2. Definition
It is a collection of pus in the peritonsillar
space which lies between the capsule of tonsil
and the superior constrictor muscle
Or
It is a localized accumulation of pus in the
peritonsillar tissues that forms as a result of
suppurative tonsillitis
3. Causes
It occurs as a complication of an untreated or
partially treated tonsillitis
Organisms
Streptococcus - GAS
Staphylococcus
Heamophilus
4. Pathophysiology
Tonsillitis or pharyngitis
Tonsilar crypt get infected and sealed off
Intra tonsillar abscess
It burst into peritonsillar space through tonsillar capsule
Peritonsillitis
Peritonsilar abscess
5. Peritonsillar abscess (if not treated)
Laryngeal edema
Parapharyngeal
Abscess
Spread through blood – septicemia – infection to
heart (endocarditis), kidney (nephritis), brain (brain
abscess), lungs (lung abscess and pneumonia),
airway obstruction, cellulitis of the jaw, neck or
chest, pleural effusion
6. Signs and symptoms
More common in children
Symptoms start two to eight days
before the formation of abscess
Unilateral sore throat and pain
during swallowing (odynophagia)
Fever, malaise, headache
Distortion of voice – hot potato
voice
Neck pain associated with
tenderness, swollen lymph nodes
Referred ear pain, halitosis
Drooling of saliva
7. Trismus – limited ability to open the mouth
Redness and edema in the tonsils
Uvula may be displaced towards the
unaffected side
8. Diagnosis
History collection
Physical examination
Aspiration of the abscess using a needle -
culture
CT scan
Ultrasonography
9. Management – surgical
management
Needle aspiration – low cost, and
good patient tolerance
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
10. Position – sitting position to make it easier to
expectorate the pus and blood that
accumulate in the pharynx
Patient experiences almost immediate relief
If 3 ml or more of purulent material is
aspirated then patient will likely need to be
seen the next day for further aspiration
11. Surgical incision and drainage of the pus –
this will relieve pain.
Tonsillectomy – for patients who are not
relieved from needle aspiration or incision
and drainage.
The risk for bleeding after surgery is more
than normal removal of tonsils in
tonsillectomy
