Peritonsillar abscess is usually the complication of a bacterial infection in the throat and throat area. The pathological process is most frequently caused by bacteria of the Streptococcus type A species. Treatment is equivalent to draining the abscess followed by removal of the tonsils.
What is a peritonsillar abscess?
The pharyngeal constrictor muscle is a multi-part muscle that is part of the pharyngeal muscles and is located near the tonsils. Abscesses can form in the area between the tonsils and the pharyngeal constrictor muscle. These are encapsulated accumulations of pus that are located in a preformed tissue cavity. Bacteria are usually involved in the formation of abscesses. See electronicsencyclopedia for Slang Hypertriglyceridemia.
In this case, the pus corresponds to a mixture of dead body cells, bacteria and immune cells. When an abscess develops between the tonsils and the pharyngeal constrictor muscle, it is called a peritonsillar abscess. Acute danger to life is associated with an untreated peritonsillar abscess because the abscess could break into the parapharyngeal space and descend into the mediastinum.
Like every abscess, the peritonsillar abscess also consists of an abscess cavity due to inflammatory melting of the tissue and the pus lying in it. With any abscess there is a risk that it will spread further along crevice spaces and thus increase considerably in size. Abscesses often form fistulas, which connect the abscess to internal or external body surfaces in the form of a duct system. The peritonsillar abscess usually corresponds to a bacterial abscess and is therefore not to be understood as a sterile abscess.
Causes
Bacterial abscesses develop 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. Such inflammations are usually the result of an infection with the bacterium Streptococcus type A.
Peritonsillar abscess can be a complication of angina lacunaris. The inflammation and with it the bacteria first spread in the connective tissue between the tonsils and the pharyngeal constrictor muscle, which leads to peritonsillitis. This peritonsillitis eventually results in abscess formation. The abscess does not necessarily have to have this etiology.
A peritonsillar abscess can also form after acute pharyngitis and treatments such as tonsillectomy, unless the tonsils have been completely removed. However, since the streptococci type A remain the preferred pathogens of the abscess, the peritonsillar abscess is often an aerobic-anaerobic mixed infection, which is to be expected as a complication of angina lacunaris and, more rarely, of acute pharyngitis.
Symptoms, Ailments & Signs
The peritonsillar abscess forms as a late consequence of angina lacunaris and accordingly does not occur in the acute phase but a few days after the inflammation. The patients suffer from one-sided swallowing difficulties that make it difficult for them to eat. Due to the reduced food intake, those affected are in a rather poor general condition, with their body temperature being infectiously elevated.
The patients’ language seems awkward. In the anamnesis, those affected often complain of stabbing ear pain, which is also known as otalgia. Excessive saliva production in the sense of hypersalivation occurs. In some cases, the patients can hardly open their mouths, so that a clenched jaw can be observed. One of the most serious complications of the abscess occurs when it penetrates the parapharyngeal space.
The abscess and with it the causative bacteria sink into the mediastinum and cause mediastinitis, which can assume life-threatening proportions. In addition, there is a risk of complications from abscesses spreading to veins in the neck region and finally bacteremia, which can cause sepsis. Like all infections, a peritonsillar abscess can be accompanied by general signs of infection such as chills, fatigue and loss of appetite.
Diagnosis & course of disease
To diagnose a peritonsillar abscess, the doctor inspects the soft palate, which is usually restricted on one side. The arch of the palate is often reddened in the front area or bulges forward. An enlarged, laterally displaced uvula completes the clinical picture.
In addition, the lymph nodes are infectious enlarged and sensitive to touch. The doctor confirms his first suspicion with a sonography of the neck area. An x-ray is also used to confirm the diagnosis. If the abscess spreads along the neck fascia, a CT scan is also done. In the differential diagnosis, the doctor rules out uvula 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 with early diagnosis and treatment, no particular complications arise and the course of the disease is always positive. Patients with this disease primarily suffer from severe swallowing difficulties and a sore throat.
The swallowing difficulties can lead to restrictions in the intake of food and liquids, which can lead to underweight and possibly also to deficiency symptoms. Earaches and headaches also occur with this disease. Those affected can no longer speak easily, so that there are considerable restrictions in the patient’s everyday life.
Furthermore, the bacteria can also spread into the blood without treatment, so that in the worst case it can lead to blood poisoning and thus to the death of the person concerned. In most cases, the patients also suffer from the symptoms of flu, so that the person concerned becomes tired and exhausted.
The symptoms of this disease can be reduced with the help of antibiotics. There are usually no complications and there is no reduced life expectancy.
When should you go to the doctor?
A peritonsillar abscess must always be treated by a doctor. If no treatment is initiated, this disease can even lead to the death of the person concerned. The earlier treatment begins, the higher the chances of a complete cure. A doctor should be consulted if there is severe difficulty in swallowing or an inflammation in the mouth area, although these symptoms do not go away on their own and are usually more severe than usual. Fever and general symptoms of a mouth infection can also occur coming flu.
Speech problems are also often an indication of a peritonsillar abscess and should therefore be examined. Many patients are unable to breathe easily and suffer from gasping or hyperventilation. It also comes to exhaustion or chills, with many patients also have a loss of appetite.
The disease is usually diagnosed and treated by a general practitioner or an ENT doctor. The course of the disease is usually positive and life expectancy is not reduced.
Treatment & Therapy
Since the peritonsillar abscess can become life-threatening due to complications or a late diagnosis, treatment and thus combating the causative bacteria must be started as soon as possible. Administration of oral or parenteral penicillin is indicated at the first sign of peritonsillitis.
In this way, the formation of the abscess can still be prevented under certain circumstances. Drugs such as clindamycin or cefuroxime are available as an alternative to penicillin administration. If a full abscess has already formed, an incision and spread takes place. The doctor uses forceps to do this. A few days after the operation, it is spread again. This treatment should require sufficient drainage of the abscess.
If the abscess does not drain adequately, an invasive abscess tonsillectomy, referred to as a hot tonsillectomy, is done. Tonsillectomy is indicated even when satisfactory emptying has been achieved. If this treatment is not performed about four days after the incision, there remains a high risk of recurrence.
Outlook & Forecast
The tonsil 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. Mostly younger adults are affected by a tonsil abscess.
The recent dramatic increase in antibiotic resistance is problematic. As a result, painful tonsil abscesses occur much more frequently after acute and purulent tonsillitis. The prognosis, which is good in itself, may be put into perspective in the future. If antibiotics are no longer effective for an abscess or purulent tonsillitis, abscess formation will probably occur more frequently in the future.
The peritonsillar abscess is caused by the spread of bacteria from the abscessed pharyngeal tonsils to the surrounding tissue. An abscess develops on at least one tonsil. This is filled with pus and extremely painful. It can subsequently lead to a locked jaw. The patient develops a 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 doctor opens and drains the abscess. Antibiotics or penicillin are then prescribed.
The prognosis is quite good with proper treatment. However, it does not rule out a recurrence of such inflammation and abscess formation. If the inflamed tonsils are not surgically removed, there is still a risk of further abscess formation.
Prevention
Peritonsillitis can only be prevented to the extent that angina can be prevented. In turn, the peritonsillar abscess can be prevented by counteracting the onset of peritonsillitis with penicillin.
Aftercare
The peritonsillar abscess requires extensive follow-up care. At the beginning there is severe pain, difficulty swallowing and fever, which severely limit well-being, but the chances of recovery are usually good. Antibiotic treatment is effective and helps relieve symptoms.
Combination therapy is particularly effective, which should quickly resolve the symptoms associated with the abscess. Life expectancy is not usually reduced by a peritonsillar abscess. Serious complications can only occur in severe cases, which can be fatal if the physical constitution is poor.
Symptoms such as blood poisoning or severe inflammation with a high fever are possible, which can result in a circulatory collapse. As part of the aftercare, the symptoms must be clarified again in order to rule out symptoms and complications. Patients should contact the responsible doctor and discuss the next steps.
If no symptoms are found, no further treatment of the abscess is usually necessary. Aftercare also includes the gradual discontinuation of the prescribed antibiotics. The doctor should then be consulted again, as a final examination of the blood values is necessary. If necessary, further imaging methods must be used.
You can do that yourself
A peritonsillar abscess must be opened and drained by a doctor. At the same time, the tonsils may be removed. The prescribed medication, mostly penicillin, must be taken consistently as directed by the doctor.
Patients require bed rest to allow the infection to subside. At the same time, they have to eat enough, even if swallowing difficulties and loss of appetite make it difficult to eat. A homemade chicken soup is particularly recommended here, as it is nutritious and also compensates for a possible lack of fluids. Experience has shown that it can also reduce fever. Chicken meat contains easily digestible protein and the vegetables cooked with it provide 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 early by a dentist. In daily oral hygiene, the teeth are brushed thoroughly at least twice with a toothpaste containing fluoride. The spaces between the teeth should also be cleaned once a day. Dental floss and interdental brushes are suitable for this.
A healthy diet with lots of fruit, vegetables and whole grain products not only supports the immune system in the fight against further bacterial infections, but also helps to keep the oral flora intact and able to fight off bacteria.
