Peritonsillar abscess

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Alternative names
Quinsy; Abscess - peritonsillar

Definition
Peritonsillar abscess is a collection of infected material in the area around the tonsils. See also retropharyngeal abscess.

Causes, incidence, and risk factors
Peritonsillar abscess is a complication of tonsillitis. Group A beta-hemolytic streptococcus is usually the cause of peritonsillar abscesses. One or both tonsils becomes infected and pus forms and may spread from the tonsil to the tissues around it. The infection may spread over the roof of the mouth (palate), and to the neck and chest, including the lungs. Swollen tissues may obstruct the airway, which would be a life-threatening medical emergency.

Peritonsillar abscess is generally a disease of older children, adolescents, and young adults. It has become relatively uncommon since the use of antibiotics to treat tonsillitis.

Symptoms

• sore throat (may be severe)
  
• tender glands of the jaw and throat
  
• facial swelling
  
• drooling
  
• headache
  
• fever
  
• chills
  
• difficulty and pain with opening the mouth
  
• hoarseness (occasionally)

Signs and tests
An examination of the throat and neck may reveal redness and swelling of the tonsil(s), palate, throat, neck, and skin of the chest.

• Aspiration of the abscess usually shows fluid containing pus.
  
• Culture of the fluid may show bacteria.

Treatment
Treatment is aimed at curing the infection and relieving symptoms. Antibiotics may be given if the infection is bacterial. Surgical drainage of the abscess by aspiration or incision will be performed. Analgesics may be used, if needed, for pain. Surgery to remove the tonsils (tonsillectomy) may be considered.

Expectations (prognosis)
Peritonsillar abscess usually responds to treatment, although it may recur.

Complications

• cellulitis of the jaw, neck, or chest
  
• pneumonia
  
• pericarditis (inflammation around the heart)
  
• pleural effusion (fluid around the lungs)
  
• endocarditis (rare)
  
• airway obstruction

Calling your health care provider
Call your health care provider if you have had tonsillitis and symptoms of peritonsillar abscess develop.

Call your health care provider if symptoms of complications develop, including worsening of symptoms, persistent fever, cough, difficulty breathing, or pain in the chest.

Prevention
Prompt and complete treatment of tonsillitis, especially bacterial tonsillitis, may help prevent formation of abscess.