Definition

Peritonsillar abscess is a collection of infected material in the area around the tonsils.

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Alternative Names

Quinsy; Abscess - peritonsillar

Causes, incidence, and risk factors

Peritonsillar abscess is a complication of tonsillitis. It is most often caused by a type of bacteria called group A beta-hemolytic streptococcus.

Peritonsillar abscess is usually a condition of older children, adolescents, and young adults. It has become uncommon with the use of antibiotics to treat tonsillitis.

Symptoms

One or both tonsils become infected. The infection usually spreads behind the tonsil and can then spread down into the neck and chest. Swollen tissues can block the airway. This is a life-threatening medical emergency.

The abscess can break open (rupture) into the throat. The content of the abscess can then travel into the lungs and cause pneumonia.

Symptoms of peritonsillar abscess include:

• Fever an chills
• Severe throat pain that is usually on one side
• Difficulty opening the mouth, and pain with opening the mouth
• Difficulty swallowing
• Drooling or inability to swallow saliva
• Facial or neck swelling
• Fever
• Headache
• Muffled voice
• Tender glands of the jaw and throat

Signs and tests

An examination of the throat often shows swelling on one side and on the roof of the mouth.

The uvula in the back of the throat may be shifted away from the swelling. The neck and throat may be red and swollen on one or both sides.

The following tests may be done:

• Aspiration of the abscess using a needle
• CT scan

Treatment

If the infection is caught early, you will be given antibiotics. More likely, if an abscess has developed, it will need to be drained with a needle or by cutting it open. You will be given pain medicine before this is done.

Sometimes, at the same time the abscess is drained, the tonsils will be removed. In this case, you will be put to sleep with anesthesia.

Expectations (prognosis)

Peritonsillar abscess usually goes away with treatment, although the infection may return in the future.

Complications

• Airway obstruction
• Cellulitis of the jaw, neck, or chest
• Endocarditis (rare)
• Fluid around the lungs (pleural effusion)
• Inflammation around the heart (pericarditis)
• Pneumonia
• Sepsis (infection in the blood) 

Calling your health care provider

Call your health care provider right away if you have had tonsillitis and you develop symptoms of peritonsillar abscess.

Call your health care provider if you have:

• Difficulty breathing
• Difficulty swallowing
• Pain in the chest
• Persistent fever
• Symptoms that get worse

Prevention

Treating tonsillitis, especially bacterial tonsillitis, quickly and completely may help prevent an abscess.

References

Shirley WP, Woolley AL, Wiatrak BJ. Pharyngitis and adenotonsillar disease. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby;2010:chap 196.

Melio FR. Upper respiratory tract infections. In: Marx JA, Hockberger RS, Wallis RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby;2009:chap 73.

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