Peritonsillar Abscess

What Is It?

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 "strep throat" bacteria (group A beta-hemolytic streptococci).

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 your throat and move the uvula (the flap of tissue hanging in the back of your throat) from the center toward the unaffected side of your throat. In severe cases, the swelling can make breathing difficult or can close your airway.

Peritonsillar abscesses most often are found in older children, adolescents and young adults. They are less common than in the past because tonsillitis now often is treated with antibiotics, which destroy the infection-causing bacteria.

Symptoms

Symptoms include:

• A very sore throat

• Difficulty swallowing or opening the mouth wide

• Swollen 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 around a mouthful of hot mashed potatoes

Diagnosis

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 telescope on flexible lighted tube, called an endoscope. He or she may also order an x-ray or computed tomography (CT) scan to better see the extent of infection in the soft tissues of the neck.

Expected Duration

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

Prevention

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

Treatment

Your doctor will prescribe antibiotics to treat the infection. In severe infections, these antibiotics may be given intravenously (into a vein). You usually will need to take antibiotics for at least 10 days, and it is important to take all the pills that are prescribed, even if you are feeling better.

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 tonsillitis or a peritonsillar abscess keeps coming back, 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

If you have been treated for a peritonsillar abscess, but you still have symptoms after two to three days, visit your doctor again.

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.

External resources

American Academy of Otolaryngology - Head and Neck Surgery One Prince St. Alexandria, VA 22314-3357 Phone: (703) 836-4444 http://www.entnet.org/

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