susceptibility

Recent genetic studies have begun to explore the potential role of genetic factors in determining an individual’s susceptibility to peritonsillar abscesses. What genetic variations might influence the risk of developing this condition?

Researchers have identified several genetic factors that may play a role in peritonsillar abscess susceptibility, including:

• Variations in genes encoding for immune system components
• Polymorphisms affecting the structure and function of tonsillar tissue
• Genetic differences in the ability to clear bacterial infections

How might understanding genetic susceptibility impact patient care? Genetic insights could lead to:

• Personalized risk assessments for peritonsillar abscess
• Tailored prevention strategies for high-risk individuals
• Development of targeted therapies based on genetic profiles

Telemedicine and Remote Management of Peritonsillar Abscess

The COVID-19 pandemic has accelerated the adoption of telemedicine across various medical specialties. How can telemedicine be effectively utilized in the management of peritonsillar abscesses?

While in-person evaluation remains crucial for definitive diagnosis and treatment, telemedicine can play a role in:

• Initial screening and triage of patients with suspected peritonsillar abscess
• Follow-up care and monitoring of patients after treatment
• Patient education and guidance on self-care measures
• Coordination of care between primary care physicians and specialists

What are the challenges and limitations of managing peritonsillar abscesses through telemedicine? Some potential issues include:

• Difficulty in performing a thorough physical examination remotely
• Limitations in assessing the severity of symptoms and potential complications
• Inability to perform drainage procedures or collect samples for culture

Novel Imaging Techniques for Peritonsillar Abscess Diagnosis

Advancements in imaging technology are providing new tools for the diagnosis and management of peritonsillar abscesses. What innovative imaging techniques are being explored?

• High-resolution ultrasound with color Doppler
• Contrast-enhanced CT scans with 3D reconstruction
• MRI with diffusion-weighted imaging
• Optical coherence tomography

How do these advanced imaging techniques benefit patients and clinicians? The advantages of these new technologies include:

• Improved accuracy in diagnosing and localizing abscesses
• Better differentiation between cellulitis and abscess formation
• Enhanced guidance for drainage procedures
• Reduced radiation exposure compared to traditional CT scans

The Impact of Antibiotic Resistance on Peritonsillar Abscess Management

Antibiotic resistance is a growing concern in the treatment of various infections, including peritonsillar abscesses. How does antibiotic resistance affect the management of this condition?

The emergence of antibiotic-resistant bacteria poses several challenges:

• Reduced effectiveness of first-line antibiotic treatments
• Increased risk of treatment failure and complications
• Need for broader-spectrum antibiotics, potentially leading to side effects and further resistance
• Longer duration of illness and increased healthcare costs

What strategies are being employed to address antibiotic resistance in peritonsillar abscess treatment? Some approaches include:

• Antibiotic stewardship programs to promote judicious use of antibiotics
• Development of rapid diagnostic tests to identify specific pathogens and their antibiotic susceptibilities
• Exploration of alternative treatments, such as bacteriophage therapy or immunomodulatory agents
• Emphasis on drainage procedures as the primary treatment, with antibiotics as adjunctive therapy

Patient-Reported Outcomes and Quality of Life in Peritonsillar Abscess

There is growing recognition of the importance of patient-reported outcomes in evaluating the effectiveness of medical treatments. How are patient-reported outcomes being incorporated into the management of peritonsillar abscesses?

Researchers and clinicians are increasingly focusing on:

• Assessing the impact of peritonsillar abscesses on patients’ quality of life
• Evaluating patient satisfaction with different treatment approaches
• Measuring long-term outcomes and recurrence rates from the patient’s perspective
• Developing and validating disease-specific quality of life questionnaires

How can patient-reported outcomes improve the care of individuals with peritonsillar abscesses? By incorporating these measures, healthcare providers can:

• Tailor treatment plans to address patients’ specific concerns and priorities
• Identify areas for improvement in the management of peritonsillar abscesses
• Enhance patient education and shared decision-making processes
• Develop more comprehensive and patient-centered clinical guidelines

As research in these areas continues to evolve, our understanding and management of peritonsillar abscesses will undoubtedly improve, leading to better outcomes and quality of life for affected individuals.

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.

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.
Please follow the website: Vinmec.com regularly to update many other useful information.

Please dial
HOTLINE
for more information or register for an appointment HERE.
Download MyVinmec app to make appointments faster and to manage your bookings easily.

XEM THÊM:

• Difference between cysts and boils, abscesses
• What is a cheek abscess?
• What is an abscess? Formation and principles of treatment

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.

Our specialists

All specialists

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.