Peritonsillar Abscess

A peritonsillar abscess is a pocket of pus that forms in the space around the tonsils.

What is going on in the body?

A peritonsillar abscess forms when tonsillitis spreads beyond the tonsils. The infection travels into the space between the tonsil and the underlying muscle. This infection then forms a gradually enlarging abscess, or pocket of pus.

What are the signs and symptoms of the infection?

Most people with a peritonsillar abscess have a sore throat for a few days that suddenly becomes very severe. It usually involves only one side. It almost never occurs in someone who has had a tonsillectomy.

Other signs and symptoms of a peritonsillar abscess include the following: · bad breath · dehydration · difficulty opening the mouth · difficulty swallowing · ear pain · fever · headache · malaise, or a generalized feeling of illness · neck pain · swollen lymph nodes in the neck

If severe swelling occurs around the abscess, the person may have difficulty breathing.

What are the causes and risks of the infection?

Most episodes of peritonsillar abscess follow tonsillitis, or an infection of the tonsils. These infections are usually caused by bacterial organisms called group A streptococci. Obstruction of certain glands around the mouth may also cause a peritonsillar abscess.

A person who has had peritonsillar abscess or chronic tonsillitis in the past is at a higher risk for another in the future. Peritonsillar abscesses are rare in children. They are more common in adolescents and adults.

What can be done to prevent the infection?

The only real way to prevent a peritonsillar abscess is to have the tonsils removed. Even people receiving antibiotics can develop a peritonsillar abscess. Usually it develops after several days of sore throat. Most viral sore throats resolve in 24 to 48 hours. If a sore throat lasts for more than about two days, the healthcare provider should be consulted.

How is the infection diagnosed?

Diagnosis of peritonsillar abscess begins with a medical history and physical examination. The provider may put a needle into the peritonsillar space to draw out fluid. In rare cases, a CT scan using a contrast agent is needed.

What are the long-term effects of the infection?

One of the main concerns is the spread of the infection to nearby areas in the neck. It can spread into the parapharyngeal space. This space houses the carotid artery, the jugular vein, and several important nerves. A long-term infection here can weaken the carotid artery and jugular vein. It also can cause life threatening bleeding.

The infection can also descend into the chest. This causes infection in the soft tissue there, which is known as mediastinitis. Pus could also collect around the lungs. If it gets into the prevertebral space, it can go into the abdomen. Peritonsillar abscess can also cause an infected clot to form in the jugular vein. Small infected clots then spread throughout the body.

What are the risks to others?

A peritonsillar abscess is mildly contagious. The infection spreads from person to person through saliva and nasal discharges.

What are the treatments for the infection?

If caught early, a peritonsillar abscess usually responds to antibiotics. These include erythromycin, penicillin, metronidazole, and nafcillin. Oral corticosteroids, such as methylprednisolone or prednisone, may be used. Steroids are used with care because they can mask the spread of the infection.

Once it has reached the abscess stage, the infection can be managed in several ways. Some people respond to oral antibiotics, pain medications, and repeated draining of the abscess with a needle.

The most time-honored treatment is to open the abscess and drain it. This is usually done in a healthcare provider's office, but it sometimes needs to be done in an operating room.

If the person does go to surgery, the tonsils are usually removed. Most people with a first occurrence of the abscess just have it drained. A person with a history of chronic or recurrent tonsillitis may need a tonsillectomy. The tonsillectomy can be done immediately or a few weeks after draining the abscess.

What are the side effects of the treatments?

Antibiotics can cause stomach upset, rash, and allergic reactions. Corticosteroids can cause sleeplessness and increased risk of infection.

If the abscess is drained with a needle, there are very few side effects. Usually the person feels much better as soon as it is drained. Opening the abscess with a knife also has very few side effects. There may be some temporary bleeding.

If the tonsils are removed, excess bleeding occurs about 3% of the time. Draining the abscess usually stops the pain very quickly. Surgery carries a risk of bleeding, infection, and allergic reaction to anesthesia.

What happens after treatment for the infection?

If treatment is successful, the symptoms improve rapidly. The person soon returns to a healthy state. The healthcare provider may recommend a tonsillectomy to prevent future peritonsillar abscesses.

How is the infection monitored?

Peritonsillar abscesses recur in 10% to 15% of the individuals. Any new or worsening symptoms should be reported to the healthcare provider.