PERITONSILLAR ABSCESS (PTA)

Pix: Right sided peritonsillar abscess

DEFINITION SIGN & SYMPTOMS

PHYSICAL SIGNS CAUSES

TREATMENT

COMPLICATION

Aka quinsy is a collection of pus beside the tonsil (peritonsillar space). A recognised complication of tonsillitis Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even age spread from children to adults. Symptoms start appearing 2-8 days before the formation of an abscess. Progressively worsening, unilateral sore throat and dysphagia usually are the earliest symptoms. As the abscess develops, persistent pain in the peritonsillar area, fever, malaise, 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 halitosis 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). Redness and edema in the tonsillar area of the affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced towards the unaffected side. Odynophagia (pain during swallowing), and ipsilateral earache also can occur. 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 abscess. PTA can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly involved species include streptococci,staphylococci and hemophilus. Treatment is, as for all abscesses, through surgical incision and drainage of the pus, thereby relieving the pain of the pressed tissues. Antibiotics are also given to treat the infection. Internationally, the infection is frequently penicillin resistant, so it is now common to treat with clindamycin. Treatment can also be given while a patient is under anesthesia, but this is usually reserved for children or anxious patients. Retropharyngeal abscess Extension of abscess in other deep neck spaces leading to airway compromise. Ludwig's angina Septicaemia Possible necrosis of surrounding deep tissues In rare cases, mediastinitis