Peri is a medical prefix that means “around”. Peri is the surrounding area. Peritonsillar means around the tonsils.
When the tonsils are infected, there are many activities of daily living that can be altered. Eating may be difficult due to pain in the throat. There can be drooling of saliva from painful swallowing.
Peritonsillar abscess is a kind of infection of the tonsils and we will discuss lots about this as you read along.
What is the function of the tonsils?
The tonsils are located on both sides of the uvula (the hanging tissue at the back of the throat area). The uvula can be seen at the back of the mouth, above the opening of the throat.
When there is an infection, the tonsils become red and swollen. The blood tests will reveal an increase in the lymphocytes.
The role of the tonsils is to trap bacteria and other microorganisms from the mouth and nose or the oral passageway.
The tonsils prevent the infection from reaching the lungs and the stomach. They are also responsible for releasing lymphocytes that attack the microorganisms that cause illness.
What cause Peritonsillar Abscess?
An abscess is a collection of pus in an infected space that can spread to nearby areas. Abscess forms due to infection.
The tonsils are surrounded by capsules that contain blood passageways like veins and nerves. This is the area where the abscess accumulates.
- Microorganisms – cause infection and result to a pus-filled capsule in the tonsils. One or more microorganisms can cause this.
- Underlying infection – when there is already an infection, peritonsillar abscess can occur. It can start from a minor sore throat (tonsillitis), then progress into an abscess. Another cause can also be an infection in the glands that produce saliva.
- Low immune system – people who are immunocompromised (with low immunity) can be affected like those with Diabetes, Lupus and those who are undergoing chemotherapy.
- Smoking – contains harmful chemicals that irritate the gums and throat. Can cause sore throat and can then worsen into a peritonsillar abscess.
- Foreign bodies – fish bone and other small objects can cause inflammation.
- Poor oral health – damaged teeth due to cavities or braces and infection on the gums (like gum abscess).
What are the signs and symptoms
- Mild to severe pain in the throat and/or ears
- Pain when swallowing or moving mouth – resulting to a decreased appetite
- Neck – painful neck area and swollen lymph nodes
- Redness in the peritonsillar area due to infection
- Hoarseness of voice – due to irritated throat
- Fever and headache– may indicate severe infection
- Increased saliva production – caused by inability to swallow or pain when swallowing
- Coughing – due to the infection and irritation in the throat. There can also be an evident phlegm production.
- Exudates or pus oozing out of the tonsils
How is the Problem Diagnosed?
There are many diagnostic tests that can be ordered to confirm peritonsillar abscess. However, it can be diagnosed from physical exam and documentation of medical history.
Assessment of the mouth, neck and throat is performed to a person with suspected Peritonsillar Abscess. The lymph nodes of the neck are palpated. The teeth and gums are examined to check for any damages and for any signs of gum abscess. The mouth is also assessed for any small objects lodging in that area.
Vital signs like blood pressure, pulse and breathing are recorded. The temperature is monitored also for any fever that may be a sign of severe infection. The breathing pattern is also noted, as this may be altered when there is a severe swelling of the throat that can block the airways.
History taking is another important basis for diagnosing Peritonsillar Abscess. Diet and lifestyle play a bigger role in contributing to this infection. Smoking history is documented in the medical form.
The diagnostic tests that can be performed are the following:
- Complete Blood Count – White Blood Cells (WBC) are noted for increase that may indicate the severity of infection.
- Blood culture – performed when the peritonsillar abscess is suspected to be systemic (has spread in the whole body).
- Head and neck CT scan – CT scan or Computed Tomography is an imaging test that uses a contrast dye to assess for any blockage or fluid accumulation. CT scan of the head and neck will determine the size and exact location of the pus. This serves as a guide if an aspiration of the abscess is indicated.
Peritonsillar Abscess Treatment
Lifestyle modification and strengthening of the immune system are both ways in treating peritonsillar abscess. These are the interventions we can do at home. Doctors may combine these ways with medications. Surgery may be done on a case to case basis.
- Antibiotics – prescribed when there is an infection. This can be seen as redness and swelling of the tonsils. It can also be seen in the blood tests, like a high White Blood Cell count.
- Antipyretic – medication given to normalize the temperature. Antipyretics have the ability to reduce pain. However, a separate pain killer may be given.
- Aspiration – a technique performed by aspirating the pus from the tonsils using a needle attached to a syringe.
- Incision and drainage – a minor surgery where a local anesthesia is injected around the tonsils to make the area numb. Then a small incision is created in the area encapsulating the pus. This can be drained using a syringe or a suction tube.
- Tonsillectomy – another form of surgery indicated for those who have frequent sore throat, throat and mouth infections and also those with frequent peritonsillar abscess. Unlike aspiration, incision and drainage, tonsillectomy is performed in the operating room under general anesthesia. Tonsillectomy is the removal of the tonsils that takes about 30 minutes or less.
Take your medications on time and make sure you do not miss them. Do not increase the dose on your own.
Perform daily oral hygiene and visit your dentist once every 3 months to maintain the health of your teeth and gums.
Drinking sufficient fluids in a day will prevent sore throat. Smoking cessation is another means of preventing peritonsillar abscess.