Peritonsillar Abscess

The Basics

Lots of kids get tonsillitis (an infection of the tonsils), especially younger kids. As kids get older, however, this throat infection can be accompanied by an unpleasant condition called a peritonsillar abscess.

A peritonsillar abscess is an area of pus-filled tissue at the back of the mouth, next to one of the tonsils. The abscess can be very painful and make it difficult to open the mouth. It can also cause swelling that can push the tonsil toward the uvula (the dangling fleshy object at the back of the mouth). This can block the throat, making it difficult to swallow, speak, and sometimes even breathe.

An untreated peritonsillar abscess can lead to a spread of the infection into the neck and chest, as well as other serious complications.

Causes

Peritonsillar abscesses are most often caused by the group A streptococcus bacteria that also cause strep throat. Sometimes other types of bacteria are also involved.

Peritonsillar abscesses usually happen as a complication of tonsillitis, when the infection spreads from a tonsil into the space surrounding it. Fortunately, these kinds of abscesses are uncommon because doctors use antibiotics to treat tonsillitis.

Tooth and gum disease and smoking can increase the chances of a peritonsillar abscess.

Symptoms

Often the first sign of a peritonsillar abscess is a sore throat. As the abscess develops, other symptoms will appear, such as:

• red, swollen tonsils
• a tonsil that’s pushing against the uvula
• tender, swollen glands (lymph nodes) on one side of the neck
• severe pain on one side of the throat
• difficulty and pain when swallowing or opening the mouth
• fever and chills
• headache
• earache
• drooling
• a muffled or hoarse voice

A peritonsillar abscess that goes untreated for a long time can lead to serious complications — for example, the infection may extend into the jaw, neck, and chest, or lead to pneumonia.

Diagnosis

Call a doctor if your child has a sore throat along with a fever or any of the other symptoms of a peritonsillar abscess. It’s rare that an abscess will restrict breathing, but if it does, you might need to take your child to the emergency room right away.

The doctor will examine your child’s mouth, throat, and neck. The doctor also might do a throat culture and a blood test. Rarely, a doctor may order a CT scan or ultrasound to help make the diagnosis.

Treatment

The usual treatment for a peritonsillar abscess involves draining the abscess. This can be done in a doctor’s office by withdrawing the pus with a needle (called aspiration) or making a small cut in the abscess with a scalpel so the pus can drain out.

If this doesn’t work, the tonsils might need to be removed in a tonsillectomy. This is especially true for kids who have had multiple recent cases of tonsillitis or a prior peritonsillar abscess.

Depending on your child’s condition and treatment, he or she may need to stay in the hospital for a short time following the procedure. The doctor probably will prescribe pain relievers and antibiotics. Make sure your child finishes the full course of antibiotics even if he or she feels better after a few days.

The earlier a case of peritonsillar abscess is diagnosed and treated, the less invasive the treatment will need to be. So if you notice symptoms, call your doctor right away.

Lowering Risk Factors

Kids can reduce their risk of a peritonsillar abscess by practicing good oral hygiene. And encourage your teens not to smoke because — among other health risks — smoking can increase the risk of developing a peritonsillar abscess.