Throat Abscess - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Symptoms and treatment of throat abscess

A throat abscess is a purulent inflammation of the pharyngeal, paratonsillar or periopharyngeal tissue, with the involvement of regional lymph nodes in the process. If delayed in diagnosis and treatment, it may lead to asphyxiation due to suffocation. It can be a complication of tonsillitis, pharyngitis, purulent otitis media, as a result of trauma to the larynx. The disease is recorded in each age category, more often affecting children of early and preschool age.

Content:

• Classification
• Causes of a throat abscess
• Throat abscess symptoms
• Complications
• Diagnostics
• Throat abscess treatment

Classification

There are the following types of throat abscess:

• Paratonsillar abscess - purulent inflammation occurs in the tissue of the tonsils;
• Retropharyngeal abscess - more common in adults, affects the tissue around the pharyngeal lymph node;
• Periopharyngeal abscess - inflammation forms in the peri-pharyngeal part of the throat.

Abscess localization classification:

• Anterior abscess - formed at the top of the tonsils;
• Posterior abscess - formed between the palatine arch and tonsils;
• Lower abscess - the variety is difficult to diagnose and treat, is located under the palatine tonsil;
• Lateral abscess - is difficult, with complications, formed on the side of the tonsil.

Types of retropharyngeal abscess at the site of its localization:

• Epipharyngeal - formed above the palatine curtain;
• Mesopharyngeal - formed between the edge of the palatine curtain and the root of the tongue;
• Hypopharyngeal - formed below the root of the tongue;
• Mixed - occupies 2-3 zones at a time.

Causes of a throat abscess

In children, the most common cause of abscess development is an infection caused by streptococcus, staphylococcus, less often E. coli. The disease is almost always secondary to the pathology that provoked it. The infection enters the throat through the lymphatic tract, so nearby lymph nodes are always affected and inflamed.

Primary foci of infection in childhood:

• Purulent otitis media;
• Mastoiditis;
• Parotitis with complications;
• Rhinitis;
• Pharyngitis;
• Complications of acute infectious diseases (influenza, ARVI, measles, scarlet fever, diphtheria);
• Complications after surgery (adenotomy, tonsillectomy).

The rapid development of the inflammatory process is facilitated by lowered immunity, rickets and diathesis in the child's history.

In adults, the formation of a pharyngeal abscess most often occurs due to tissue trauma.

Reasons for the appearance of a throat abscess in adults:

• Injury to the throat by rough food, bone, foreign matter;
• Injury of the mucous throat after gastroscopy, bronchoscopy, endotracheal anesthesia;
• Complication after tonsillitis;
• Consequence of tuberculosis, syphilis;
• The presence of caries.

The early spread of infection is facilitated by the presence of HIV infection, diabetes mellitus, malignant tumor, somatic diseases, any process that lowers immunity in an adult. The causes of a purulent inflammatory process in the throat cannot be strictly limited by age categories. Predisposing factors from each group can occur at any age.

Throat abscess symptoms

Any form of throat abscess begins with a sharp increase in body temperature to critical values - 39-40 ° C. The febrile condition is accompanied by a deterioration in the general condition.

Symptoms and manifestations of a throat abscess:

• In children, tearfulness and anxiety, loss of appetite, restless sleep;
• In infants, sucking disorder;
• Increased pain when swallowing food and saliva;
• Violation of nasal breathing with damage to the upper pharynx;
• Nasty voice;
• Asthma attacks with localization of an abscess in the middle and lower part of the pharynx;
• Breathing disorder in an upright position due to the drainage of pus along the wall of the larynx, closing the lumen of the trachea;
• Hoarseness of the voice;
• Gurgling at the throat during sleep;
• Swelling and soreness of the occipital and upper cervical occipital lymph nodes;
• Swelling of the neck in the area of the lower jaw.

Due to severe pain, the patient takes a forced position when his head is turned towards the lesion and is slightly thrown back.

Complications

The development of a purulent inflammatory process leads to the appearance of severe complications:

• Bronchopneumonia as a result of the spread of infection through the upper respiratory tract;
• Congestive pneumonia due to respiratory failure;
• Brain abscess, purulent meningitis due to the spread of infection into the cranial cavity through the circulatory system;
• Cardiac arrest;
• Asphyxia (suffocation) due to the overlap of the trachea with an abscess, edema of the larynx, effusion of purulent masses into the larynx during self-opening of the formation;
• Purulent mediastinitis - the spread of infection into the mediastinum;
• Phlebitis;
• Jugular vein thrombosis;
• Arrosive bleeding due to purulent fusion of blood vessels;
• Sepsis (blood poisoning).

Diagnostics

A vivid clinical picture of the disease will allow the otolaryngologist to make an accurate diagnosis. During a visual examination of the patient, he draws attention to the swelling of the neck, the forced adoption of a fixed position, hypertrophied lymph nodes. Examination of the throat with a pharyngoscope will reveal an infiltration in the throat, tissue hyperemia, a spherical formation.

On palpation, the doctor notes the soreness of the lymph nodes. A more detailed examination can fix the area of fluctuation on one of the walls of the abscess - an accumulation of pus under the tense tissue.

Laboratory research:

• Complete blood count - leukocytosis is detected, an increase in ESR;
• Microscopic examination of a smear from the throat - reveals the type of pathogen (streptococcus, staphylococcus, Escherichia coli, Klebsiella);
• Bacteriological examination of a smear - determines the sensitivity of the pathogen to antibiotics;
• PCR test for tuberculosis, syphilis;
• Sputum analysis for the detection of mycobacteria;
• Anticardiolipin test for syphilis.

Instrumental studies to find the cause of throat infection:

• Ultrasound of the paranasal sinuses;
• Otoscopy;
• Rhinoscopy;
• X-ray of the maxillary sinuses;
• X-ray of the cervical spine.

Throat abscess treatment

Throat abscess is treated exclusively with surgery in a hospital setting. Before opening the abscess, local anesthesia is performed with Lidocaine, Procaine.

Operation technique:

• Incision of the abscess with a scalpel in the place of fluctuation by 2 cm or preliminary puncture of the abscess to prevent pus from leaking into the airways.
• The introduction of an electric pump into the incision to suck out pus.
• Dilution of the edges of the abscess with Hartmann's forceps or a probe.
• Installation of drainage into the abscess cavity.
• Monitoring the drainage condition for 3-4 days.

With a low-lying abscess, the abscess is opened from the outside of the neck along its anterior-lateral surface.

In case of respiratory failure, the breathing tube is not installed in the trachea, that is, the patient is not intubated. Instead, an incision is made in the laryngeal cartilage (cricotomy) to make breathing easier. If, due to respiratory failure, the patient suffers from hypoxia, oxygen therapy is performed - the installation of an oxygen mask, pillows, artificial ventilation of the lungs.

If an abscess of the throat is a result of syphilis or tuberculosis, it is not opened, preferring to puncture the abscess because of the risk of infection of the surrounding tissues. Specific drugs for the treatment of syphilis and tuberculosis are injected into the abscess, and general therapy for these diseases is prescribed.

Drug therapy accompanying surgical treatment and sanitation of foci of infection:

• Broad-spectrum antibiotics (Amoxiclav, Augmentin, Amoxil, Roamycin, Josamycin, Ceftriaxone) to eliminate the causative agent of the disease;
• NSAIDs (Ibuprofen, Nimesulide), antipyretics (Nurofen, Paracetamol) to relieve inflammation, relieve pain and reduce fever;
• Hyposensitizers (Loratadin, Fenspirid, Desloratadin, Zyrtec, Tavegil) to reduce puffiness and prevent autoimmune complications;
• Antiseptics (Miramistin, Furozolidone, Chlorgesidine, Hexoral) for local treatment, gargling;
• Multivitamins;
• Immunostimulants (Imudon).

With timely medical care, the patient recovers. Severe complications are rare at the current level of development of medicine. To prevent the development of a throat abscess, timely treatment of foci of infection of the ear, throat, nose, and dental procedures is required. The doctor is required to strictly adhere to the technique of performing manipulations on the tissues of the throat - the introduction of probes, breathing tubes, operations to remove tonsils and tumors, to remove foreign bodies.

The author of the article: Lazarev Oleg Vladimirovich | ENT

Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)