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Peritonsillar Abscess

Peritonsillar Abscess (PTA)

  • Peritonsillar Abscess

○ The most common deep infection of the head and neck in adults

○ Typically by a combination of aerobic and anaerobic bacteria

  • Who gets it?

○ most common in persons 20 to 40 years of age, does not discriminate by gender

○ Young children are seldom affected unless they are immuno-compromised

In children however the infection can cause significant airway obstruction

Previous episodes of tonsillitis

Multiple trials of antibiotics for tonsillitis, pharyngitis, and other oral/dental processes

  • Most common presenting Symptoms

Progressively worsening sore throat, often localized to one side

Fever

○ Dysphagia – difficulty swallowing

○ Odynophagia – painful swallowing

○ Otalgia – ear pain, typically only on the side of the oral/throat pain

  • Most common presenting Exam Findings

Erythematous (red & angry) swollen tonsil

○ …with contralateral uvular deviation

the little punching bag that hangs in the throat points AWAY from the bad tonsil

○ Trismus – inability to completely open the mouth & pain when you try

○ Purulent exudate – nasty chunky pus on tonsils

Drooling with a muffled voice

○ Lymph nodes under the jaw and in the neck that tender and swollen

  • Diagnosis

Needle aspiration – as with our patient – remains the gold standard for treatment & diagnosis of PTA

○ Ultrasound and CT scanning are also useful

  • After performing aspiration, appropriate antibiotic therapy must be initiated

○ To obtain this sample the region needs to be anesthetized – as we did with our patient – and then the abscess punctured and drained

These procedures aren’t for everybody nor are they common in the office, these are only for specifically trained physicians

○ Most Common Organisms

Aerobic: Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenza, Neisseria species

Anaerobic: Fusobacterium, Peptostreptococcus, Prevotella, Bacteriodes

● Treatment requires both:

Removal of the abscess material, and

Selection of the best antibiotic

Initially that choice is empiric until the cultures of the abscess come back

Augmentin; Clindamycin; Metronidazole; or an oral Cephalosporin – in that order – can be used