The following system wise signs and symptoms are commonly seen in peritonsillar abscess formation among patients:

• General Appearance: Patients usually comes in with complains of fever and chills. The pathognomonic muffling of voice or “hot potato” voice heralds the disease.
• Integumentary: The skin may appear flushed due to fever. Facial cellulitis may be seen as complications of the disease.
• Head and Neck: Painful swallowing (odynophagia) is noted in all cases of peritonsillar abscess. There is difficulty in swallowing (trismus) and patients may drool out their saliva because they are unable to swallow it. Significant findings of uvular deviation and the inferior displacement of the superior pole of the tonsils correlates with the profile of peritonsillar abscess formation [3]. Facial and neck swelling may also be evident. Patients may subsequently complain of headaches.
• Chest and Heart: Tachycardia may follow with high fever and murmurs may be appreciated when the disease complicates to endocarditis. Dyspnea or difficulty of breathing may be noted with pneumonia, pleural effusion and large empyema of the lungs.
• Extremities: Peripheral pulses will be fast and weak especially during complicated endocarditis. Microhemorrages may be seen in the fingernails with bacterial endocarditis.

Peritonsillar abscess is best diagnosed by direct examination with a penlight. The presence of multiple abscess formation on the soft tissue structures of the supratonsillar fossa and the exudative formation clinches the diagnosis of peritonsillar abscess. Exudates and suppurations may be aspirated and cultured to isolate the invading pathogen and determine the best antimicrobial to be used.

Imaging modalities like Computed Tomography (CT) Scans and Magnetic Resonance Imaging (MRI) will elucidate the abscess formation in the Weber glands and identify other concurrent complications within other organs [4]. Consequently, a transoral ultrasound (TUS) can effectively identify peritonsillar abscess from pharyngeal cellulitis to prevent unnecessary surgical removal of the tonsils [5].

The early diagnosis of peritonsillar abscess may warrant antibiotics use for a more 7 to 10 days [6]. Hospital researches confers that the use of intravenous steroids in the treatment of peritonsillar abscess relieves trismus, controls inflammation, lessens pain, subdues fever and shortens hospital stay [7].

In some cases, the abscess are incised, aspirated or drained by the otolaryngologist or ENT surgeon under local anesthesia [8]. There are cases of acute peritonsillar abscess that may require immediate tonsillectomy to prevent its progression [9].

Peritonsillar abscess is usually controlled with adequate antibiotic coverage. Recurrence may be expected in some cases depending on the immune status of the patient. Untreated peritonsillar abscess may rupture and aspirate to the lungs causing serious pulmonary infections that could be fatal.

Prognosis is usually good but immunocompromised hosts like the elderly, patients in immunosuppressant states and chronic steroid users may have trouble overcoming the infections.

Complications

The following possible complications may be seen in peritonsillar abscess:

• Airway obstruction: Due to pharyngeal and laryngeal inflammation.
• Cellulitis: Infection may spread to the neck and jaw.
• Pleural effusion: Lung infection may cause fluid accumulation in the pleura.
• Empyema: β-hemolytic streptococci and anaerobes may cause abscess formation in the lung tissues.
• Pneumonia: Infectious aspirates may lead to lung infections.
• Endocarditis: This is a rare complication.
• Pericarditis: Inflammation of the pericardium due to infection.
• Sepsis: The uncontrolled infection may spread to the blood stream.
• Brain abscess: This is a rare but lethal complication of peritonsillar abscess [2].

Peritonsillar abscess is most commonly caused by group A β-hemolytic streptococcus. This is closely followed by staphylococcus, pneumococcus and Haemophilus species that abounds in young adults.

They may be caused less commonly by yeasts cells like actinomyces and micrococci. Some studies supports that anaerobic bacterial pathogens may have a major role in peritonsillar abscess formation [1].

Etiology in peritonsillar abscess mirrors that of acute tonsillitis because all organism that are known to cause acute and chronic tonsillitis may result to peritonsillar abscess.

In the United States, the incidence of peritonsillar abscess averages to 30 cases per 100,000 population per annum. New cases mounts up to 45,000 each year in the Americas.

Age specific incidence rating for peritonsillar abscess peaks at ages 15 to 35 years old representing a third of all cases. There are no sexual predominance and racial predilections noted for this pharyngeal infection.

The exact mechanism of pathology for peritonsillar abscess is still unclear. However, modern medicine confers to this mostly accepted theory that peritonsillar abscess stems out as a direct complication of exudative tonsillitis.

The inflammatory extension to soft tissues in the supratonsillar fossa spreads the infection in the salivary glands and the base of the tongue leading to abscess formation. It is also postulated that any scarring, obstruction and necrosis that occurs among the Weber glands may also lead to widespread infection and peritonsillar abscess formation.

Peritonsillar abscess is effectively prevented by treating every episode of bacterial tonsillitis with adequate antimicrobial coverage that may preceed it. When peritonsillar abscess is noted, patients should immediately visit their ENT doctors for prompt treatment and prevent untoward complications. Patients should always be alert in identifying the signs of peritonsillar abscess for it can still recur even after tonsillectomy [10].

Peritonsillar abscess is clinical emergency characterized by an acute pharyngeal infection involving the soft tissues surrounding the tonsils.

Peritonsillar abscess may also be described as the abscess formation of the group of salivary glands located within the supratonsillar fossa known as Weber glands triggered by an episode of suppurative or exudative tonsillitis.

This acute pharyngeal infections commonly affects adolescents and young adults. They are usually characterized by a severe sore throat with “hot potato” voice and uvular deviation.

Definition

Peritonsillar abscess is an acute pharyngeal infection of the soft tissues that surrounds the tonsils. The abscess formation amongst the Weber glands usually occurs among adolescents and young adults.

Cause

It is caused by bacterial pathogens like β-hemolytic streptococcus, pneumococcus and Haemophilus species. 

Symptoms

Throat pain, muffled voice (hot potato voice), difficulty swallowing, neck enlargement, fever and chills may occur.

Diagnosis

The diagnosis of peritonsillar abscess is done by the direct examination of the pharynx. Imaging techniques may be implored to elucidate affected structures that are otherwise inaccessible by direct examination.

Treatment and follow-up

Peritonsillar abscess is treated with antibacterial specific for the bacterial pathogen. Tonsillectomy may be done to control the abscess and spread. Patients must remain vigilant for peritonsillar abscess may recur even after treatment.

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