First of all, an abscess is a collection of pus within a cavity of tissue.
Peritonsillar abscess means that there is a pus pocket in the throat surrounding a tonsil.
Quickcare or ER
If an abscess develops then it is best cared for in the ER.
How do you know if it is an abscess and not “just a sore throat?”
Red Flags that will send you to the ER:
- difficulty breathing
- painful swallowing
- difficulty opening the mouth
- muffled speech
What was your experience with a Peritonsillar abscess?
What will your doctor ask?
Your doctor will want to know your symptoms. Remember, symptoms are a description of your condition to your doctor. It is your story.
Your doctor will want to know if breathing is a problem. So I always first ask if breathing is a problem.
Then, your will doctor will ask if swallowing is impossible. The more throat swelling, the more difficult it is to pass even saliva.
Once breathing and swallowing are established, then your doctor will want to know the following:
- When did it start?
- Do you have a lot of pain?
- Do you have a fever?
What will your doctor look for?
Your doctor will look for signs. A sign is an objective finding that a doctor discovers during the examination.
Your doctor will walk in the room and get a gestalt. A first impression. An overview.
Breathing is paramount. If the patient is sitting up with his neck sticking out, then you know breathing is an issue. Also, if the patient is unable to speak, then it suggests that his/her airway is compromised.
The back of the throat needs a detailed exam. There may be simply a tonsillitis or a peritonsillar cellulitis. Your doctor will look at the tonsils to see if they are inflamed.
What is your doctor thinking?
A sore throat could be a simple pharyngitis. Mononucleosis could present as a sore throat.
A patient with difficulty swallowing could also be epiglottitis.
Key point: When your doctor looks in the throat and sees the uvula pushed to one side, peritonsillar abscess is high on the differential diagnosis.
Your doctor is will want to protect the airway.
What is the treatment of a peritonsillar abscess?
Like any abscess, it needs to be incised (cut open). The pus needs to drain.
This is a little tricky since the abscess in inside the throat.
Peritonsillar treatment involves both antibiotics and opening up the infection.
The antibiotics I use come in shots and pills. I like to start with a Rocephin shot. Usually for adults I give one gram. Then oral antibiotics are given for one week. I like using Clindamycin
Lately, I have added steroids such as Depomedrol (80 mg) This helps with the swelling and inflammation.
These infections hurt. Pain control with a narcotic such as Vicodin or Norco is greatly appreciated.
The real question is whether your doctor is comfortable incising (cutting into) the abscess. In the ER, we use topical anesthetic sprays to start. Suction is at the bedside. Back up specialists are readily available.
In the clinic setting, these extra services usually do not exist.
Thus, cutting into the abscess is normally done in the ER.
A recheck the next day is good idea
How long will you be sick with a peritonsillar abscess?
After the incision is done and, antibiotics and steroids are started, most patients feel much better the next day.
Still a full week of antibiotics is a good practice. I generally have my patients on the steroids for 3-5 days.
Let Me Tell You a Story
Peritonsillar abscess (also known as quinsy) killed George Washington…..well kinda. The first US President had a very bad throat infection. At the time, doctors did not know of bacteria and there were no antibiotics.
So what did the good doctors of the 17th century do? They bled him. That is, they took out his blood as a form of treatment. Oops. They took out too much blood causing The Father of our US country to bleed to death.
Fast forward to today…….Burt presented to the clinic with a bad sore throat. At first his treatment was a simple. Warm tea. Hot soups. But it kept getting worse. Finally, he had to have his little sister drive him to the clinic.
Burt, being the star volley ball player in college, is so tall and thin. Not an ounce of fat on him. His face grimaced every time he swallowed. He sat straight up with neck protruding just slightly forward. He spoke but in a muffled manner. This is not good!
He complained of a sore throat on one side.
On exam, his uvula was pushed to one side. A huge peritonsillar abcess was staring right at me.
In the case of Burt, he had no difficulty breathing but a lot of pain with swallowing. His sore throat started 5 days prior to his visit. The pain got worse and then Burt developed a fever at night
Like so many that I see, he adamantly refused to go the ER. They hate the wait. They hate the large fees. They hate the noise of the ER.
I can only do so much in the clinic setting. It is like trying to fight with one hand tied behind my back.
After I gave him his Rocephin and steroid shot, his little sister finally convinced him to go the ER.
I hope this helps
David Reyes MD
Si queres leer en Español, haz clic aqui.