definition.caues clinicalfeatures management

2.  A peritonsillar abscess is a collection of purulent exudate between
 the tonsillar capsule and the surrounding tissues, including the
 soft palate. It is believed to develop after an acute tonsillar
infection,
 which progresses to a local cellulitis and abscess.

3.  Clinical Manifestations
 The usual symptoms of an infection are present, together with
 such local symptoms as a raspy voice, odynophagia (a severe
sensation
 of burning, squeezing pain while swallowing), dysphagia
 (difficulty swallowing), otalgia (pain in the ear), and drooling. An
 examination shows marked swelling of the soft palate, often
occluding
 almost half of the opening from the mouth into the pharynx,
 unilateral tonsillar hypertrophy, and dehydration.

4.  Assessment and Diagnostic Findings
 Aspiration of purulent material (pus) by needle aspiration is required
 to make the appropriate diagnosis. The aspirated material
 is sent for culture and Gram’s stain. A CTscan is performed when
 it is not possible to aspirate the abscess.

5.  Medical Management
 Antibiotics (usually penicillin) are extremely effective in controlling
 the infection in peritonsillar abscess. If antibiotics are prescribed
 early in the course of the disease, the abscess may resolve
 without needing to be incised.

6.  SURGICAL MANAGEMENT
 If treatment is delayed, the abscess is evacuated as soon as possible.
 The mucous membrane over the swelling is first sprayed with
 a topical anesthetic and then injected with a local anesthetic. Single
 or repeated needle aspirations are performed to decompress
 the abscess. The abscess may also be incised and drained. These
 procedures are performed best with the patient in the sitting position
 to make it easier to expectorate the pus and blood that accumulate
 in the pharynx. Almost immediate relief is experienced.
 Approximately 30% of patients with peritonsillar abscess have indications
 for tonsillectomy (Tierney et al., 2001).

7.  Nursing Management
 Considerable relief may be obtained by the use of topical anesthetic
 agents and throat irrigations or the frequent use of mouthwashes
 or gargles, using saline or alkaline solutions at a temperature
 of 105°F to 110°F (40.6°C to 43.3°C). The nurse instructs the
 patient to gargle at intervals of 1 or 2 hours for 24 to 36 hours.
 Liquids that are cool or at room temperature are usually well
 tolerated.