A peritonsillar abscess is a pocket of pus that forms in the space around the tonsils.
An infection of the tonsils, called tonsillitis, can spread beyond the tonsils into the space between the tonsil and the underlying muscle. At this stage, it is known as peritonsillitis. If peritonsillitis is not treated adequately in a timely fashion, it can form a gradually enlarging pocket of pus known as an abscess.
Most people with a peritonsillar abscess have a sore throat for a few days that suddenly becomes very severe, usually only on one side of the throat. The condition rarely occurs in someone who has had a tonsillectomy.
Other signs and symptoms of a peritonsillar abscess include the following: bad breathdehydrationdifficulty opening the mouthdifficulty swallowingear painfeverheadachemalaise, a generalized feeling of illnessneck painswollen lymph nodes in the neck
If severe swelling occurs around the abscess, the person may have difficulty breathing.
Most episodes of peritonsillar abscess follow tonsillitis, 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 much less common in children than in adolescents and adults.
The only reliable 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. If a sore throat lasts for more than about two days, it is less likely to be an ordinary viral sore throat, so a healthcare provider should be consulted to examine for more serious conditions, including peritonsillar abscess.
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.
One of the main concerns is the spread of the infection to nearby areas in the neck, especially the parapharyngeal space, which houses the carotid artery, the jugular vein, and several important nerves. Over time, the abscess can erode into the walls of the carotid artery or jugular vein. If one of these vessels ruptures, life threatening bleeding may result.
Peritonsillar abscess can also cause an infected clot to form in the jugular vein. Small infected clots then spread throughout the body. The infection can also descend into and infect the soft tissues of the chest, a condition known as mediastinitis. Pus could also collect around the lungs, or travel through the prevertebral space into the abdomen..
A peritonsillar abscess is mildly contagious. The infection spreads from person to person through saliva and nasal discharges.
If caught early, peritonsillitis usually responds to antibiotics. These include erythromycin, penicillin, metronidazole (i.e., Flagyl), and nafcillin. Oral corticosteroids, such as methylprednisolone (i.e., Medrol) or prednisone, may be helpful but must be used with caution 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 surgically open the abscess and drain it. This can usually be done in a healthcare provider's office, but severe cases are sometimes handled in the operating room.
If the person does go to surgery, the tonsils are usually removed at the same time. For a first occurrence of the abscess, drainage is usually sufficient.
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.
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 scalpel 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. Like any surgery, a tonsillectomy can also be complicated by infection or an allergic reaction to the anesthetic.
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.
Peritonsillar abscesses recur in 10% to 15% of the individuals. Any new or worsening symptoms should be reported to the healthcare provider.