Peritonsillar abscess: Causes, Symptoms, Treatment and Cost

A peritonsillar abscess (PTA) is an accumulation of pus that forms in the area around the tonsils. It is a bacterial infection that develops in the tissues around the tonsils. It causes severe pain in the throat, difficulty swallowing, and difficulty speaking.

There are three types of PTA:

• Uncomplicated PTA: This is the most common type and does not involve any complications. It typically occurs due to untreated strep throat or tonsillitis and can cause fever, sore throat, difficulty swallowing, swelling around the neck, and bad breath.
• Complicated PTA: This type is less common but more serious than uncomplicated PTA as it may involve additional complications such as airway obstruction or sepsis (blood infection).
• Refractory PTA: This type occurs when an uncomplicated or complicated PTA fails to respond to treatment with antibiotics or drainage procedures after several attempts have been made. Treatment usually requires removal of part or all of the tonsils in order to resolve the issue completely.

• Peritonsillar abscess is caused by an infection of the throat, usually a bacterial infection.
• Risk factors for developing an abscess include tonsillitis, pharyngitis, dental disease, smoking and poor oral hygiene.
• Other causes include trauma to the area from dental work or surgery and viral or fungal infections such as mononucleosis or candidiasis.

Severe throat pain and difficulty swallowing

• Muffled voice
• Enlarged, tender tonsils
• Fever
• Bad breath or foul taste in the mouth
• Swollen lymph nodes in the neck
• Headache
• Fatigue

• Practice good oral hygiene.
• Avoid sharing cups and utensils with others.
• Treat any underlying conditions that can affect the throat or mouth, such as strep throat or tonsillitis.
• Avoid smoking and secondhand smoke exposure.
• Stay away from people who are sick with throat infections or colds.
• Keep vaccinations up to date, particularly for the flu and pertussis (whooping cough).

• Rapid strep test or culture: Rapid strep test or culture test may be performed to determine if the abscess is caused by a bacterial infection, specifically by group A Streptococcus bacteria.
• Laboratory Tests: Laboratory tests such as a complete blood count (CBC) can be used to help identify an infection and to check for other underlying health conditions that may be contributing to the formation of the abscess. Blood culture is rarely performed in this condition.
• Physical Exam: A physical exam is typically the first step in diagnosing a peritonsillar abscess. During the exam, the healthcare provider will inspect the tonsils for signs of redness, swelling, and asymmetry. They will also palpate the tonsils and surrounding areas for tenderness and fluctuance (a 'boggy' feeling indicating the presence of pus). Trismus, or limited opening of the mouth, is also a common symptom of a peritonsillar abscess.
• Imaging: These tests can provide detailed images of the soft tissue structures in the area, including the tonsils and surrounding tissue, and can help to identify the presence and size of an abscess.

• Airway obstruction: Peritonsillar abscess can cause swelling of the throat, leading to difficulty in breathing.
• Spread of infection: This illness has the potential to spread to other areas of the body, including the chest, the neck, and even the blood.
• Septic shock: Bacteria may enter the bloodstream and cause a severe reaction called septic shock.
• Brain abscess: If left untreated, it can lead to a brain abscess or meningitis.
• Peritonsillar cellulitis: This is an inflammation of the tissue around the tonsils caused by bacteria from the abscess.

• Gargle with warm saline water: Gargling with salt water is one of the most common and effective home remedies for peritonsillar abscess.
• Turmeric and honey paste: Make a paste of turmeric powder and honey and apply it around the affected area. It helps reduce swelling, pain and infection caused by the abscess.
• Steam inhalation: Inhale steam to get relief from pain in the throat area due to peritonsillar abscess.
• Onion juice: Onion juice has antibacterial properties which help reduce inflammation and fight off infection-causing bacteria in the body.
• Fenugreek seeds: Boil fenugreek seeds in water and strain it to make a tea-like solution that can be used as a gargle for reducing swelling, pain, and infection caused by peritonsillar abscesses

Foods that are soft and easy to swallow: soups, stews, mashed potatoes, yogurt, applesauce, cooked vegetables

Drink lots of liquids to stay hydrated

• Hot, spicy or acidic foods: These can irritate the throat and worsen the symptoms of a peritonsillar abscess.
• Hard or crunchy foods: Foods that require a lot of chewing can irritate the area around the abscess and cause pain.
• Nuts, popcorn, and other small, hard items: These can get stuck in the throat and cause irritation or blockage of the airway.
• Alcohol or caffeine:These things have the potential to aggravate symptoms while also irritating the throat.
• Dairy products: Dairy products such as milk, cheese, and yogurt may increase mucus production in some people with an abscess, making it harder to swallow and causing more discomfort.

• Incision and drainage: The most common surgical intervention for peritonsillar abscess is incision and drainage
• Tonsillectomy:It may be necessary to remove the tonsils in order to successfully cure the infection in certain patients. Tonsillectomy refers to the process of removing the tonsils, which can be done by either an open or a closed procedure depending on the surgeon's preference.
• Adjuvant antibiotics: After surgical treatment, antibiotics may be prescribed to help prevent further infection or complications from developing.

The best doctor to consult would be an ENT (ear, nose, and throat) specialist, such as an otolaryngologist or otologist.

• Antibiotics: Penicillin or amoxicillin are the most commonly prescribed antibiotics for treating a peritonsillar abscess.
• Pain relievers: Oral pain medications such as ibuprofen or acetaminophen can help relieve pain and discomfort associated with a peritonsillar abscess.

Recovery time depends on the severity of the infection, but it typically takes between 1-2 weeks for a full recovery. During this time, antibiotics may be prescribed to help with healing and reduce pain.

The treatment for a peritonsillar abscess can provide relief from the symptoms and help to resolve the infection, but it is not necessarily permanent.

The infection may return if the underlying cause is not addressed. Furthermore, even after successful treatment of a peritonsillar abscess, some patients may experience long-term complications such as chronic throat pain or difficulty swallowing.

• Antibiotics: Penicillin or amoxicillin are the most commonly prescribed antibiotics for treating a peritonsillar abscess.
• Pain relievers: Oral pain medications such as ibuprofen or acetaminophen can help relieve pain and discomfort associated with a peritonsillar abscess.

Generally, medications such as antibiotics, analgesics and anti-inflammatory drugs will cost around Rs. 500-1000.

Surgery may be required to drain the abscess, which can cost anywhere between Rs. 15000-30000 depending on the type of hospital and doctor consulted

Common side effects of common treatments include:

• Pain, swelling and tenderness at the site of incision for surgical drainage.
• Bleeding from the wound.
• Infection or bleeding from the drainage tube after insertion.
• Scarring of the tonsils and surrounding tissue.
• When surgical instruments are used for drainage, there is a risk of causing damage to the surrounding tissues, such as blood vessels or nerves.
• Swelling and difficulty swallowing due to infection spreading to other parts of the throat or neck.
• In rare cases, surgery may lead to airway obstruction and difficulty breathing.

If you are suffering from any complications relating peritonsillar abscess then you should consult a doctor nearby as they can complications like ' difficulty swallowing and speaking, airway obstruction, and spread of infection to other parts of the body such as the chest or bloodstream'in which treatment course can range from a few months to years depending on the severity of the situation.