Paratonsillar Abscess - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-15 09:49

Symptoms and treatment of paratonsillar abscess

Acute purulent inflammation of the tonsil tissue is a paratonsillar abscess, the last and most severe stage of paratonsillitis. Most often this disease occurs in the 15-35 age group. Both women and men suffer from paratonsillar abscess with the same frequency. Synonyms for the disease are acute paratonsillitis, phlegmonous tonsillitis. The incidence of diseases increases during the off-season - in winter and autumn.

Content:

• Causes of the disease
• Pathogenesis
• Classification
• Symptoms
• Complications of paratonsillar abscess
• Diagnostics
• Treatment
• Prevention of paratonsillar abscess

Causes of the disease

The formation of a paratonsillar abscess in most cases is provoked by the introduction of pathogenic microbes into the tissues of the tonsils. The disease is almost always a secondary lesion, a complication of chronic tonsillitis.

The reasons for the formation of an abscess:

• Bacterial infection of the pharynx - develops as a complication of chronic tonsillitis, acute tonsillitis or pharyngitis.
• Dental diseases - caries, periostitis of the alveolar tissue, chronic inflammation of the gums and papillae (gingivitis);
• Injuries to the oral cavity, neck, pharynx, infected wounds, burns;
• Penetration of infection through the middle ear;
• Purulent process in the salivary glands.

All these reasons could not contribute to the development of a paratonsillar abscess, if the patient did not have a reduced general and local immunity. Patients with diabetes mellitus and patients with a history of anemia, oncological pathologies, and HIV are in the high-risk group. Obesity, smoking, anatomical abnormalities of the pharynx and tonsils, hypothermia increase the risk of developing a paratonsillar abscess.

Pathogenesis

The causative agents of the disease are streptococci, staphylococci, pneumococci, echshiria and klebsiella, a fungus of the genus Candida. Deepenings of the tonsils (crypts) in chronic tonsillitis are filled with purulent discharge. They are deepest in the upper part of the tonsils - in the place of the most pronounced inflammation.

After several cases of acute inflammation, the tonsil tissue is replaced by scar tissue. Due to scars, the outflow of pus from deep crypts is disturbed, they are not completely cleared. The infection, concentrated in the tonsils, penetrates deep into the tonsils, into the paratonsillar space around the tonsils.

Frequent localization of an abscess in the upper part of the tonsils is facilitated by the looseness of its tissue. With reduced local immunity, the infection easily penetrates into the deep layers of tissue.

Classification

Forms of abscess depending on the stage of development:

• Edematous stage - the tissues around the tonsils swell, there is no inflammation, as well as the clinical symptoms of the disease.
• Infiltration stage - the affected tonsil is hyperemic, there is pain, fever.
• The abscess stage - 4-7 days after the formation of the infiltrate, a large fluctuating protrusion is formed.

Localization classification:

• Anterior or anterior-superior abscess - diagnosed in 75% of cases, formed above the amygdala;
• Posterior abscess - diagnosed in 10-15% of cases in the posterior arch or between the edge of the amygdala and the edge of the arch.
• Inferior abscess is diagnosed in 5% of cases between the lower edge of the amygdala and the lateral pharyngeal wall.

symptoms

Lateral or external abscess - diagnosed in 5% of cases between the wall of the pharynx and the lateral edge of the tonsil, it is very difficult.

Symptoms

In all cases, the disease begins with a sharp pain when swallowing. Since paratonsillar abscess most often occurs on one side, the pain is unilateral. Bilateral abscess occurs much less frequently - in only 10% of cases. The intensity of the pain increases rapidly, and soon it becomes difficult for the patient to swallow not only food, but also saliva. Its amount increases, hypersalivation is recorded, saliva flows from the corner of the mouth.

Visually, the abscess looks like a rounded formation of bright red color. Its surface is tense, white-yellow contents shine through it. A part of the abscess on palpation has a fluctuation focus - a piece of tissue softened due to purulent fusion. The tongue of the pharynx is displaced to the side opposite to the pathology, the palatine tonsil is pushed back.

The main symptoms of a paratonsillar abscess:

• Irradiation of pain in the ear, in the lower jaw;
• Symptoms of intoxication with the waste products of pathogenic bacteria appear - headache, hyperthermia up to 38.5 °, fever, weakness, insomnia:
• Regional lymph nodes are hypertrophied;
• A putrid odor from the oral cavity is fixed;
• With the development of the disease, trism occurs - a spasm of the chewing muscles;
• Speech is broken, it acquires a nasal tone;
• Due to the ingress of liquid food into the larynx and nasopharynx, the patient chokes;
• He takes a forced posture with a tilt to the affected side or with a tilt of the head forward due to excessive saliva.

The patient is mentally overstrained due to insomnia, inability to eat, due to exhausting pain.

After 4-7 days, a spontaneous opening of the paratonsillar abscess occurs. The general well-being of the patient sharply and significantly improves, the body temperature decreases and the symptoms of the disease decrease. Pus appears in saliva, trismus is minimized.

With a complicated course of a paratonsillar abscess, it breaks out after 2-2.5 weeks. If purulent masses penetrate deep into the tissues of the periopharyngeal space, the abscess may not open. With a similar course of the disease, the severity of the patient's condition increases.

Complications of paratonsillar abscess

With adequate therapy, the disease ends with recovery. With unqualified therapy or no treatment, the purulent process spreads to the pharyngeal space. Such complications can provoke damage to the walls of the pharynx during an operation to open an abscess, a spontaneous breakthrough of an abscess into deeply located tissues.

Possible complications:

• Cellulitis of the neck tissue, periopharyngeal tissue;
• Parapharyngeal abscess;
• Sepsis;
• Asphyxia due to stenosis of the larynx (compression of the pharynx from the inside);
• Purulent mediastinitis, or inflammation of the mediastinum - purulent damage to the tissue of the heart, aorta, vena cava and pulmonary veins;
• Thrombophlebitis of the cavernous sinus of the brain;
• Brain abscess;
• Meningitis;
• Encephalitis;
• Arrosive bleeding due to purulent fusion of the arteries of the periopharyngeal space.

Diagnostics

The clinical picture of a paratonsillar abscess is so vivid that a diagnosis by an otolaryngologist does not cause difficulties. For express diagnostics, there is enough data obtained as a result of pharyngoscopy, studying the patient's anamnesis.

In-depth diagnostic examination program:

• The study of the anamnesis - special attention is required for the presence of injuries of the oral cavity and pharynx, infectious processes in them;
• Visual examination - the doctor pays attention to head tilt, hypertrophied lymph nodes, bad breath, hyperthermia;
• Pharyngoscopy - a rounded formation with a hyperemic surface and a fluctuation zone is visually determined;
• Study of data from a general blood test (increased erythrocyte sedimentation rate, leukocytosis), bacterial inoculation of an abscess discharge from the cavity to determine the pathogen;
• Differential diagnosis of paratonsillar abscess using ultrasound and CT of the neck, X-ray of the neck and head from mediastinal abscess, parapharyngeal abscess, diphtheria, aneurysm, tumors of the pharynx and oral cavity, aortic aneurysm.

Treatment

Due to the high risk of complications, the treatment of paratonsillar abscess is carried out exclusively in a hospital setting. The surgeon performs an immediate dissection of the formation under local anesthesia (Dikan, Lidocaine). On the protruding part of the abscess, an incision is made with a scalpel, the cavity of the abscess is expanded with pharyngeal forceps, and the pus is cleaned.

The operating wound is thoroughly washed with an antiseptic solution, a drainage is installed to remove exudate.

With surgery, carried out against the background of frequent tonsillitis, it is possible to remove the tonsils. If sore throats rarely occur, the doctor recommends carrying out such an operation no earlier than 1.5-2 months after opening the abscess. In the recovery period, the patient is recommended drug treatment.

Groups of drugs:

• Intramuscular and intravenous administration of antibiotics (Amoxicillin, Ceftriaxone, Amikacin, Penicillin, Gentamicin, Cefuraxim), the choice of which depends on the causative agent of the paratonsillar abscess;
• Infusion administration of Gemodez for body detoxification;
• Local treatment - gargling with antiseptic solutions (Miramistin, Furacillin);
• Prevention of candidiasis with the introduction of antibacterial drugs (Intraconazole);
• Antihistamines;
• NSAIDs for the relief of pain and inflammation.

Since the patient experiences an acute sore throat, the drugs are administered mainly in the form of injections, rectal suppositories.

If the treatment of an abscess is started on time, a complete recovery occurs after 2-3 weeks. With the addition of complications, inflammatory processes affecting the brain and mediastinum, the prognosis of recovery is doubtful, a lethal outcome is possible.

Prevention of paratonsillar abscess

To prevent the occurrence of an abscess in the oral cavity, it is necessary to timely treat angina, gingivitis, inflammation of the adenoids, sanitize carious cavities in the teeth. Strengthening immunity through the use of physical education, adequate hardening, and the use of large quantities of fresh fruits and vegetables will help resist the disease.

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)