What are the other names for this Condition? (Also known as/Synonyms)

• PTA (Peritonsillar Abscess)
• Quinsy

What is Peritonsillar Abscess? (Definition/Background Information)

• Peritonsillar Abscess (PTA) is a bacterial infection in which pus-filled tissue forms at the back of the mouth, near one of the tonsils
• The condition primarily develops due to biological factors, and can be caused by Streptococcus pyogenes, the bacteria that cause strep throat. Individuals may also develop Peritonsillar Abscess as a result of untreated strep throat or tonsillitis
• The infection may start as a sore throat that may worsen over time. Peritonsillar Abscess may result in intense pain on one side of the throat, causing difficulty in opening one’s mouth and in swallowing
• The treatment options for Peritonsillar Abscess may vary from one individual to another, and may require the use of medication and/or surgery to heal symptoms
• If Peritonsillar Abscess is not treated promptly, the infection may spread to the neck, roof of the mouth, and lungs, which can cause problems with breathing 
• The prognosis for Peritonsillar Abscess is generally good. Once the condition has been diagnosed, it is easy to treat and most individuals recover fully from the infection
• However, in case of complications, such as retropharyngeal abscess, the prognosis may depend on the severity of the condition. In such cases, early diagnosis and prompt management is very important

Who gets Peritonsillar Abscess? (Age and Sex Distribution)

• Peritonsillar Abscess is a rare infectious disorder that commonly affects children, adolescents, and young adults
• The infection affects both males and females equally
• Individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Peritonsillar Abscess? (Predisposing Factors)

Some known risk factors for Peritonsillar Abscess may include:

• Smoking
• Tooth disease; gum disease
• Strep throat
• Tonsillitis: Acute and chronic infection of the tonsils
• Presence of tonsillar stones (tonsilloliths), which can occur due to variety of causes
• Infectious mononucleosis
• Chronic lymphocytic leukemia
• Trauma from foreign bodies, such as pieces of bones, pins, etc.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Peritonsillar Abscess? (Etiology)

Peritonsillar Abscess (PTA) infection may be caused by the following factors:

• Throat infection by streptococcal bacteria such as Streptococcus pyogenes (that is also the cause of strep throat)
• Untreated strep throat
• Tonsillitis

Common organisms responsible for PTA may include:

• Beta-hemolytic streptococci
• Staphylococcus aureus
• Haemophilus parainfluenzae
• Anaerobic organisms such as bacteroides Spp

What are the Signs and Symptoms of Peritonsillar Abscess?

The signs and symptoms of Peritonsillar Abscess may include the following:

• Sore throat, especially involving one side of the throat
• Pus accumulation in the space around the tissues, at the back of the throat
• Difficulty speaking; muffled or hoarse voice
• Drooling from the mouth; uncontrollable flow of saliva from the mouth
• Cough
• Red and swollen tonsils
• Intense pain on one side of the throat
• A tonsil pushing against the uvula (the hanging tissue at the back of the mouth)
• Swollen glands on one side of the neck; neck pain and stiff neck
• Difficulty and pain opening one’s mouth (trismus)
• Swallowing difficulties (dysphagia)
• Body pain including headache and earache
• High-grade fever
• Airways obstruction
• Abnormal breathing sound that is very high-pitched (stridor)
• Malaise, which is general discomfort and uneasiness

How is Peritonsillar Abscess Diagnosed?

A diagnosis of Peritonsillar Abscess is made based on the basis of information gathered from the following tests and exams:

• Complete physical evaluation and comprehensive analysis of medical history
• Blood tests that include a complete blood count (CBC), which gives a picture of infection in the body
• Throat culture: A sample tissue is taken from the tonsils and throat and sent to the lab for testing
• Chest X-ray: It gives an image of the lungs and is helpful in identifying the focus of infection or abnormality in the lung
• Ultrasound imaging scan of the tonsils
• CT scan of chest: This imaging tool helps present detailed pictures of the lungs and is helpful in determining the extent of the disease
• Sputum microscopy and culture: Staining the phlegm with special staining techniques and observing them under microscope can help identify the disease. Also, growing the microorganisms under special conditions in the laboratory can help identify them, as they have a typical appearance and characteristics
• Differential diagnosis to rule out other conditions/infections that may be present with similar signs and symptoms

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Peritonsillar Abscess?

The following complications may be observed in Peritonsillar Abscess:

• Blockage of airway leading to respiratory and breathing troubles
• Bleeding in the mouth
• Dehydration
• Infection in the breastbone
• Aspiration pneumonia: Inflammation/infection of the lungs and airways caused by breathing in the infectious material
• Meningitis
• Sepsis (bacteria in the bloodstream)
• Development of acute retropharyngeal abscess, which usually results from formation of pus in the retropharyngeal lymph nodes due to infected tonsils

Peritonsillar Abscess can lead to spread of infection around the tonsils causing retropharyngeal abscess (or RPA). Development of RPA may further lead to the following complications:

• Mediastinitis: Inflammation of the tissues present in the mid-chest
• Osteomyelitis: Infection of the bone, caused by bacteria and other germs
• Pericarditis: Inflammation of the tissue surrounding the heart
• Epidural abscess: Collection of pus between the covering of the brain and spinal cord and the bones of the skull or spine
• Septicemia, when bacteria enters the bloodstream, resulting in severe infection
• Adult respiratory distress syndrome: Severe infection of the lungs caused by filling-up of fluid in the air sacs, within the lungs
• Wearing away of the 2nd and 3rd cervical vertebrae (present close to the site of infection)
• Deficit of cranial nerves IX and XII
• Septic thrombosis of the jugular vein, a neck vein that is present near the site of infection

How is Peritonsillar Abscess Treated?

The treatment for Peritonsillar Abscess may include the following:

• Administration of medication: Antibiotics can help heal the infection completely following the drainage of pus
• Corticosteroids are given to reduce the swelling in the airways
• Care is taken to protect the airway, so that it is not blocked completely
• Needle aspiration: Inserting a needle to remove the pus from the affected area
• Incision and drainage: Surgery of the affected area using a scalpel to drain the pus
• Surgery: Acute tonsillectomy may be needed to remove tonsils (generally undertaken as a last resort)

How can Peritonsillar Abscess be Prevented?

The following methods may aid in preventing Peritonsillar Abscess onset:

• Refraining from smoking; quitting smoking
• Maintaining good dental hygiene
• Diagnosing and treating oral infections and upper respiratory infections promptly and adequately
• Frequent cleaning of hands with soap and water
• Covering the mouth while coughing or sneezing
• Avoid sharing personal items, such as drinking glasses, utensils, clothes, etc., while being infected
• Children with strep throat should refrain from going to school (per advise of the healthcare provider)

What is the Prognosis of Peritonsillar Abscess? (Outcomes/Resolutions)

• The prognosis for Peritonsillar Abscess is normally good; most affected individuals are able to fully recover from this infection. The likelihood of infection recurrence after treatment is generally low
• However, in case of complications, such as retropharyngeal abscess, which is a life-threatening medical emergency, the prognosis may be guarded, if early and appropriate treatment is not provided
• Care should be taken to avoid a complete blockage of the airways, a condition that is potentially fatal

Additions and Relevant Useful Information for Peritonsillar Abscess:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/infection-center/