What is a Peritonsillar Abscess?

A peritonsillar abscess, also known as a quinsy, is a rare and serious complication of your tonsils. A peritonsillar abscess is a condition that forms in the tissues of your throat next to any of the tonsils.

The peritonsillar space is a space which is found between each tonsil and the throat wall. A certain infection, mostly a bacterial infection, may cause a pus-filled swelling on the peritonsillar space known as an abscess. This is a complication of the tonsils and is often caused by the strep throat bacteria known as group A beta-hemolytic streptococci.

A peritonsillar abscess is a complication which causes painful swelling that can sometimes block the throat. If your throat is blocked, breathing, swallowing and speaking becomes a problem. This complication can occur at any age, but it mostly affects young adults and teenagers. It is possible to get a peritonsillar abscess more than once in your lifetime.

What causes peritonsillar abscesses?

A peritonsillar abscess is a condition which comes as result of tonsillitis complications. The bacteria which causes this condition is usually the same bacteria that causes strep throat. This is a streptococcal bacteria known as group A streptococcus. Although other types of bacteria are involved, this same bacteria causing strep throat is the major cause of infection. Streptococcus bacteria causes an infection on the soft tissues surrounding the tonsils after which the tissue is invaded by other anaerobic bacteria which enter the tonsils through the adjacent glands.

Other causes and risk factors of peritonsillar abscesses include:

• Smoking
• Tooth diseases such as gum disease and gingivitis
• Chronic tonsillitis
• Calcium or stone deposits on the tonsils also called tonsilloliths
• Infectious mononucleosis
• Lymphocytic leukemia

Signs and symptoms

The first symptom you may experience with a peritonsillar abscess is a sore throat. You may experience other symptoms such as a fever as an abscess develops. It may take less than two days to experience your first symptoms after abscess formation.

Peritonsillar abscess major symptoms include:

• Tenderness and enlargement of lymph glands of the neck
• Swelling of throat and mouth and this inflammation or swelling may be found on one side only
• The uvula or finger-like tissue that hangs in the middle of the throat can be seen but away from the mouth's swollen side

Other signs and symptoms you are likely to experience are:

• Bad breathe
• Problems with opening the mouth
• Fever
• Chills
• Problems or difficulty in swallowing saliva
• Muffled voice commonly known as “hot potato”
• Headache
• Pain when swallowing food

Diagnosis

You should talk to your doctor about your sore throat accompanied by other symptoms such as fever. In case you have a sore throat, difficulty in swallowing, drooling, speaking and breathing difficulty, you should go for testing to see if you have a peritonsillar abscess.

Testing and diagnosis for this condition depends on your sore throat history plus a physical examination. It is easy to diagnose a peritonsillar abscess at a stage when it is large enough to be seen. The doctor will examine your mouth and throat using light. Swelling and redness on any side of your throat or near the tonsils may suggest an abscess. The doctor may also push the inflamed area with a finger to see any presence of pus.

Diagnosis for peritonsillar abscesses may include the following tests:

• Imaging tests: CT-scans, X-rays and/or ultrasound imaging tests may be performed to factor out other upper airway illnesses. These illnesses may be:
  • Inflammation of the epiglottis, a flap-like tissue that prevents food from getting through the windpipe
  • Retropharyngeal abscess - A condition which causes pus formation on the soft tissue behind your throat
  • Periotonsillar cellulitis - An infection affecting the soft tissue only and can include the formation of an abscess slightly beneath the surface of the soft tissue

• Lab tests: The laboratory tests for this condition involve testing for mononucleosis virus. According to scientific research, 20 percent of cases of peritonsillar abscesses are caused by this virus. Your doctor may also take your pus to the lab to test for bacteria. This is to identify the exact bacteria causing the inflammation for treatment purposes.

 

Treatment

Those with a peritonsillar abscess should receive their treatment in the hospital or at home depending on the severity of the condition. You may also receive the treatment in a hospital for a few days and then go home to rest. Treatment for this condition can be medicinal or surgical.

Medicinal treatment:

If your doctor decides to offer medication for your peritonsillar abscess, antibiotics are the best way to treat the bacterial infection. For the first time, the antibiotics are given through the intravenous route, but you can switch to a short dose of capsules or tablets after leaving the hospital. Some of these antibiotics are clindamycin, penicillin and erythromycin.

Some painkillers such as ibuprofen and paracetamol may also be used to reduce pain caused by this condition. At times, corticosteroids can be given to reduce the inflammation of the throat and quicken recovery.

Surgical treatment:

In many cases, use of antibiotics to treat peritonsillar abscesses can be ineffective. In such cases, there is a need to drain the pus from the abscess. This can be achieved by:

• Incision and drainage - In this procedure, a small incision or cut is made on the inflamed area to drain out the pus.
• Needle aspiration - A fine and long needle is pierced on the inflamed area to draw out the pus.
• Tonsillectomy - This is an operational procedure aimed to remove the tonsils completely. This is less often recommended to treat peritonsillar abscesses but is performed after six weeks of recovery.

During these surgical procedures you will remain awake, but you are given a sedative to help you relax or a local anesthesia to numb the cells on the treated area.

Can I prevent getting a peritonsillar abscess?

Yes you can. One of the best ways you can prevent this complication is by reducing the risk factors for tonsillitis. You can achieve this by:

• Avoiding any close contact with people who have bacterial and/or viral infections that cause tonsillitis
• Regularly washing your hands with warm water and soap
• Not sharing utensils with people who have tonsillitis
• Quitting smoking

Bottom line

A peritonsillar abscess can be a very serious complication, even more so than tonsillitis. However, it is a condition which can be easily prevented and treated. If you believe you may have a peritonsillar abscess, seek a doctor's help immediately.