Peritonsillar Abscess (for Teens) – Nemours KidsHealth

en español: Abscesos periamigdalinos

Medically reviewed by: Elana Pearl Ben-Joseph, MD

What’s a Peritonsillar Abscess?

A peritonsillar abscess is an area of pus-filled tissue at the back of the mouth, next to one of the tonsils. The abscess can be very painful and can make it hard to open the mouth.

It can also cause swelling that can push the tonsil toward the uvula (the dangling fleshy object at the back of the mouth). This can block the throat, making it hard to swallow, speak, and sometimes even breathe.

If you think you have an abscess in the back of your throat, you need to see a doctor. A peritonsillar abscess that isn’t treated can lead to more serious health problems.

What Causes Peritonsillar Abscesses?

Most peritonsillar abscesses are caused by the same bacteria that cause strep throat. Sometimes, other types of bacteria are involved.

Peritonsillar abscesses usually happen as a complication of tonsillitis. If the infection breaks out of a tonsil and gets into the space around it, an abscess can form. Luckily, peritonsillar abscesses aren’t that common these days because doctors use antibiotics to treat tonsillitis.

Gum disease and smoking can increase a person’s chances of developing an abscess.

What Are the Signs of a Peritonsillar Abscess?

Often, the first sign of a peritonsillar abscess is a sore throat. As the abscess develops, other symptoms start, such as:

• red, swollen tonsils
• tender, swollen glands (lymph nodes) on one side of the neck
• severe pain on one side of the throat
• difficulty and pain when swallowing or opening the mouth
• fever and chills
• headache
• earache
• drooling
• a muffled or hoarse voice
• bad breath

An abscess that’s not treated quickly can lead to serious problems — for example, the infection may go into the jaw and neck. If the abscess pops, the infection may spread to the chest and lead to pneumonia.

How Is a Peritonsillar Abscess Diagnosed?

Call your doctor if you have a sore throat with a fever or any of the other problems that can be caused by a peritonsillar abscess. It’s rare that an abscess will get in the way of your breathing, but if it does, you may need to go to the emergency room right away.

The doctor will examine your mouth, throat, and neck. They will look for an extremely swollen red area around the tonsil that pushes against the uvula. They also may take a throat culture and a blood test. On rare occasions, a doctor may order a CT scan or ultrasound.

How Is a Peritonsillar Abscess Treated?

The usual treatment for a peritonsillar abscess involves having a doctor drain the abscess. The doctor does this either by withdrawing the pus with a needle (called aspiration) or making a small cut in the abscess with a scalpel so the pus can drain out.

If this doesn’t work, a patient’s tonsils might have to be removed in a procedure called a tonsillectomy. This is especially true for people who have had tonsillitis a lot or who have had a peritonsillar abscess in the past.

If it’s hard to eat or drink, patients may need IV (intravenous, given into a vein) fluids for hydration. A doctor also will prescribe painkillers and antibiotics. Whenever you take antibiotics, always finish them as prescribed, even if you feel better after a few days. Otherwise, the infection could come back.

People who have a tonsillectomy may need a brief stay in the hospital. That way, doctors can keep an eye on them to make sure everything went as planned.

Can Peritonsillar Abscesses Be Prevented?

To lower your risk of getting an abscess in your tonsils, don’t smoke and make sure you keep your teeth and mouth clean.

But sometimes a peritonsillar abscess is beyond your control. If you think you have an abscess, call your doctor right away. The earlier a doctor diagnoses it, the easier treatment will be.

Medically reviewed by: Elana Pearl Ben-Joseph, MD

Date reviewed: March 2023

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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.

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 treatment.

Paratonsillar abscess symptoms.

Paratonsillar
or peritonsillar abscess (PTA) is a collection of pus between the palatine capsule
tonsils and pharyngeal muscles, that is, in the paratonsillar space. At
If left untreated, the condition poses a threat to life.

Peritonsillar abscess more common
most commonly occurs in adolescents and young adults, but can occasionally occur
in young children and in old age.

Classic
localization of paratonsillar abscess – the space around the upper pole of the palatine tonsil. Also
may occur around the middle or lower tonsil or have
multiple localization.

What causes paratonsillar
abscess?

Usually
an abscess is the result of a bacterial infection, which is most often
becomes a complication of acute pharyngitis or tonsillitis. In more rare cases
peritonsillar abscesses may occur without prior infection in the throat.

Predominant
pathogenic bacteria isolated from paratonsillar abscess are Streptococcus pyogenes
(group A streptococcus), Streptococcus anginosus , Staphylococcus aureus and
respiratory anaerobes.

How
Is there a paratonsillar abscess?

One of
the most characteristic symptoms to distinguish paratonsillar abscess from other diseases,
is difficulty opening the mouth (trismus). Sore throat is localized
as a rule, on the one hand, and is so pronounced that sometimes the patient cannot
take not only food, but also water, which can lead to dehydration.

Otherwise, the symptoms of paratonsillar abscess are similar to those of acute tonsillitis or pharyngitis, but more pronounced: increased
body temperature, sore throat aggravated by swallowing, which may
give into the ear, an increase in the submandibular and cervical lymph nodes, a change in voice,
malaise, muscle aches, headache, nausea.

When inflammation spreads to the structures of the larynx, as well as down the
pharyngeal space, breathing difficulties may occur.

As
Is a paratonsillar abscess being diagnosed?

Peritonsillar abscess is dangerous
its complications, therefore, it requires an emergency consultation with a doctor. Main
diagnostic method is the examination of the oropharynx by an otorhinolaryngologist with
assessment of symptoms characteristic of the disease.

Laboratory
assessment is not necessary to make a diagnosis, but may help
determine disease severity and adjust treatment and may include general
blood test, serum electrolytes, rapid test for the determination of b-hemolytic
group A streptococcus, cultured for microflora.

Instrumental
methods (ultrasound of the neck, MRI or CT studies with contrast) can
be required to confirm the presence of an abscess, to diagnose other infections
deep spaces of the neck (retro- or parapharyngeal abscess) or epiglottitis.

Ilinskaya
The hospital is equipped with modern CT and MRI machines. Diagnostic images
are stored in the electronic system of the hospital and are always available to doctors.

What
diseases can proceed as a paratonsillar abscess?

Similar
symptoms may occur in diseases such as:

• Acute tonsillitis or pharyngitis
• Retro- or parapharyngeal abscess
• Mononucleosis
• Tumor of the palatine tonsil

Related with
Therefore, a visit to the doctor is necessary for the correct diagnosis and
development of the optimal treatment strategy.

Treatment of paratonsillar abscess

If present
signs of an abscess, surgical intervention is indicated – drainage of the abscess.
This manipulation can be performed by several methods: needle aspiration,
incision and drainage or tonsillectomy (removal of the tonsils). The choice of one or
different procedure depends on several factors: age, state of mind,
indications for tonsillectomy. Each procedure has its own advantages in
certain situations.

In line
cases, opening of the abscess is indicated simultaneously with the removal of the palatine tonsils :

• Development of a repeated paratonsillar abscess
  recur a few weeks or months after the previous one)
• Peritonsillar abscess with three or more episodes of acute tonsillitis within a year
• Absence
  positive dynamics after the opening of the abscess
• Spread of inflammatory
  process on surrounding organs and tissues

Aspiration
needle and incision can be performed under local anesthesia, however, given
the size of the abscess, the pain of the procedure (local anesthesia does not allow
completely anesthetize the manipulation), the presence of a pronounced gag reflex,
the reluctance of many patients to “be present” at the operation, these manipulations are performed
under short-term general anesthesia. In children, such manipulations are performed
only under general anesthesia. Tonsillectomy is performed only under general
anesthesia in the operating room.

Antibiotic therapy
indicated for all patients with paratonsillar infection. For some patients
antimicrobial therapy alone may be sufficient (there are signs
paratonsillar infection, but no evidence of pus accumulation).

In addition
surgical methods and antibiotic therapy, anti-inflammatory
therapy, pain relief, fluid replacement (hydration) if due to pain
The patient could not eat or drink. As a result, it may be necessary to
hospital.

All rooms
hospital Ilyinsky hospital single or double. Relatives may
visit the patient around the clock. The patient’s vital signs (pulse,
pressure, oxygen saturation, etc.) are controlled by monitors and recorded
electronic system.

Author: Sergey Aleksandrovich Gorbunov Otorhinolaryngologist

Specialists on this issue

PolevGeorgiyAlexandrovich

ENT surgeon, head and neck surgeon

Candidate of Medical Sciences.