Introduction To Peritonsillar Abscess

An abscess is an accumulation of pus that develops near an infected region of the skin or soft tissue and leads to pain, swelling, and, in the worst-case scenario, throat blockage. 

Swallowing, speaking, and even breathing becomes difficult when the throat is obstructed. A peritonsillar abscess can develop when a tonsil infection (also known as tonsillitis) travels to the soft tissues and causes inflammation. But the infection is still quite rare. When they do occur, they are more common in young adults, teenagers, and older children.

Let’s learn about the infection in detail.

Symptoms and Causes of Peritonsillar Abscess

A sore throat is frequently the first sign of a peritonsillar abscess. As the abscess grows, a period of no fever or other symptoms may occur. Some of them are discussed below.

• A swollen area of inflammation in the mouth and throat, usually on one side, can be seen.

• The uvula (a tiny finger of tissue in the middle of the throat) can be pushed away from the enlarged or swollen side of the mouth.

• The lymph glands in the neck may swell and become painful.

• Other signs may include painful swallowing, fever and chills, spasms in the muscles of the jaw and neck, ear pain on the same side as the abscess, a muffled voice, often described as a “hot potato” voice, as if you have a mouthful of hot potatoes when you talk, and difficulty swallowing saliva.

A gap of 2 to 5 days between the onset of symptoms and the formation of an abscess is common. 

Peritonsillar abscess is caused by an infection. The majority of them are caused by tonsillitis (an infection of the tonsils). Mononucleosis (commonly known as mono), and tooth and gum infections can also cause them. A peritonsillar abscess is more prone to developing in smokers.

Diagnosis of Peritonsillar abscess

The diagnosis of a peritonsillar abscess is generally made based on the patient’s medical history and a physical examination. When a peritonsillar abscess is large enough to be seen, it is easy to diagnose. The doctor will use a light and possibly a tongue depressor to examine the patient’s mouth. An abscess is indicated by swelling and redness on the side of the neck around the tonsil. The doctor sometimes also uses a gloved finger to gently press on the region to examine whether there is pus from infection inside.

X-rays and lab testing are rarely used. An X-ray, CT scan, or ultrasound may be used to rule out the presence of other upper airway disorders. The following examples of these conditions are :

• Epiglottitis: a condition in which the epiglottis becomes inflamed.

• Retropharyngeal abscess: A pocket of pus grows behind the soft tissue in the back of the throat.

• Peritonsillar cellulitis is a soft tissue infection that affects the tonsils.

Sometimes, the doctor tests for mononucleosis, which is a virus that is linked to up to 20% of peritonsillar abscesses, according to some researchers. Additionally, the doctor may also send pus from the abscess to the lab for identification of the bacteria. Despite this, identifying the bacteria rarely leads to a change in treatment.

Treatment of Peritonsillar abscess

If the patient’s life is at risk due to a blocked throat, the initial approach may be to stick a needle into the pus pocket and drain enough fluid to allow him to breathe freely.

A local anaesthetic (similar to what you’d get at the dentist) will be injected into the skin above the abscess, and if necessary, pain drugs and sedation will be administered through an IV implanted in his arm. The suction will be used by the doctor to keep pus and blood from being swallowed. 

An antibiotic will be given to a patient. An IV may be used to provide the initial dosage. The best antibiotic for this sort of illness is penicillin, but if the patient is allergic to it, another antibiotic can be used such as erythromycin or clindamycin.

If the patient is severely unwell, unable to swallow, or has complicated medical problems (such as diabetes), he needs to be admitted to the hospital. Young toddlers who require general anaesthesia for drainage typically require observation in the hospital.

As a result, a variety of procedures, including needle aspiration, incision and drainage, and tonsillectomy, can be used to remove the pus. Although there is some indication that incision and drainage are associated with a lower risk of recurrence than needle aspiration.

Prevention of Peritonsillar abscess

Other than lowering risks (do not smoke, maintain good dental hygiene, and treat oral infections promptly), there is no viable technique for preventing a peritonsillar abscess. If one has a peritonsillar abscess, taking antibiotics might help avoid peritonsillar cellulitis. If one gets tonsillitis regularly, they can consult their doctor about having their tonsils removed.

Conclusion

Peritonsillar abscesses that are uncomplicated and well-treated usually heal completely. If one doesn’t have chronic tonsillitis (in which tonsils get inflamed regularly), the chances of the abscess recurring are only 10%, and tonsil removal is usually unnecessary.

People with diabetes, people with weaker immune systems, such as those with AIDS, transplant recipients on immune-suppressing medicines, or cancer patients, are the most likely to have problems.

Some major complications of peritonsillar abscesses include obstruction of the airway, dehydration due to difficulties swallowing, bleeding from the abscess eroding into the main blood vessel, pneumonia, and sepsis meningitis (bacteria in the bloodstream).