Peritonsillar Abscess

What is a peritonsillar abscess?

The peritonsillar abscess is the most common complication of tonsillitis and the bacteria most frequently involved in this type of Abscess is the Streptococcus.

An abscess is a collection of puss that forms and accumulates near the site of infection. It happens because of the spread of the infection to the soft tissue located around the tonsills. This disease is seen more frequently in adults and rarely in infants or teenagers.

What are the symptoms of a peritonsillar abscess?

The abscess can cause a variety of symptoms like intense throat pain (sore throat), swelling and blockage of the throat. If the throat is blocked, then swallowing, speaking (muffle voice also known as “hot-potato” voice) and even breathing becomes difficult. Also high fever and chills may be present, ear pain on the affected side and/or trismus (muscle spasm in the muscles of the jaw).

What are the risk factors to develop a perintosillar abscess?

There are certain risk factors that make one more prone to a get a peritonsillar abscess such as gum infections (gingivitis or periodontitis), chronic tonsillitis, smoking, infectious mononucleosis, chronic lymphocitic leukemia (CLL) and stones or calcium deposits in the tonsills (tonsilloliths).

Diagnosis?

Usually, the diagnosis of a peritonsillar abscess is based on the history and the physical exam during the consultation of the patient. The diagnosis is usually made easier since swelling and redness on one side of the throat near the affected tonsil suggests the abscess. The uvula (structure that hangs from the middle of the throat), may be shoved away from the swollen side of the oropharynx. Also, sometimes if the doctor touches the tonsil with a tongue depressor, he/she may see puss draining from the site of infection.

Lab studies, such as X-rays, CT (computed tomography) scan of the neck or MRIs (magnetic resonance imaging) are not usually required unless other upper airway diseases are suspected (epiglotitis, retropharyngeal abscess).

What is the treatment for a peritonsillar abscess?

There are several options for the treatment depending on the severity of the case. One of treatments consists of puncturing the abscess with a needle to withdraw the puss into a syringe. Also, an incision and drainage using a scalpel to drain the puss can be used.

Antibiotics will be administered usually through an I.V., if the patient is very ill, have trouble swallowing or have other medical problems such as diabetes, the patient should be admitted to the hospital. But If the abscess drains well, then the patient can be discharged home with a checklist consisting of “alarming signs” such as bleeding, trouble breathing or swallowing, difficulty speaking, drooling, high fever and chills, which would mean that the problem got worse and that the patient's life is in danger.

A Tonsillectomy may be needed in those cases where there is an obstruction of the upper airway, or history of chronic tonsillitis and patients with a previous episode of peritonsillar abscess.

What are the complications of a peritonsillar abscess?

The complications of a peritonsillar abscess can be major and all of them endanger the life of the patient. This complications are airway blockage, bleeding from erosion of the abscess into a major blood vessel, dehydration from difficulty swallowing, a deep neck abscess that could reach the site where the heart is located (mediastine), pneumonia, meningitis and sepsis (bacteria in the bloodstream).

This disease should be treated by a specialist, in this case an ear, nose and throat surgeon (ENT Dr.).

So, if you are experiencing a severe sore throat, difficulty breathing, swallowing or speaking, drooling or other potential signs of upper airway obstruction, call your doctor imme`iately!