Peritonsillar Abscess

Quinsy, Abscess of Tonsil, Peritonsillar Cellulitis

What is peritonsillar abscess?

A peritonsillar abscess is a collection of pus between a tonsil and the tissue at the back of the throat. It usually occurs as a complication of tonsillitis. It can significantly prolong recovery from tonsillitis. Peritonsillar abscess occurs most frequently in young adults. The infection may begin with a simple tonsil infection that spreads within the soft tissues at the back of the throat before it actually forms an abscess. Thus the total area of the infection can be quite extensive. Very often this abscess is caused by streptococcal bacteria but it can also be caused by other organisms. If the abscess does not respond to antibiotic therapy, it must be surgically drained. Because a peritonsillar abscess tends to recur, the tonsils are usually removed (tonsillectomy) after abscess healing is complete.

How is it diagnosed?

History: Symptoms may include a painful throat (especially when swallowing) headache, high fever, impaired speech, and drooling.

Physical exam: Examination of the throat reveals redness with swelling of the tonsils and surrounding tissues. The uvula may be swollen and displaced to the unaffected side of the throat. The collection of pus that forms the abscess can be directly observed. Lymph nodes in the neck are swollen and tender.

Tests: A throat culture may be done to rule out a streptococcal infection. A complete blood count (CBC) examines the body's white cell response to the infection. Also, an x-ray of the neck may be ordered to rule out other diagnoses.

How is peritonsillar abscess treated?

The infection must be treated with antibiotics. The abscess itself usually requires surgical incision and drainage. Pain relievers (analgesics) may be given for the throat pain. Rest and a diet of cool, easily swallowed foods such as pudding and ice cream is recommended. Because peritonsillar abscesses tend to recur, a tonsillectomy is recommended when the infection is cleared, usually about six weeks after the abscess was treated. In some cases immediate tonsillectomy is performed in order to both drain the abscess and prevent recurrence (Quinsy tonsillectomy).

Medications

Information Brand Generic Label Rating
http://medtips.org/a/azithromycin.html Zithromax Azithromycin Off-Label
http://medtips.org/c/co-amoxiclav.html Augmentin Amoxicillin/Clavulanate Off-Label
Cleocin Clindamycin Off-Label

What might complicate it?

Complications include the spread of the underlying infection into spaces in the neck and chest, the lining of the lungs, or the heart. Pus may be aspirated into the lungs, causing pneumonia. If the infection or swelling pushes the tongue upward and backward in the throat, the individual's ability to breathe may be compromised.

Predicted outcome

An individual with uncomplicated peritonsillar abscess can expect full recovery in a relatively short period of time. However, because a peritonsillar abscess tends to recur, the tonsils are usually removed (tonsillectomy) after abscess healing is complete.

Alternatives

The early symptoms of peritonsillar abscess can mimic influenza, nasopharyngitis, pharyngitis, tonsillitis or strep throat. Once the abscess is visible, the diagnosis is clear.

Appropriate specialists

Otolaryngologist.

Last updated 18 December 2015

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