What is the causation and treatment for a peritonsillar abscess?
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Peritonsillar abscess is an infection of the tonsil and surrounding tissues that results in a closed off accumulation of pus usually behind one tonsil. This results in one tonsil becoming markedly swollen and pushed beyond the midline of the back of the throat causing deviation to the uvula. It may begin as a common strep throat but often times involves other bacterial organisms. There is often a history of a sore throat that was present a week or two before that seemed to clear up before returning. Occasionally a patient may have even been prescribed antibiotics for the initial sore throat but stopped taking them prematurely when the sore throat went away instead of taking the full 10 day course. Then severe sore throat occurs usually worse on one side or the other and often with ear pain. Lymph node swelling in the neck on the side of the abscess is also common. There is usually fever and difficulty swallowing, even difficulty swallowing one's own saliva. The voice may also be altered because of the swelling of the tonsil.
When a patient with findings consistent with a peritonsillar abscess is seen by a primary care physician or in an ER, referral to an ENT specialist is appropriate. Based upon individual considerations the ENT specialist may 1)anesthetize the throat and place a needle into the tissue in an attempt to aspirate the pus then treat with antibiotics; 2) anesthetize the throat and then make a small incision just to the side of the swollen tonsil and evacuate the pus then followed by antibiotic treatment; 3) remove the tonsil under anesthesia either after antibiotic therapy or before antibiotic therapy; or 4) in some cases where a bad infection without abscess formation is suspected (cellulitis), intravenous antibiotic therapy alone may be tried initially.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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