Peritonsillar Abscess – Causes, Symptoms & Treatment
A peritonsillar abscess is a collection of pus in the tissue next to the tonsil. It usually develops as a complication of tonsillitis and requires immediate medical attention.
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A peritonsillar abscess is a collection of pus in the tissue next to the tonsil. It usually develops as a complication of tonsillitis and requires immediate medical attention.
What is a Peritonsillar Abscess?
A peritonsillar abscess (also known as quinsy) is a localized collection of pus in the soft tissue surrounding the palatine tonsil. It develops when a bacterial infection of the tonsils – most commonly acute tonsillitis – spreads into the adjacent connective tissue and forms a walled-off pocket of pus. A peritonsillar abscess is the most common deep neck space infection and is considered a medical emergency, as severe swelling can potentially compromise the airway.
Causes
The most frequent cause is a bacterial throat infection that spreads beyond the tonsil itself. Common causative organisms include:
- Streptococcus pyogenes (Group A Streptococcus) – the most common pathogen
- Staphylococcus aureus
- Anaerobic bacteria (e.g., Fusobacterium, Prevotella species)
Risk factors include recurrent tonsillitis, poor oral hygiene, smoking, and a weakened immune system.
Symptoms
Symptoms typically develop rapidly and are usually severe:
- Intense, one-sided throat pain that worsens when swallowing
- Difficulty or inability to swallow (dysphagia)
- Trismus – reduced ability to open the mouth (lockjaw)
- A muffled, hot-potato voice
- High fever and general malaise
- Visible one-sided swelling of the soft palate
- Swollen, tender lymph nodes in the neck
- Drooling due to difficulty swallowing
Diagnosis
Diagnosis is primarily clinical, based on examination of the throat. Characteristic findings include a unilateral bulging of the soft palate, deviation of the uvula to the opposite side, and a swollen, erythematous tonsil. Additional investigations may include:
- Ultrasound (intraoral or transcutaneous) – to visualize the abscess
- CT scan of the neck – if the diagnosis is uncertain or deep spread is suspected
- Blood tests (full blood count, CRP, white cell count) – to assess infection severity
- Throat swab – for pathogen identification and antibiotic sensitivity testing
Treatment
Immediate medical treatment is essential. The management of a peritonsillar abscess includes:
Abscess Drainage
Draining the pus is the most important step. This is achieved either by needle aspiration (drawing out the pus with a syringe) or by incision and drainage (a small surgical cut to release the pus). Both procedures are typically performed under local anaesthesia.
Antibiotic Therapy
Antibiotics are prescribed alongside drainage to eradicate the bacterial infection. Penicillin-based antibiotics (e.g., amoxicillin-clavulanate) are the first-line choice. For patients with a penicillin allergy, clindamycin is a common alternative.
Supportive Care
- Pain relief with ibuprofen or paracetamol
- Adequate hydration (intravenous fluids if swallowing is severely impaired)
- Hospital admission in severe cases
Tonsillectomy
For patients with recurrent peritonsillar abscesses or chronic tonsillitis, surgical removal of the tonsils (tonsillectomy) may be recommended. This can be performed as an interval procedure several weeks after the acute infection has resolved.
Possible Complications
If left untreated, a peritonsillar abscess can spread to deeper neck spaces and cause life-threatening complications:
- Parapharyngeal abscess (spread into the lateral neck space)
- Retropharyngeal abscess (behind the pharynx)
- Descending necrotizing mediastinitis – rare but potentially fatal
- Airway obstruction due to extensive swelling
- Sepsis (bloodstream infection)
Prognosis
With prompt and appropriate treatment, a peritonsillar abscess generally heals completely. The recurrence rate without tonsillectomy is approximately 10–15%. Patients with repeated episodes should be evaluated by an ear, nose and throat (ENT) specialist to discuss the potential benefits of tonsillectomy.
References
- Galioto NJ. Peritonsillar Abscess. American Family Physician. 2017;95(8):501-506.
- Windfuhr JP, Toepfner N, Steffen G, et al. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. European Archives of Oto-Rhino-Laryngology. 2016;273(4):973-987.
- Powell J, Wilson JA. An evidence-based review of peritonsillar abscess. Clinical Otolaryngology. 2012;37(2):136-145.
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