A Family Doctor's Tale - PERITONSILLAR ABSCESS

DOC I HAVE PERITONSILLAR ABSCESS

When I was working at the ENT department, I had many cases of peritonsillar abscess.

Most of them thought they need to be admitted.

In actual fact, a day surgery to incise and drain the pus from the peritonsillar abscess was all that was needed.

There was a Japanese tourist who had a severe peritonsillar abscess, could swallow, could not talk properly and had to return home by airplane the next day.

I sprayed his throat with local anesthetic and after 10 minutes incised the abscess and drained the pus from the peritonsillar space.

The swelling went down rapidly and he was surprised that he could swallow and talk as normal.

He was also able to take his flight home the next day.

He was advised to see a ENT surgeon for removal of his tonsils 6 weeks later.

Most patients are surprised by the speed of their recovery.


Peritonsillar abscess is an acute infection of the peritonsillar space in the capsule surrounding the tonsils.

It is more common in young adults 20-30 years of age.

Peritonsillar abscess is usually caused by the following:

1.The causative agent is usually group A beta hemolytic streptococci.

Other bacteria such as staphylloccocus, E. coli are less common

Viral infection such herpes and Epstein Barr viruses attack children but seldom cause peritonsillar abscess

2. It usually follows an acute attack of tonsillitis about 7 days after the tonsillitis

Persons who has Acute Peritonsillar abscess has the following symptoms:
1.severe pain on swallowing with referred pain to the ear

2.high fever, headache and bodyaches

3.Tenderness of the jaw and throat

4.Voice changes, loss of voice

5.Foul breath, drooling of saliva

Signs:
1.the enlarged tonsil on one side displaced medially

2.the soft palate is red and swollen

3. the uvula is edematous and pushed to the opposite side

4.throat swab may help to identify the specific bacteria and the best antibiotic for treatment.

Treatment:
1.Analgesic medicine in liquid form

2.Antibiotics for infections is usually Penicillin injection for 2days followed by oral penicillin

3.Erythromycin is an alternative for pencillin sensitive patients

4.Incision and drainage is done if pus is present.

The patient must be co-operative and in an upright position.

Local anesthetic is sprayed on the middle of the palate midpoint between the uvula and the upper wisdom tooth.

A blade is inserted at this spot and usually pus and blood will flow out.

The patient spits the pus and blood into a basin and usually the swelling of the peritonsillar abscess will shrink considerably

5.Lots of fluids

Prognosis is usually good with medication.

Recurrence is quite common.

Tonsillectomy is done 4-6 weeks after the peritonsillar abscess attack to prevent further attacks.