What are the main causes of peritonsillar abscesses. How can you recognize the symptoms of a peritonsillar abscess. What treatment options are available for peritonsillar abscesses. How can peritonsillar abscesses be prevented.

Understanding Peritonsillar Abscesses: A Comprehensive Guide

A peritonsillar abscess is a potentially serious condition that affects the area surrounding the tonsils. This pus-filled infection can cause significant discomfort and, if left untreated, may lead to more severe health complications. In this comprehensive guide, we’ll explore the causes, symptoms, diagnosis, and treatment options for peritonsillar abscesses, providing you with the information you need to understand and manage this condition effectively.

What Exactly Is a Peritonsillar Abscess?

A peritonsillar abscess, sometimes referred to as quinsy, is a collection of pus that forms in the tissues surrounding one of the tonsils. This condition typically develops as a complication of tonsillitis, when the infection spreads beyond the tonsil itself. The abscess can cause significant pain and swelling, making it difficult to open the mouth, swallow, or even breathe in severe cases.

Can a peritonsillar abscess be life-threatening? While rare, untreated peritonsillar abscesses can lead to serious complications. The infection may spread to the jaw, neck, or chest, potentially causing pneumonia or obstructing the airway. This is why prompt medical attention is crucial if you suspect you have developed this condition.

The Root Causes of Peritonsillar Abscesses

Understanding the underlying causes of peritonsillar abscesses is essential for both prevention and treatment. Here are the primary factors that contribute to their development:

• Bacterial infection: The most common cause is the same bacteria responsible for strep throat, typically Group A Streptococcus.
• Tonsillitis complications: Peritonsillar abscesses often occur as a complication of acute or chronic tonsillitis.
• Poor oral hygiene: Inadequate dental care and gum disease can increase the risk of developing an abscess.
• Smoking: Tobacco use can weaken the immune system and make the oral tissues more susceptible to infection.
• Weakened immune system: Individuals with compromised immune systems are more prone to developing various infections, including peritonsillar abscesses.

Is it possible for other types of bacteria to cause peritonsillar abscesses? While Group A Streptococcus is the most common culprit, other bacteria can indeed be involved. This is why proper diagnosis and targeted antibiotic treatment are crucial for effective management of the condition.

Recognizing the Signs and Symptoms of a Peritonsillar Abscess

Early detection of a peritonsillar abscess is key to preventing more serious complications. Here are the most common signs and symptoms to watch out for:

1. Severe sore throat, typically on one side
2. Difficulty and pain when swallowing
3. Trouble opening the mouth (trismus)
4. Swollen, red tonsils with possible white or yellow coating
5. Swollen lymph nodes in the neck
6. Fever and chills
7. Earache on the affected side
8. Muffled or hoarse voice
9. Bad breath
10. Drooling due to difficulty swallowing

How quickly do symptoms of a peritonsillar abscess develop? Symptoms can develop rapidly, often within a few days of an initial sore throat or tonsillitis. The progression from mild discomfort to severe pain and swelling can occur quickly, emphasizing the importance of seeking medical attention promptly if you experience these symptoms.

Diagnosing Peritonsillar Abscesses: Medical Evaluation and Imaging

Accurate diagnosis of a peritonsillar abscess is crucial for appropriate treatment. Healthcare providers use a combination of methods to confirm the presence of an abscess:

Physical Examination

A doctor will carefully inspect the mouth, throat, and neck, looking for telltale signs such as:

• Swelling and redness around the affected tonsil
• Displacement of the uvula
• Asymmetry in the soft palate
• Swollen lymph nodes in the neck

Throat Culture

A sample from the throat may be taken to identify the specific bacteria causing the infection. This helps in selecting the most effective antibiotic treatment.

Blood Tests

Blood work can reveal elevated white blood cell counts, indicating the presence of an infection.

Imaging Studies

In some cases, especially if the diagnosis is uncertain, a CT scan or ultrasound may be ordered to confirm the presence and exact location of the abscess.

Are there any risks associated with diagnostic procedures for peritonsillar abscesses? While most diagnostic procedures are safe, there is a small risk of spreading the infection during a physical examination or throat culture. Healthcare providers take precautions to minimize this risk, and the benefits of accurate diagnosis generally outweigh the potential risks.

Treatment Approaches for Peritonsillar Abscesses

The treatment of peritonsillar abscesses typically involves a combination of drainage procedures and medication. The primary goals are to eliminate the infection, relieve pain, and prevent complications. Here are the main treatment options:

Drainage Procedures

There are two main methods for draining a peritonsillar abscess:

1. Needle aspiration: A doctor uses a needle to puncture the abscess and withdraw the pus.
2. Incision and drainage: A small cut is made in the abscess to allow the pus to drain out.

In some cases, especially for recurrent abscesses or chronic tonsillitis, a tonsillectomy (surgical removal of the tonsils) may be recommended.

Medications

Several types of medications may be prescribed to manage the infection and symptoms:

• Antibiotics: To fight the bacterial infection
• Pain relievers: To manage pain and reduce fever
• IV fluids: In cases of severe dehydration due to difficulty swallowing

How long does it take for a peritonsillar abscess to heal after treatment? With proper treatment, most people start to feel better within a few days. However, complete healing may take up to two weeks. It’s crucial to finish the entire course of prescribed antibiotics, even if symptoms improve, to prevent recurrence and antibiotic resistance.

Preventing Peritonsillar Abscesses: Practical Steps for Reducing Risk

While it’s not always possible to prevent peritonsillar abscesses, there are several steps you can take to reduce your risk:

• Maintain good oral hygiene: Brush and floss regularly to keep your mouth clean and healthy.
• Quit smoking: Smoking weakens your immune system and irritates your throat, increasing your risk of infections.
• Treat throat infections promptly: Seek medical attention for persistent sore throats or suspected strep throat.
• Stay hydrated: Drinking plenty of water helps flush out bacteria and keeps your throat moist.
• Boost your immune system: Eat a balanced diet, exercise regularly, and get enough sleep to support your body’s natural defenses.

Can recurrent tonsillitis increase the risk of developing a peritonsillar abscess? Yes, individuals with a history of frequent tonsillitis are at a higher risk of developing peritonsillar abscesses. In such cases, a healthcare provider might recommend a tonsillectomy to prevent future occurrences.

Long-term Outlook and Potential Complications

When treated promptly and appropriately, most peritonsillar abscesses resolve without long-term consequences. However, it’s important to be aware of potential complications that can arise if the condition is left untreated or if treatment is delayed:

Possible Complications

• Spread of infection to surrounding tissues (cellulitis)
• Airway obstruction
• Sepsis (a life-threatening systemic infection)
• Necrotizing fasciitis (rare but severe infection of soft tissues)
• Thrombosis of the internal jugular vein

What is the recurrence rate for peritonsillar abscesses? While exact recurrence rates vary, studies suggest that about 10-15% of individuals who have had a peritonsillar abscess may experience a recurrence. Factors such as chronic tonsillitis, incomplete treatment, or underlying health conditions can increase this risk.

Understanding the causes, symptoms, and treatment options for peritonsillar abscesses is crucial for early detection and effective management of this condition. By staying informed and seeking prompt medical attention when necessary, you can minimize the risk of complications and ensure a speedy recovery. Remember, maintaining good oral hygiene and overall health is key to reducing your risk of developing this painful condition.

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.

Peritonsillar abscess treatment. Paratonsillar abscess symptoms.

Paratonsillar
or peritonsillar abscess (PTA) is an accumulation 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?

Generally
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
types of 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.

How
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 available
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 :

• 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.

ShmelevaLyubovPetrovna

Otorhinolaryngologist

Samarin Nikolay Evgenievich

Otorhinolaryngologist

NersesyanMarinaVladislavovna

Otorhinolaryngologist

Professor, Doctor of Medical Sciences.

Gorbunov Sergey Alexandrovich

Otorhinolaryngologist

Candidate of Medical Sciences.

Treatment of paratonsillar abscess – symptoms and causes

Article rating

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Contents

• Symptoms of paratonsillar abscess

• Treatment of paratonsillar abscess

• Measures to prevent paratonsillar abscess

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

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

Symptoms of paratonsillar abscess

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

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

Treatment of peritonsillar abscess

Treatment of peritonsillar abscess is carried out by three main methods

• conservative;

• surgical;

• integrated.

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

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

In this case, the patient is hospitalized for the opening of 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.