peritonsillar abscess

Physical signs of a peritonsillar abscess include redness and swelling in the tonsillar area of the affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced towards the unaffected side.{{cite web |url= https://www.lecturio.com/concepts/peritonsillar-abscess/| title= Peritonsillar Abscess

|website=The Lecturio Medical Concept Library |access-date= 4 October 2021}}

Unlike tonsillitis, which is more common in children, PTA has a more even age spread, from children to adults. Symptoms start appearing two to eight days before the formation of an abscess. A progressively severe sore throat on one side and pain during swallowing (odynophagia) usually are the earliest symptoms. As the abscess develops, persistent pain in the peritonsillar area, fever, a general sense of feeling unwell, headache, and a distortion of vowels informally known as "hot potato voice" may appear. Neck pain associated with tender, swollen lymph nodes, referred ear pain and foul breath are also common. While these signs may be present in tonsillitis itself, a PTA should be specifically considered if there is limited ability to open the mouth (trismus).

While most people recover uneventfully, there is a wide range of possible complications.{{cite journal |vauthors=Klug TE, Greve T, Hentze M |title=Complications of peritonsillar abscess |journal=Annals of Clinical Microbiology and Antimicrobials |volume=19 |issue=1 |pages=32 |date=2020 |pmid=32731900 |pmc=7391705 |doi=10.1186/s12941-020-00375-x |doi-access=free}} These may include:

• Retropharyngeal abscess
• Extension of abscess in other deep neck spaces leading to airway compromise (see Ludwig's angina)
• Airway obstruction
• Aspiration pneumonitis
• Lung abscess (following rupture)
• Sepsis
• Life-threatening hemorrhage (following erosion or septic necrosis into the carotid sheath of the neck)
• Glomerulonephritis and rheumatic fever (chronic complications of strep throat)

Difficulty swallowing can lead to decreased oral intake and dehydration.

PTA usually arises as a complication of an untreated or partially treated episode of acute tonsillitis. The infection, in these cases, spreads to the peritonsillar area (peritonsillitis). This region comprises loose connective tissue and is hence susceptible to formation of an abscess. PTA can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly involved aerobic pathogens include Streptococcus, Staphylococcus and Haemophilus. The most common anaerobic species include Fusobacterium necrophorum, Peptostreptococcus, Prevotella species, and Bacteroides.{{cite journal | vauthors = Brook I, Frazier EH, Thompson DH | title = Aerobic and anaerobic microbiology of peritonsillar abscess | url = https://archive.org/details/sim_laryngoscope_1991-03_101_3/page/289 | journal = The Laryngoscope | volume = 101 | issue = 3 | pages = 289–92 | date = March 1991 | pmid = 2000017 | doi = 10.1288/00005537-199103000-00012 | s2cid = 23505346 }}{{cite journal | vauthors = Sakae FA, Imamura R, Sennes LU, Araújo Filho BC, Tsuji DH | title = Microbiology of peritonsillar abscesses | journal = Brazilian Journal of Otorhinolaryngology | volume = 72 | issue = 2 | pages = 247–51 | year = 2006 | pmid = 16951860 | doi = 10.1016/S1808-8694(15)30063-X | pmc = 9445683 | doi-access = free }}{{cite journal | vauthors = Gavriel H, Lazarovitch T, Pomortsev A, Eviatar E | s2cid = 26365493 | title = Variations in the microbiology of peritonsillar abscess | journal = European Journal of Clinical Microbiology & Infectious Diseases | volume = 28 | issue = 1 | pages = 27–31 | date = January 2009 | pmid = 18612664 | doi = 10.1007/s10096-008-0583-6 }}{{cite journal | vauthors = Sunnergren O, Swanberg J, Mölstad S | s2cid = 40973972 | title = Incidence, microbiology and clinical history of peritonsillar abscesses | journal = Scandinavian Journal of Infectious Diseases | volume = 40 | issue = 9 | pages = 752–5 | year = 2008 | pmid = 19086341 | doi = 10.1080/00365540802040562 }}{{cite journal | vauthors = Klug TE, Henriksen JJ, Fuursted K, Ovesen T | s2cid = 6451474 | title = Significant pathogens in peritonsillar abscesses | journal = European Journal of Clinical Microbiology & Infectious Diseases | volume = 30 | issue = 5 | pages = 619–27 | date = May 2011 | pmid = 21181222 | doi = 10.1007/s10096-010-1130-9 | url = https://hal.archives-ouvertes.fr/hal-00654477 }}{{cite journal | vauthors = Powell EL, Powell J, Samuel JR, Wilson JA | title = A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation | journal = The Journal of Antimicrobial Chemotherapy | volume = 68 | issue = 9 | pages = 1941–50 | date = September 2013 | pmid = 23612569 | doi = 10.1093/jac/dkt128 | citeseerx = 10.1.1.1001.2391 }}

File:Peritonsilarabs.png

Diagnosis is usually based on the symptoms. Medical imaging may be done to rule out complications. Medical imaging may include CT scan, MRI, or ultrasound is also useful in diagnosis.

Medical treatment with antibiotics, volume repletion with fluids, and pain medication is usually adequate, although in cases where airway obstruction or systemic sepsis occurs, surgical drainage may be necessary.{{cite journal |vauthors=Johnson RF |title=Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess |journal=Laryngoscope |volume=127 |pages=S1–S9 |date=October 2017 |issue=Suppl 5 |pmid=28782104 |doi=10.1002/lary.26777 |s2cid=206205296 }} Corticosteroids may also be useful. Admission to hospital is generally not needed.

The infection is frequently penicillin resistant. There are a number of antibiotics options including amoxicillin/clavulanate, ampicillin/sulbactam, clindamycin, or metronidazole in combination with benzylpenicillin (penicillin G) or penicillin V.{{cite journal | vauthors = Visvanathan V, Nix P | title = National UK survey of antibiotics prescribed for acute tonsillitis and peritonsillar abscess | url = https://archive.org/details/sim_journal-of-laryngology-and-otology_2010-04_124_4/page/420 | journal = The Journal of Laryngology and Otology | volume = 124 | issue = 4 | pages = 420–3 | date = April 2010 | pmid = 19930783 | doi = 10.1017/S0022215109991939 | s2cid = 27721802 }} Piperacillin/tazobactam may also be used.

The pus can be removed by a number of methods including needle aspiration, incision and drainage, and tonsillectomy. Incision and drainage may be associated with a lower chance of recurrence than needle aspiration but the evidence is very uncertain. Needle aspiration may be less painful but again the evidence is very uncertain.{{cite journal | vauthors = Chang BA, Thamboo A, Burton MJ, Diamond C, Nunez DA | title = Needle aspiration versus incision and drainage for the treatment of peritonsillar abscess | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD006287 | date = December 2016 | issue = 12 | pmid = 28009937 | pmc = 6463807 | doi = 10.1002/14651858.CD006287.pub4 | collaboration = Cochrane ENT Group }}

Treatment can also be given while a patient is under anesthesia, but this is usually reserved for children or anxious patients. Tonsillectomy can be indicated if a patient has recurring peritonsillar abscesses or a history of tonsillitis. For patients with their first peritonsillar abscess most ENT-surgeons prefer to "wait and observe" before recommending tonsillectomy.

It is a commonly encountered otorhinolaryngological (ENT) emergency.{{cite journal | vauthors = Raut VV | title = Management of peritonsillitis/peritonsillar | journal = Revue de Laryngologie - Otologie - Rhinologie | volume = 121 | issue = 2 | pages = 107–10 | date = 2000 | pmid = 10997070 }}

The number of new cases per year of peritonsillar abscess in the United States has been estimated approximately at 30 cases per 100,000 people.{{cite journal | vauthors = Johnson RF, Stewart MG | s2cid = 38122236 | title = The contemporary approach to diagnosis and management of peritonsillar abscess | journal = Current Opinion in Otolaryngology & Head and Neck Surgery | volume = 13 | issue = 3 | pages = 157–60 | date = June 2005 | pmid = 15908813 | doi = 10.1097/01.moo.0000162259.42115.38 }} In a study in Northern Ireland, the number of new cases was 10 cases per 100,000 people per year.{{cite journal | vauthors = Hanna BC, McMullan R, Gallagher G, Hedderwick S | title = The epidemiology of peritonsillar abscess disease in Northern Ireland | journal = The Journal of Infection | volume = 52 | issue = 4 | pages = 247–53 | date = April 2006 | pmid = 16125782 | doi = 10.1016/j.jinf.2005.07.002 }}

In Denmark, the number of new cases is higher and reaches 41 cases per 100,000 people per year.{{cite journal | vauthors = Ehlers Klug T, Rusan M, Fuursted K, Ovesen T | title = Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark | journal = Clinical Infectious Diseases | volume = 49 | issue = 10 | pages = 1467–72 | date = November 2009 | pmid = 19842975 | doi = 10.1086/644616 | doi-access = free }} Younger children who develop a peritonsillar abscess are often immunocompromised and in them, the infection can cause airway obstruction.{{cite journal | vauthors = Hardingham M | title = Peritonsillar infections | url = https://archive.org/details/sim_otolaryngologic-clinics-of-north-america_1987-05_20_2/page/273 | journal = Otolaryngologic Clinics of North America | volume = 20 | issue = 2 | pages = 273–8 | date = May 1987 | pmid = 3474580 | doi = 10.1016/S0030-6665(20)31644-3}}

The condition is often referred to as "quincy", "quinsy",{{cite book|title=Marx: Rosen's Emergency Medicine|edition=7th|publisher=Mosby, An Imprint of Elsevier|chapter-url=http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05472-0..00073-6--s0105&isbn=978-0-323-05472-0&type=bookPage&from=content&uniqId=416217162-691|access-date=8 July 2013 | chapter = Peritonsillitis (Peritonsillar Cellulitis and Peritonsillar Abscess) |date=2009}}{{cbignore}} or "quinsey", anglicised versions of the French word esquinancie which was originally rendered as squinsey and subsequently quinsy.{{cite book|title=The International cyclopedia: a compendium of human knowledge, Volume 12| first = Richard Gleason | last = Greene | name-list-style = vanc |publisher = Mead Dodd |year=1890|pages=355–6|url=https://books.google.com/books?id=mXgWAAAAYAAJ&q=esquinaneie+The+international&pg=PA355|url-status=live|archive-url=https://web.archive.org/web/20160925181624/https://books.google.com/books?id=mXgWAAAAYAAJ&pg=PA355&dq=esquinaneie+The+international&hl=en|archive-date=2016-09-25}}

• Sultan Tekish of Kwarezm{{cite book |last = Juvaini | first = Ala-ad-Din Ata-Malik | name-list-style = vanc |title=History of the World Conqueror |publisher=Manchester University Press |location=Manchester U.K. |year=1997 |page=314 }}
• Osceola{{cite book | last = Wickman | first = Patricia Riles | name-list-style = vanc |title=Osceola's Legacy |publisher=University of Alabama Press |year=2006 |page=144 }}
• Michel de Montaigne{{cite book | last = de Montaigne | first = Michel | name-list-style = vanc | chapter = Essays of Michel de Montaigne | translator = Charles Cotton | editor = William Carew Hazlitt | editor-link = William Carew Hazlitt | date = 1877 | title = The Life of Montaigne | volume = 1 | edition = Kindle }}
• Dan Minogue, the captain/coach of Australian Rules football team Richmond was rumoured to be dead a week before the 1920 VFL Grand Final, but in fact, was in his hometown of Bendigo recovering from quinsy.
• Eiichiro Oda, author of the best-selling One Piece manga, was hospitalized due to complications.{{cite web |url=http://shonenjump.viz.com/node/1608 |title=NEWS: One Piece on Break |publisher=Viz Media |access-date=2013-05-21 |url-status=live |archive-url=https://web.archive.org/web/20130607142603/http://shonenjump.viz.com/node/1608 |archive-date=2013-06-07 }}
• Ian Maclaren died of complications from quinsy while on a lecture tour of the United States.{{cite book|last1=Nicoll|first1=W. Robertson | name-list-style = vanc |title='Ian Maclaren': Life of the Rev. John Watson, D.D.|url=https://archive.org/details/ianmaclarenlifeo0000nico|date=1908|publisher=Hodder and Stoughton|location=London|page=[https://archive.org/details/ianmaclarenlifeo0000nico/page/379 379]}}

The ancient Roman goddess Angerona was claimed to cure quinsy (Latin angina) in humans and sheep.{{Cite web|url=https://books.google.com/books?id=PbYzAQAAMAAJ&q=quinsy+angerona+angina|title=Classical World|date=February 13, 1918|publisher=Classical Association of the Atlantic States.|via=Google Books}}{{Cite web|url=https://theodora.com/encyclopedia/a2/angerona.html|title=Angerona - Encyclopedia|website=theodora.com}}

{{Reflist|32em}}

{{Medical resources

| DiseasesDB = 11141

| ICD10 = {{ICD10|J|36||j|30}}

| ICD9 = {{ICD9|475}}

| ICDO =

| OMIM =

| MedlinePlus = 000986

| eMedicineSubj = emerg

| eMedicineTopic = 417

| MeshID = D000039

}}

{{Respiratory pathology}}

{{DEFAULTSORT:Peritonsillar Abscess}}

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