An Overview of Peritonsillar Abscess

Peritonsillar abscess (PTA), or quinsy, is a bacterial infection that causes pus to collect next to the tonsils and the pharynx towards the back of the throat. It usually occurs only next to one of your tonsils and usually progresses from cellulitis to an abscess. In general, peritonsillar abscesses take about 2 to 8 days to form and are normally caused by Staphylococcus aureus (staph infection), Haemophilus influenzae (pneumonia and meningitis) and Group A hemolytic streptococci (GAS; common for strep throat or pharyngitis) bacteria.

The peritonsillar abscess is typically sandwiched between the palatine tonsil and the superior constrictor muscle (which is used in the process of swallowing food) in the back of the throat. There are three "compartments" that the abscess, or pus, typically locates in. The topmost area, called superior, is where the majority of cases of peritonsillar abscess occur. The rest occur in either the middle or lower section between the tonsil and the muscle.

Prevalence and Risk Factors

Peritonsillar abscesses are a common cause to seek the help of an otolaryngologist(healthcare provider specializing in disorders of the ears, nose, and throat) emergently. You have about a 30 in 100,000 chance of getting PTA and this can be higher due to antibiotic-resistant strains of bacteria.

You will be at an increased risk for developing peritonsillar abscess under the falling situations:

• Tonsillitis
• Chronic and recurrent tonsillitis
• Smoking
• Respiratory infections
• Weakened immune system
• Recent dental work

You are also likely to have an increased risk of developing peritonsillar abscesses if you abuse alcohol or illegal drugs like cocaine. These drugs along with stereotypical other habits that may accompany the use of illegal drugs likely will decrease your health and weaken your immune system making you more susceptible to peritonsillar abscesses. If you are involved in any of these substances, seek help immediately.

Symptoms

Preceding a peritonsillar abscess, a sore throat is one of the most common complaints. In some cases, strep throat will not be caught by culture or rapid strep test and worsen to becoming a peritonsillar abscess. In these cases, the peritonsillar abscess causes a worse sore throat than when you just had strep throat. Other symptoms include:

• Fever
• "Hot potato" voice
• Drooling
• Bad breath (halitosis)
• Trismus (difficulty opening mouth) is always present but may vary in severity
• Painful swallowing (odynophagia)
• Difficulty swallowing (dysphagia)
• Ear pain

Diagnosis

Tests will be performed to help identify whether or not you really have a peritonsillar abscess. Your health history is a very important part of determining whether or not you likely have a peritonsillar abscess, but your healthcare provider will also perform some additional tests to make a stronger determination. Common tests that may be performed include a visual exam of your throat, CT scan, and/or ultrasound. An ultrasound of your throat is becoming more popular as ultrasound devices are becoming more readily available. Ultrasound also has the added benefit of not requiring radiation. However, not all hospitals or clinics will have the right ultrasound attachments to do a sufficient exam. In this case, the CT scan is the next best choice.

Other tests that are likely to be performed include mono spot test, blood count, cultures of throat and pus. These tests will be performed to help determine whether or not you have another problem that should be considered. Cultures will also help determine the best ongoing treatment for you.

Ultrasound, CT scans, lab work, or endoscopy can be used to rule out similar diagnoses like:

• Epiglottitis
• Parapharyngeal abscess
• Retropharyngeal abscesses
• Infectious mononucleosis
• Diphtheria

Treatment

Management of peritonsillar abscess may include hospitalization in small children if dehydration is present. However, in most circumstances, hospitalization will not be necessary. Antibiotics will be necessary to treat the cause of the infection and one of the following procedures will need to be performed:

• incision and drainage of the pus
• Needle aspiration (withdrawing through a needle) of pus
• tonsillectomy

A tonsillectomy is rarely needed to be done and the pus is simply removed and antibiotics continued for 10 to 14 days started to treat your infection.