Peritonsillar abscess is usually a complication of a bacterial infection in the throat. Most commonly, the pathological event is caused by bacteria of the Streptococcus type A species. Treatment is equivalent to abscess drainage followed by removal of the tonsils.
What is a peritonsillar abscess?
The constrictor pharyngis muscle is a multi-part muscle that is part of the pharyngeal musculature and is located not far from the palatine tonsils. Abscesses can form in the area between the palatine tonsil and the constrictor pharyngis muscle. These are encapsulated collections of pus located in a preformed tissue cavity. Bacteria are usually involved in the formation of abscesses. The pus in this case corresponds to a mixture of dead body cells, bacteria and immune cells. When an abscess forms between the tonsils and the constrictor pharyngis muscle, it is called a peritonsillar abscess. Acute danger to life is associated with an untreated peritonsillar abscess, as the abscess could break into the spatium parapharyngeum and descend into the mediastinum. Like any abscess, peritonsillar abscess consists of an abscess cavity due to inflammatory melting of the tissue and the pus within. With any abscess, there is a risk that it will continue to spread along stomata, increasing in size considerably. Abscesses often form fistulas that connect the abscess to internal or external body surfaces in the form of a duct system. Peritonsillar abscess usually corresponds to a bacterial abscess and thus tends not to be a sterile abscess.
Causes
Bacterial abscesses occur as a result of a bacterial infection. One such infection is angina lacunaris. This is a form of tonsillitis in which the bacterial plaque extends beyond the structure of the tonsils. Most often, such inflammations are the result of infection with the Streptococcus type A bacterium. Peritonsillar abscess can be the complication of angina lacunaris. The inflammation, and with it the bacteria, initially spreads to the connective tissue between the palatine tonsils and the constrictor pharyngis muscle, resulting in peritonsillitis. This peritonsillitis eventually results in abscess formation. The abscess does not necessarily arise with this etiology. A peritonsillar abscess can also form after pharyngitis acuta and treatments such as tonsillectomy, unless the tonsils have been completely removed. However, because streptococcus type A remains the preferred pathogen of the abscess, peritonsillar abscess is often referred to as a mixed aerobic-anaerobic infection, which is expected to be a complication of angina lacunaris and, less commonly, pharyngitis acuta.
Symptoms, complaints, and signs
Peritonsillar abscess forms as a late sequela of angina lacunaris and, accordingly, does not occur in the acute phase but several days after the inflammation. Patients suffer from unilateral dysphagia, which makes it difficult for them to ingest food. Due to the reduced food intake, the affected persons are in a rather poor general condition, and their body temperature is infectiously elevated. The speech of the patients seems dumbstruck. Often the affected persons complain in the anamnesis of stabbing earache, which is also known as otalgia. Excessive saliva production in the sense of hypersalivation occurs. In some cases, patients are barely able to open their mouths, so that lockjaw can be observed. One of the most serious complications of the abscess is the invasion of the spatium parapharyngeum. The abscess and with it the causative bacteria thus descend into the mediastinum and cause mediastinitis, which can assume life-threatening proportions. In addition, a complication risk is abscess encroachment on veins in the neck region and, finally, bacteremia, which can cause sepsis. Like all infections, peritonsillar abscess may be accompanied by general signs of infection such as chills, lassitude, and loss of appetite.
Diagnosis and course of the disease
To diagnose a peritonsillar abscess, the physician inspects the soft palate, which is usually affected by restrictions on one side. Often, the palatal arch is reddened or bulges forward in the anterior region.An enlarged, laterally displaced uvula completes the clinical picture. In addition, the lymph nodes are infectiously enlarged and sensitive to touch. The physician secures his first suspicion by a sonography of the neck area. An x-ray also serves to confirm the diagnosis. If the abscess spreads along the cervical fascia, a CT scan is also performed. Differentially, the physician rules out uvular edema. Early diagnosis of peritonsillar abscess is associated with a favorable prognosis. If the above complications have already occurred, the prognosis is much less favorable.
Complications
In most cases, this disease can be treated relatively well. Especially if diagnosed and treated early, no particular complications occur and the course of the disease is always positive. In this disease, patients primarily suffer from severe swallowing difficulties as well as sore throat. The swallowing difficulties can lead to restrictions in the intake of food and liquids, so that underweight and possibly deficiency symptoms can occur. Earaches or headaches also occur with this disease. The affected persons can no longer speak easily, so that there are considerable restrictions in the patient’s everyday life. Furthermore, without treatment, the bacteria can also spread into the blood, so that in the worst case it can lead to blood poisoning and thus to the death of the affected person. Likewise, in most cases, patients suffer from the symptoms of influenza, so that fatigue and exhaustion of the affected person occur. With the help of antibiotics, the symptoms of this disease can be limited. Complications usually do not occur and there is also no reduced life expectancy.
When should you go to the doctor?
A peritonsillar abscess must always be treated by a physician. If treatment is not initiated, this condition may even cause the death of the affected person. The earlier treatment begins, the higher the chances of complete recovery. A doctor should be consulted if there is severe difficulty in swallowing or inflammation in the area of the mouth. These symptoms do not disappear on their own and are usually more severe than usual. Similarly, fever and the general symptoms of flu may occur. Speech difficulties are also often indicative of a peritonsillar abscess and should be investigated. Many patients can no longer breathe easily and suffer from gasping or hyperventilation. Fatigue or chills also occur, and many patients also have a loss of appetite. The disease is usually diagnosed and treated by a general practitioner or by an otolaryngologist. There is usually a positive course of the disease and life expectancy is not reduced.
Treatment and therapy
Since peritonsillar abscess can become life-threatening due to complications or too late diagnosis, treatment and thus control of the causative bacteria must be started as soon as possible. Even at the first signs of peritonsillitis, the administration of oral or parenteral penicillin is indicated. In this way, the formation of the abscess can possibly still be prevented. As an alternative to the administration of penicillin, drugs such as clindamycin or cefuroxime are available. If a full abscess has already formed, incision and spreading takes place. The physician uses a grain forceps for this purpose. A few days after the procedure, the abscess is re-spread. This treatment should cause sufficient emptying of the abscess. If the abscess does not empty sufficiently, an invasive abscess tonsillectomy is performed in the sense of a hot tonsillectomy. Tonsillectomy is also indicated if satisfactory emptying has been achieved. If this treatment is not performed approximately four days after incision, a high risk for recurrence remains.
Outlook and prognosis
Tonsillar abscess or peritonsillar abscess is a relatively common complication of purulent tonsillitis. Statistically, there are about 40 peritonsillar abscesses per year for every 100,000 cases of tonsillitis. Those affected by a tonsillar abscess are usually younger adults. The dramatic increase in antibiotic resistance in recent times is problematic.As a result, acute and purulent tonsillitis is followed by a significantly higher incidence of painful tonsillar abscesses. The prognosis, which is good in itself, can thus be relativized in the future. If antibiotics are no longer effective in the case of an abscess or purulent tonsillitis, abscess formation will probably occur even more frequently in the future. Peritonsillar abscess results from the spread of bacteria from the suppurated pharyngeal tonsil to surrounding tissue. An abscess forms on at least one tonsil. This is filled with pus and is extremely painful. It may subsequently lead to lockjaw. The patient develops fever, and severe difficulty swallowing. These can radiate into the ear, and also cause the lymph nodes to swell. The prognosis can only be improved if the physician opens and drains the abscess. Antibiotics or penicillin are then prescribed. The prognosis is quite good with proper treatment. However, it does not exclude recurrence of such inflammation and abscess formation. Unless the adenoids, which are prone to inflammation, are surgically removed, there remains a risk of further abscess formation.
Prevention
Peritonsillitis can be prevented only to the extent that angina can be prevented. Peritonsillar abscess, in turn, can be prevented by counteracting incipient peritonsillitis with penicillin.
Follow-up
Peritonsillar abscess requires comprehensive follow-up care. Initially, severe pain, difficulty swallowing, and fever occur, severely limiting well-being, but the prospects for recovery are usually good. Antibiotic treatment is effective and helps to alleviate the symptoms. A combination therapy is especially effective, which should quickly resolve the symptoms associated with the abscess. Life expectancy is usually not limited by a peritonsillar abscess. Only in severe cases can serious complications occur, which can be fatal if the patient has a poor physical constitution. Possible complications include blood poisoning or severe inflammation with high fever, which may result in circulatory collapse. During follow-up care, the complaints must be clarified once again in order to rule out discomfort and complications. Patients should contact the responsible physician and discuss further steps. If no complaints have been identified, no further treatment of the abscess is usually necessary. Follow-up care also includes the gradual discontinuation of prescribed antibiotics. Subsequently, the physician should be consulted again, as a final examination of the blood values is necessary. If necessary, further imaging procedures must be used.
What you can do yourself
It is essential that a peritonsillar abscess be opened and drained by a physician. At the same time, the tonsils may be removed. The prescribed medications, usually penicillin, must be taken consistently as directed by the physician. Patients need bed rest to allow the infection to subside. At the same time, they must eat sufficiently, even if swallowing difficulties and loss of appetite make it difficult to eat. Here, homemade chicken soup is particularly recommended, as it is nutritious on the one hand and also compensates for any lack of fluids on the other. In addition, experience has shown that it can reduce fever. Chicken meat contains easily digestible protein and the cooked vegetables bring additional vitamins. Of course, nicotine and alcohol are taboo for patients with a peritonsillar abscess. Since bacteria have triggered the disease, intensive oral hygiene is important both during the healing process and for prophylaxis. Even minor damage to the teeth and gums can harbor bacteria and should be treated by a dentist at an early stage. Daily oral hygiene involves brushing the teeth thoroughly at least twice a day with a fluoride toothpaste. The spaces between the teeth should also be cleaned once a day. Dental floss and interdental brushes are suitable for this purpose. A healthy diet with plenty of fruit, vegetables and whole grain products not only supports the immune system in the fight against further bacterial infections, but also helps to ensure that the oral flora remains intact and can fight off bacteria.
