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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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Things worth knowing about "Peritonsillar Abscess"

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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