Peritonsillar abscess (infiltration)

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A local complication of angina is a peritonsillar infiltration or abscess, which may even develop without previous angina. The peritonsillar abscess is manifested by increased pain on the side of the infiltration and problems with swallowing. Patients with this ailment should urgently consult a specialist.

What is a peritonsillar abscess?

A peritonsillar abscess is a local complication of angina in the form of a pus reservoir located in the peritonsillar area. The infiltration is usually on one side (bilateral abscesses are relatively rare). It is worth mentioning that an abscess can develop without previous angina. This ailment is manifested by a very sharp pain on the side of the infiltrate, which may radiate to the ear, moreover, the pain is often accompanied by trismus. Patients who develop a peritonsillar abscess should go to the ENT as soon as possible, as an untreated infiltration may result in meningitis. Complication of a peritonsillar abscess usually occurs when angina is poorly treated or completely ignored. Although tonsillitis is most common in children, abscesses are relatively rare. The highest percentage of cases is recorded among adolescents and adolescents.

The causes of the peritonsillar abscess

A peritonsillar abscess is a complication of:

1. poorly treated or ignored strep throat,
2. untreated or poorly treated tonsillitis.

The discomfort may also appear (rarely) without previous infection. The abscess is then suspected to originate in the salivary glands behind the tonsils.

Symptoms of peritonsillar abscess

Symptoms of a beginning infiltration or peritonsillar abscess are:

1. gradually worsening pain on one side of the throat (infiltrates and abscesses are usually one-sided),
2. increasing difficulty in swallowing
3. trismus.

These symptoms are accompanied by:

1. salivation,
2. difficulty speaking – the timbre of the voice is changed,
3. high fever,
4. Headache,
5. chills,
6. unpleasant smell from the mouth,
7. enlargement of the lymph nodes on the side of the infiltration,
8. swelling of the face on one side (painful when touched)
9. earache on the infection side due to improper middle ear ventilation,
10. redness of the mucosa and swelling of the tonsil area.

In the event of the above symptoms, immediate specialist intervention is necessary, and often the abscess incision, which causes immediate relief and a quick recovery.

Types of peritonsillar abscess

Peritonsillar abscesses can be of several types:

1. anterosuperior abscess – this is the most common form of abscess, which is characterized by a bulge located on the anterior arch and soft palate (this bulge usually covers the tonsil);
2. lower abscess – causes the tonsil to be pushed upwards;
3. posterior-superior abscess – develops in the upper part of the palatopharyngeal arch and causes the almond to be pushed forward;
4. intra-tonsil abscess – this is a rare type of abscess;
5. external abscess – characterized by a shift of the tonsil to the midline.

Diagnosis of peritonsillar abscess (infiltration)

The diagnosis of this ailment is based on a medical interview with the patient and clinical tests. In order to establish a XNUMX% diagnosis, the doctor takes the purulent content with a needle and syringe. If doubts as to the correct diagnosis are greater, computed tomography and ultrasound of the neck are indicated.

Treatment of peritonsillar abscess

One of the methods of treating peritonsillar abscess is antibiotic therapy, which consists in administering the drug intravenously – thanks to this, a better treatment effect is achieved. However, in many cases this type of treatment does not bring the expected benefits and it is necessary to use a surgical method. This may be, for example, an incision and drainage of an abscess under local anesthesia (rather, general anesthesia is used in young children).

Surgical treatment stages

1. First you should carefully locate where the abscess is located. For this purpose, a needle is used which punctures a potential spot and its contents are aspirated with a syringe. If you hit it correctly – there will be yellow discharge in the syringe. This method helps to avoid possible damage to neighboring vessels.

2. When finding the cause of the abscess is impossible – the collected material is sent to the laboratory so that it can be determined which pathogen caused the ailment.

3. Subsequently, a wide abscess incision is made (drainage) at the site of its greatest bulge (this helps to evacuate the pus into the oral cavity). The incision gives the patient immediate relief as the pressure on the surrounding tissues is reduced. For the next few days, the patient should visit the doctor to widen the incision so that the pus has a permanent outlet (this is performed under local anesthesia).

In the case when the peritonsillar abscess results from inflammation of the tonsils, and the patient continues to experience angina – it is recommended to remove the tonsils, as they may be a source of recurring infections and infiltrates. In addition, it is important to remember about the analgesic treatment and intravenous hydration of the patient so that the patient does not become dehydrated (the pain is so severe that even simple drinking is impossible).

Complications of peritonsillar abscess

They are relatively rare, but should not be ignored. Untreated peritonsillar infiltration can cause the following ailments:

1. trouble breathing
2. blockage of the airways,
3. purulent parotitis,
4. bacterial infections of the jaw, neck or chest tissues (e.g. endocarditis),
5. sepsis,
6. meningitis,
7. neck phlegmon,
8. pneumonia as a result of abscess rupture.

How to prevent peritonsillar abscesses?

Prophylaxis should be based on the earliest possible implementation of treatment when angina appears. Even if there is improvement, you must not stop taking the antibiotic, but continue taking it until advised by your doctor. If you suffer from chronic tonsillitis – think about tonsillectomy (enucleation of the tonsils), which greatly reduces the risk of peritonsillar abscesses.

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