Peritonsillar Abscess

Definition

The peritonsillar space is situated in the middle of the wall of the throat and on each tonsil. Peritonsillar abscess which is also called as quinsy, is a typical bacterial infection that commonly presents as a complication of an untreated tonsillitis or strep throat and produces an abscess or a pus-filled swelling. If this infection is not treated, it can spread to other areas of the body such as the lungs, neck, and roof of the mouth.

pus follicle on left tonsil peritonsillar abscess

Peritonsillar abscess is more frequently found in older children, young adults, and adolescents. They usually appear at the start or end of the winter season, when conditions like tonsillitis and strep throat are most widespread. They become less common today compared to the past, since there are certain treatments that can destroy the bacterial infection.

Symptoms of Peritonsillar Abscess

The symptoms of a peritonsillar abscess are almost the same to those of strep throat and tonsillitis although with this condition, the abscess may be visible towards the back of the throat. It looks like a whitish blister or boil that is swollen. It is not uncommon if the onset of symptoms and formation of abscess is delayed for about 2 to 5 days.

Pay close attention to the following symptoms that may occur such as:

  • Headache
  • Sore throat that is typically worse on one side
  • Uvula might be pushed away from the swollen area of the mouth
  • Bad breath
  • Infection on either or both tonsils
  • Muffled voice
  • Difficulty swallowing
  • Drooling
  • Inflamed face
  • Fever or chills
  • Specific changes in speech
  • Difficulty opening the mouth widely
  • Ear pain on where the sore throat is
  • Swollen glands in the jaw and throat that is tender to the touch

Peritonsillar abscess can possibly cause severe complications or symptoms. These more serious symptoms that rarely occur include:

  • Sudden bursting of the abscess
  • Infected lungs
  • Spreading of infection to the chest, neck, throat, and mouth
  • Obstructed airway passages

Once the abscess burst all of a sudden, it could transport infection all throughout the body and result to further blockage of the airway.

Causes

A peritonsillar abscess is frequently a tonsillitis complication that involves the bacteria which also causes strep throat, by a group A beta-hemolytic streptococci. Streptococcal bacteria often lead to an infection in the soft tissue surrounding the tonsils and typically affect one specific side. The tissue is then attacked by anaerobes which are another type of bacteria that can freely survive without oxygen. Anaerobes will then enter to other glands close by.

Possible risk factors of peritonsillar abscesses involve:

  • Dental infection such as gingivitis and gum infections periodontitis
  • Smoking
  • Calcium deposits or stones inside the tonsils
  • Chronic tonsillitis
  • Chronic lymphocytic leukemia (CLL)
  • Infectious mononucleosis

Diagnosis

A peritonsillar abscess is commonly diagnosed according to the medical history of the patient and a physical examination. Peritonsillar abscesses are easy to diagnose when it is big enough to see. The physician will inspect the mouth with the use of light and a tongue depressor.

The following signs may indicate an abscess upon assessment:

  • Swelling on one specific side of the throat
  • Swelling and redness of the throat and neck
  • Swelling on the roof of the mouth
  • Lymph nodes that are enlarged on both sides

The physician might also push the area gently to check if pus develops from an inner infection. Other tests to confirm the diagnosis may involve:

  • Ultrasound or X-ray – The physician may order either of these tests, to ascertain that other upper airway conditions are not present.
  • Computed tomography (CT) scan – An imaging test that can help the physician see a closer view of the abscess and the extent of the infection.

ct scan peritonsillar abscess

  • Endoscopy – The physician may want to assess the patient’s throat through this method with the use of a small telescope with a flexible lighted tube known as an endoscope.
  • Mononucleosis test – It is a type of blood test that may be ordered by the physician to know if the mononucleosis virus is present. Researchers suggest that it is linked with about 20% of peritonsillar abscesses.

The physician may also use a needle or a swab to get some sample fluid from the abscess and is sent to the laboratory in order to confirm or determine the type of bacteria that caused the infection.

Treatment

The most common form of treating a peritonsillar abscess is through antibiotics, although other individuals go together with pus drainage to aid antibiotics in working properly. Before a patient leaves the clinic of the physician on a first visit, the abscess is most-likely drained.

Treatment options may include:

Needle aspiration – The use of a needle could also be another option in draining an abscess and extracting the pus into a syringe.

Incision and drainage – This is performed by cutting, lancing directly into the abscess to release fluids.

area of aspiration of peritonsillar abscess

Acute tonsillectomy – A surgical procedure which involves the removal of the tonsils that may be proposed by the physician if the chronic forms of tonsillitis and strep throat is present, wherein the abscesses are recurring. This can also avoid future and more acute infections.

Complications

If peritonsillar abscess is not treated right away, long-term potential complications may present such as:

  • Pneumonia
  • Airway obstruction
  • Bacterial infection in the chest, jaw, or neck
  • Inflammation in the region of the heart
  • Fluid around the lungs

Pictures

peritonsillar abscess photo peritonsillar abscess pathology anatomy peritonsillar abscess image

References:

http://www.healthline.com/health/peritonsillar-abscess#Overview1

http://www.webmd.com/oral-health/guide/peritonsillar-abcess?page=1#1

http://www.drugs.com/health-guide/peritonsillar-abscess.html

Qureshi HA, Ference EH, Tan BK, et al (2015 Jan 20). National Trends in Retropharyngeal Abscess among Adult Inpatients with Peritonsillar Abscess. Otolaryngol Head Neck Surg.

Powell EL, Powell J, Samuel JR, Wilson JA (2013 Sep). A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother. 68(9):1941-50.

Costantino TG, Satz WA, Dehnkamp W, Goett H (2012 Jun). Randomized trial comparing intraoral ultrasound to landmark-based needle aspiration in patients with suspected peritonsillar abscess. Acad Emerg Med. 19(6):626-31.

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