Peritonsillar abscess – it’s not only a mouthful to say, but the pain may bring a “lump” to your throat.
“PA is a collection of pus between the tonsil and the pharyngeal muscles that surround the tonsil in the throat,” says Dr. Rachel Brock, a board-certified otolaryngologist and head and neck surgeon at Health First’s Melbourne office.
“While it can occur in people of any age, it is the most common deep neck tissue infection in children and adolescents, affecting about 30 in every 100,000 people annually,” she adds.
“It usually starts with tonsillitis, progressing to cellulitis (soft tissue inflammation and swelling) and then to an abscess.
“It can sometimes be caused by obstruction of a small gland near the tonsils,” Dr. Brock adds.
“It differs from tonsillitis – that is an infection of both tonsils, causing them to be red and swollen but with no abscess present.”
Cleveland Clinic says PA can be serious, especially if the abscess grows so large that it blocks your throat. This can make it difficult to speak, swallow or breathe. Left untreated, it can become a life-threatening infection.
Dr. Brock says, “Several different types of bacteria can cause peritonsillar abscess, although the strep species are the most common.”
Harvard Health Publishing says symptoms include:
- Very sore throat.
- Difficulty swallowing or opening the mouth wide.
- Swollen lymph nodes in the neck.
- Headache.
- Chills or fever.
- Swelling of the face.
- Specific changes in speech, sometimes called “hot potato voice” because it sounds as if you’re talking with a mouthful of hot mashed potatoes.
Dr. Brock adds that someone suffering with what he or she thinks is tonsilitis will notice a severely painful one-sided sore throat if the problem is PA – usually by the third or fourth day. That’s the time to seek medical help if you haven’t already done so.
“[The sore throat] will be accompanied by a muffled voice and drooling that is caused by severe pain when swallowing,” Dr. Brock says.
“Also look for a large, swollen, red tonsil on one side, uvula deviation past the midline, painful, swollen lymph nodes, and a fever.” The uvula is the small, teardrop-shaped piece of fleshy tissue that hangs down from the back of the roof of your mouth.
A peritonsillar abscess is usually diagnosed based on history and a physical exam, according to WebMD. The doctor will look into your mouth using a light and, possibly, a tongue depressor.
Dr. Brock adds that, while it usually isn’t necessary, an ultrasound or CT scan can confirm the diagnosis and determine the size of the abscess.
“Strep testing can also be done,” she adds, “to see if the body is trying to fight that infection.
“Ultimately, confirmation of the diagnosis is made by aspirating pus from around the tonsil with a needle and syringe.”
Treatment depends in large part on the size of the abscess.
“If it is small – 1 centimeter or less – it can be treated with antibiotics administered intravenously, followed by oral antibiotics to be taken at home,” Dr. Brock says. “Reevaluation should take place within 24 to 36 hours.
“Larger abscesses require intravenous antibiotics and drainage. Often, pain medication and intravenous fluids are also given. The patient can go home after drainage.”
Tonsillitis, which PA is often mistaken for, is a serious condition, too.
Dr. Brock says it is important to see a doctor for treatment of tonsillitis as soon as possible, especially if symptoms begin to worsen.
“Left untreated, it may cause airway obstruction or spread to the surrounding structures, sometimes it may travel down into the chest and cause more infection.”
Rachel Brock, MD, is a board-certified otolaryngologist and head and neck surgeon. She received her medical degree from University of South Florida Morsani College of Medicine and completed her training in otolaryngology at University of Oklahoma Health Sciences. Her office is located at Health First Medical Group Gateway, 1223 Gateway Dr., Suite 1G Melbourne. Call 321-729-8079 for an appointment.
