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Peritonsillar abscess
Quinsy; Abscess - peritonsillar; Tonsillitis - abscess
Peritonsillar abscess is a collection of infected material in the area around the tonsils.
Causes
Peritonsillar abscess is a complication of tonsillitis . It is most often caused by a type of bacteria called group A beta-hemolytic streptococcus.
Tonsillitis
Tonsillitis is inflammation (swelling) of the tonsils.
Peritonsillar abscess most often occurs in older children, adolescents, and young adults. The condition is rare now that antibiotics are used to treat tonsillitis.
Symptoms
One or both tonsils become infected. The infection most often spreads to behind the tonsil. It can then spread down into the neck and chest. Swollen tissues can block the airway. This is a life-threatening medical emergency.
The abscess can break open (rupture) into the throat. The content of the abscess can travel into the lungs and cause pneumonia.
Symptoms of peritonsillar abscess include:
- Fever and chills
- Severe throat pain that is usually on one side
-
Ear pain on the side of the abscess
- Difficulty opening the mouth, and pain with opening the mouth
- Swallowing problems
- Drooling or inability to swallow saliva
- Facial or neck swelling
-
Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Headache
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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- Tender glands of the jaw and throat
Exams and Tests
An exam of the throat often shows swelling on one side and on the roof of the mouth.
The uvula in the back of the throat may be shifted away from the swelling. The neck and throat may be red and swollen on one or both sides.
The following tests may be done:
-
Aspiration
of the abscess using a needle
Aspiration
Aspiration means to draw in or out using a sucking motion. It has two meanings:Breathing in a foreign object (sucking food into the airway). A medic...
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CT scan
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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Fiber optic endoscopy
to check if the airway is blocked
Fiber optic endoscopy
Endoscopy is a way of looking inside the body using a flexible tube that has a small camera and light on the end of it. This instrument is called an...
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Treatment
The infection can be treated with antibiotics if it is caught early. If an abscess has developed, it will need to be drained with a needle or by cutting it open. You will be given pain medicine before this is done.
If the infection is very severe, the tonsils will be removed at the same time the abscess is drained, but this is rare. In this case, you will have general anesthesia so you will be asleep and pain-free.
Outlook (Prognosis)
Peritonsillar abscess goes away with treatment in most cases. The infection may return in the future.
Possible Complications
Complications may include:
-
Airway obstruction
Airway obstruction
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
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Cellulitis
of the jaw, neck, or chest
Cellulitis
Cellulitis is a common skin infection caused by bacteria. It affects the middle layer of the skin (dermis) and the tissues below. Sometimes, muscle...
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Endocarditis
(rare)
Endocarditis
Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium). It is caused by a bacterial or, rarely a fun...
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Fluid around the lungs (
pleural effusion
)
Pleural effusion
A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity.
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Inflammation around the heart (
pericarditis
)
Pericarditis
Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.
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Pneumonia
Pneumonia
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). ...
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Sepsis
(infection in the blood)
Sepsis
Sepsis is an illness in which the body has a severe, inflammatory response to bacteria or other germs.
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When to Contact a Medical Professional
Call your health care provider right away if you have had tonsillitis and you develop symptoms of peritonsillar abscess.
Call your provider if you have:
- Breathing problems
- Trouble swallowing
- Pain in the chest
- Persistent fever
- Symptoms that get worse
Prevention
Quick treatment of tonsillitis, especially if it is caused by bacteria, may help prevent this condition.
References
Melio FR, Berge LR. Upper respiratory tract infections. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 75.
Meyer A. Pediatric infectious disease. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 197.
Pappas DE, Hendley JO. Retropharyngeal abscess, lateral pharyngeal (parapharyngeal) abscess, and peritonsillar cellulitis/abscess. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 382.
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Lymphatic system - illustration
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Lymphatic system
illustration
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Throat anatomy - illustration
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
Throat anatomy
illustration
-
Lymphatic system - illustration
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Lymphatic system
illustration
-
Throat anatomy - illustration
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
Throat anatomy
illustration
Review Date: 8/17/2016
Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
