What Are the Symptoms of an Abscessed Tonsil?

Peritonsillar abscess is a purulent inflammation of the tissue space around the tonsil, which is one of the complications of acute tonsillitis. Occurrence of anterior and upper tonsils is often unilateral, and it is rare for both sides to occur at the same time. This disease is more common in young adults, and it is rare under 10 years of age and the elderly.

Basic Information

Visiting department

ENT

Common locations

Upper and upper tonsil

Common causes

Secondary to acute tonsillitis

Common symptoms

Difficulty swallowing, salivation overflow, ambiguity in speech, cervical lymphadenopathy, tenderness, etc.

Causes of peritonsillar abscess

Most of them are secondary to acute tonsillitis, especially in chronic acute tonsillitis. Due to poor drainage of the tonsil crypts, especially the upper crypts, or deep follicular suppuration, the infection develops deeper and penetrates the tonsil capsule into the peritonsillar space. Initially inflammatory infiltration, that is, inflammation around the tonsils, followed by the formation of abscesses. Abscesses are mostly located above and below the tonsils, that is, above the lingual palatine arch and between the tongue and tonsils, and those below or above the back are rare. Often occurs on one side. The pathogenic bacteria are Staphylococcus aureus, B hemolytic streptococcus, Streptococcus aureus green, and anaerobic streptococcus (foul smell).

Clinical manifestations of peritonsillar abscess

1. Most of them occur 3 to 5 days after the onset of acute tonsillitis, and the fever continues or worsens. The sore throat on one side is more severe than that of tonsillitis, and it often radiates to the ears and teeth on the same side. Due to severe sore throat and swelling of the soft palate, the patient has difficulty swallowing, saliva overflows, drinking water flows back to the nasal cavity, and the language is ambiguous. Difficulty in opening mouth when peripheral inflammation spread to internal pterygoid muscles. Very large abscesses may cause upper airway obstruction.

2. The patient has a painful expression, and his head tilted slightly forward toward the affected side. Bad breath, salivation, thick greasy tongue, restricted mouth opening, cervical lymphadenopathy, tenderness. If it is an anterior superior abscess, the upper part of the tongue and palatine arch and soft palate on the affected side are congested and swollen, with obvious bulges. The tonsils are covered with purulent secretions and pushed inward and downward. The uvulla congestion and swelling turn to the opposite side. The lateral pharyngeal iliac arch was obviously swollen and bulged, and the tonsils were pushed forward and downward; lower abscesses were rare, but pharyngeal, laryngeal edema, and carotid sphingitis may be complicated by swelling and bulge between the lower pole of the tonsil and the base of the tongue. Congestion and swelling of the soft palate and uvula were not obvious.

Examination of peritonsillar abscess

The pharyngeal mucosa was congested, and the soft palate congestion and swelling on the affected side were significant. Abscesses were common between the upper poles of the tonsils and the arch of the tongue and palate. There was a significant uplift, and the soft palate and overhang were pushed to the opposite side. If the abscess is located between the upper poles of the tonsils and the lingual palatine arch, the raised tonsils above the lingual palatal arch are covered and pushed inward and downward. If it is located between the tonsil and the pharyngeal arch, the pharyngeal arch is raised and the tonsil is pushed forward and downward. Swollen neck and mandibular lymph nodes on the affected side are not difficult to diagnose based on symptoms and signs. Usually based on the onset of 4 to 5 days, severe sore throat and local uplift are obvious, and the experimental puncture and pus extraction at the most uplifted location can be clearly diagnosed.

Diagnosis of peritonsillar abscess

1. Often secondary to acute and chronic tonsillitis, mostly on one side, and common in adults.

2. Severe sore throat on one side, which worsens when swallowed, and radiates to the ear on the same side. Difficulty in mouth opening due to pain, inability to swallow, saliva retention, and vague speech. Fever, general discomfort and acute illness.

3. The affected side of the tongue and palatine arch and soft palate is highly red and swollen, and the uvula is swollen to the healthy side.

4. Sometimes the neck is restricted, the head is often biased to the affected side, and the submandibular lymph nodes are enlarged.

5. Withdraw the pus from the most raised part of the tongue and palatine arch, and do bacterial culture and drug sensitivity test.

6. Increased white blood cell and neutrophil counts.

Differential diagnosis of peritonsillar abscess

Parapharyngeal abscess

The affected side of the pharyngeal wall and the tonsils were pushed inwardly to bulge inward, and the opening of the mouth could also be restricted, but the inflammation of the pharynx was lighter and the tonsil itself had no obvious lesions. Radiation neck pain is severe, often with inflammatory abscesses and marked tenderness.

2. Wisdom Tooth Coronitis

It is often accompanied by impacted mandibular wisdom teeth and periodontal pocket formation. The gingival flap and surrounding soft tissues are red and swollen and painful. The inflammatory swelling can spread to the tongue and palatine arch, but the tonsils and uvula are not affected.

3. tonsil abscess

As an abscess of the tonsil itself, the pus axillary can be extracted by puncture in the tonsil. The pus can be seen from the crypt on the tonsil. The affected tonsil was enlarged and the inflammation infiltrated into the surroundings, but there was no restriction on opening.

4. Purulent mandibitis

It is an acute inflammation of the floor of the mouth, forming diffuse cellulitis. There are inflammatory masses at the floor of the mouth and under the diaphragm to raise the tongue, pain in pressing the tongue, difficulty in extending the tongue, restricted mouth opening but non-closed closure, infection and invasion Upper respiratory tract obstruction may occur in the throat and throat.

Per tonsil abscess treatment

1. Treatment before abscess formation

As with acute tonsillitis, sufficient antibiotics must be given intravenously to control the spread of inflammation, prevent the formation of abscesses and prevent complications, and give infusions for symptomatic treatment.

2. Management after abscess formation

(1) Puncture and abscess By puncture, it is possible to determine whether an abscess has formed and the location of the abscess, and also achieve the purpose of treatment. Under 0.5% to 1% dicaine mucosal surface anesthesia, select the most elevated and softened part of the abscess, and tentatively insert the needle. Pay attention to the orientation. Do not pierce too deeply to avoid accidentally injuring the large blood vessels next to the pharynx. There is a sense of emptiness when the needle enters the pus cavity, and pus is withdrawn when it is drawn back.

(2) Incision and drainage Under local anesthesia, incision and drainage are performed at the puncture site of the abscess. If the incision site cannot be determined, an imaginary horizontal line is made from the root of the uvula; an imaginary vertical line is made from the lower end of the free edge of the tongue and palatine arch, and the intersection of the two lines is slightly outside, which is the place where the incision is suitable. The incision is 1 to 1.5 cm in length, and the mucosa and superficial tissues (not too deep) are cut. A vascular forceps is used to separate the soft tissues layer by layer toward the posterior outer muscle fibers until the pus cavity is drained.

(3) Tonsilectomy in the abscess period Under normal circumstances, surgery can only be performed 2 to 3 weeks after the tonsillitis has subsided. However, for patients with abscesses around the tonsil, the affected tonsillectomy can be performed under the control of a sufficient amount of antibiotics a few days after the diagnosis or incision and drainage, and it is especially suitable for a long course of disease. By. At this time, the pus is separated between the tonsil capsule and the tonsil fossa. Therefore, it is easier to remove the tonsil with less bleeding and less pain. After tonsillectomy, the pus cavity is completely open and the pus is completely drained, which is easy to cure. Removal of the lesions as early as possible can reduce the occurrence of complications, and can also avoid the pain during reoperation and the difficulty of peeling the tonsils due to scar formation.

3. Management after abscess subsides

Tonsil should be removed two weeks after the abscess subsides to prevent recurrence.