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Peritonsillar abscess

Quinsy; Abscess - peritonsillar; Tonsillitis - abscess

 

Peritonsillar abscess is a collection of infected material in the area around the tonsils.

Causes

 

Peritonsillar abscess is a complication of tonsillitis. It is most often caused by a type of bacteria called group A beta-hemolytic streptococcus.

Peritonsillar abscess most often occurs in older children, adolescents, and young adults. The condition is rare now that antibiotics are used to treat tonsillitis.

 

Symptoms

 

One or both tonsils become infected. The infection most often spreads to behind the tonsil. It can then spread down into the neck and chest. Swollen tissues can block the airway. This is a life-threatening medical emergency.

The abscess can break open (rupture) into the throat. The content of the abscess can travel into the lungs and cause pneumonia.

Symptoms of peritonsillar abscess include:

  • Fever and chills
  • Severe throat pain that is usually on one side
  • Ear pain on the side of the abscess
  • Difficulty opening the mouth, and pain with opening the mouth
  • Swallowing problems
  • Drooling or inability to swallow saliva
  • Facial or neck swelling
  • Fever
  • Headache
  • Muffled voice
  • Tender glands of the jaw and throat

 

Exams and Tests

 

An exam of the throat often shows swelling on one side and on the roof of the mouth.

The uvula in the back of the throat may be shifted away from the swelling. The neck and throat may be red and swollen on one or both sides.

The following tests may be done:

  • Aspiration of the abscess using a needle
  • CT scan
  • Fiber optic endoscopy to check if the airway is blocked

 

Treatment

 

The infection can be treated with antibiotics if it is caught early. If an abscess has developed, it will need to be drained with a needle or by cutting it open. You will be given pain medicine before this is done.

If the infection is very severe, the tonsils will be removed at the same time the abscess is drained, but this is rare. In this case, you will have general anesthesia so you will be asleep and pain-free. 

 

Outlook (Prognosis)

 

Peritonsillar abscess goes away with treatment in most cases. The infection may return in the future.

 

Possible Complications

 

Complications may include:

  • Airway obstruction
  • Cellulitis of the jaw, neck, or chest
  • Endocarditis (rare)
  • Fluid around the lungs (pleural effusion)
  • Inflammation around the heart (pericarditis)
  • Pneumonia
  • Sepsis (infection in the blood)

 

When to Contact a Medical Professional

 

Call your health care provider right away if you have had tonsillitis and you develop symptoms of peritonsillar abscess.

Call your provider if you have:

  • Breathing problems
  • Trouble swallowing
  • Pain in the chest
  • Persistent fever
  • Symptoms that get worse

 

Prevention

 

Quick treatment of tonsillitis, especially if it is caused by bacteria, may help prevent this condition.

 

 

References

Melio FR, Berge LR. Upper respiratory tract infections. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 75.

Meyer A. Pediatric infectious disease. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 197.

Pappas DE, Hendley JO. Retropharyngeal abscess, lateral pharyngeal (parapharyngeal) abscess, and peritonsillar cellulitis/abscess. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 382.

 
  • Lymphatic system

    Lymphatic system - illustration

    The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).

    Lymphatic system

    illustration

  • Throat anatomy

    Throat anatomy - illustration

    Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

    Throat anatomy

    illustration

    • Lymphatic system

      Lymphatic system - illustration

      The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).

      Lymphatic system

      illustration

    • Throat anatomy

      Throat anatomy - illustration

      Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

      Throat anatomy

      illustration

    Self Care

     

      Tests for Peritonsillar abscess

       

       

      Review Date: 8/17/2016

      Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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