Synonym:
Peritonsillar abscess.
A peritonsillar abscess is collection of pus between the fibrous capsule of tonsil and the superior constrictor muscle of the pharynx.

Aetiology:

1. Usually seen in adult males.

2. As a complication of acute tonsillitis.

3. Foreign bodies like small fish bone embedded into tonsillar tissue.

Bacteriology:

Beta haemolytic streptococcus is the most frequent organism along with other aerobic and anaerobic organisms.

Pathophysiology:

Clinical features:

Symptoms:

• Usually fit young adult male.
• May have had repeated attacks of acute tonsillitis or may be de-novo.
• It is preceded by a sore throat 2 or 3 days, which gradually becomes more severe and unilateral.
• Usually unilateral but occasionally can be bilateral.
• Patient presents with high-grade fever.
• Muffled and thick speech, often called 'hot potato voice'.
• Foetor may be present due to secondary infection.

Signs:

• Classical appearance is striking asymmetry, enlargement, hyperemia, and displacement of the affected tonsil with edema and hyperemia of the soft palate.
• Tender, enlarged lymph nodes in the jugulodigastric region on the same side.
• Patient has foul oral odor.

Treatment:

Medical:

• Hospitalization.
• Intravenous antibiotics.
• Analgesics and oral antiseptic gargles.

Complications:

a) Rapidly increasing inflammation can lead to laryngeal oedema with respiratory obstruction. Hence patient may require tracheostomy.

b) Parapharyngeal abscess involving carotid sheath leading to jugular vein thrombosis or fatal carotid hemorrhage.

c) In severe cases mediastinitis.

Surgical:

• Incision and drainage if:
  • Presence of discrete abscess.
  • Infection not responding to antibiotics.
  • Patient should undergo interval tonsillectomy after 4-6 weeks after the acute attack subsides.
  • Emergency abscess tonsillectomy. This is rarely done due to the increased chances of bleeding and thromboembolism.