Peritonsillar abscess

What is a peritonsillar abscess?

The peritonsillar space lies between each tonsil and the wall of the throat. An infection can cause a pus-filled swelling (abscess) to develop in this space. Peritonsillar abscesses, also called quinsy, usually occur as a complication of tonsillitis. They most often are caused by streptococcal (Strep, as with “strep throat”) and staphylococcal (staph) bacteria.

If a peritonsillar abscess is not treated promptly, the infection can spread to the neck, roof of the mouth, and lungs. The swelling can push the tonsil closest to it into the center of the throat and move the uvula (the flap of tissue hanging in the back of the throat) from the center toward the unaffected side of the throat. In severe cases, the swelling can make breathing difficult or can block the airway.

Peritonsillar abscesses most often develop in older children, adolescents, and young adults. They are less common than in the past because bacterial throat infections, including tonsillitis, are usually treated promptly with antibiotics, which destroy the infection-causing bacteria.

Symptoms of peritonsillar abscess

Symptoms include:

• a very sore throat
• difficulty swallowing or opening the mouth wide
• swollen lymph nodes (often called “glands”) in the neck
• headache
• chills or fever
• swelling of the face
• specific changes in speech, sometimes called "hot potato voice" because it sounds as if you're talking with a mouthful of hot mashed potatoes.

Diagnosing peritonsillar abscess

Your doctor will examine your throat, mouth, and neck, and swab your throat. Material on the swab is sent to the laboratory for a culture, which can identify the type of bacteria causing the infection. Your doctor may want to look at your throat by using a small scope mounted on a flexible lighted tube, called an endoscope. He or she may also order an x-ray, ultrasound, or computed tomography (CT) scan to better see the extent of infection in the soft tissues of the neck.

Expected duration of peritonsillar abscess

After treatment, symptoms should disappear within five to seven days.

Preventing peritonsillar abscess

Tonsillitis should be diagnosed and treated as soon as possible to help prevent a peritonsillar abscess from developing.

Treating peritonsillar abscess

Your doctor will prescribe antibiotics to treat the infection. In severe infections, these antibiotics may be given intravenously (into a vein).

Many abscesses will not respond to antibiotics alone and will need to be drained. This can be done with a needle or by making a small incision and suctioning out the fluid. This often is done in a doctor's office or emergency room but occasionally may need to be done in an operating room, especially if the infection has extended down into your neck. Your doctor will provide adequate sedation and pain medication to make you comfortable during this procedure. Because the symptoms make it difficult to eat or drink, some people may need intravenous fluids (injected into a vein) to treat or prevent dehydration.

If peritonsillar abscess, tonsillitis or other throat infections recur, you may need to have your tonsils removed surgically in a procedure called a tonsillectomy.

When to call a professional

Call your doctor if:

• you have a severe sore throat, especially with fever, or have been exposed to someone with strep throat
• you have a sore throat combined with difficulty swallowing, change in voice or swelling of the face.

Let your doctor know if you still have symptoms two or three days after treatment for a peritonsillar abscess.

Prognosis

After treatment, the outlook is usually excellent. Peritonsillar abscess can come back, however. Possible complications of a severe abscess include pneumonia, fluid around the lungs or heart, airway obstruction, and skin infection of the neck or jaw.

Additional info

American Academy of Otolaryngology - Head and Neck Surgery
https://www.entnet.org/