How does an abscess form?
The palatine tonsil lies in a niche between the arches, surrounded by loose tissue. With a sore throat or exacerbation of chronic tonsillitis, the infection from deep lacunae and small glands penetrates through the tonsil capsule into this tissue. First, swelling and penetration of the tissue occurs - the stage of paratonsillitis, then a cavity with pus is formed. The abscess is almost always one-sided, most often located above the tonsil. The loose tissue of the neck does not create a reliable barrier, so pus can spread downwards.
- Anterosuperior abscess is the most common option
- Posterior - between the tonsil and the posterior arch
- Lower and outer - less common, more severe
- The infiltration stage precedes suppuration
- Spread is possible to the tissue of the neck and mediastinum
Causes and risk factors
The main cause is a bacterial infection of the pharynx, most often streptococcal, often in combination with anaerobic flora. The risk increases if the sore throat was treated incorrectly: the antibiotic course was interrupted at the first improvement or even rinsing was avoided. In people with chronic tonsillitis, the tonsils contain a constant source of infection, and an abscess can develop even without a severe sore throat. Smoking, dry air, diabetes and conditions with reduced immunity play a separate role.
- Postponed or untreated sore throat
- Chronic tonsillitis
- Interrupted antibiotic course
- Smoking
- Diabetes mellitus
- Sore teeth and gum disease
- Decreased immunity
Symptoms
A typical picture: after several days of sore throat, the pain in the throat does not go away, but sharply intensifies and becomes one-sided, radiating to the ear and lower jaw. Trismus appears - a spasm of the masticatory muscles, which makes it difficult to open the mouth. The voice becomes nasal and muffled, it hurts to swallow so much that saliva flows out of the mouth, the head is tilted towards the affected side. The temperature is high, the lymph nodes in the neck are enlarged. Upon examination, a displacement of the tonsil and uvula to the healthy side is visible.
- Sharp unilateral sore throat
- Pain radiates to ear
- Difficulty opening your mouth
- Nasal muffled voice
- Drooling and refusal to eat
- High fever and chills
- Forced head tilt
Diagnostics
An experienced ENT doctor usually only needs to examine the pharynx: asymmetry, bulging above the tonsil and displacement of the uvula speak for themselves. The difficulty is created by trismus, which interferes with examination. To distinguish the stage of edema from a formed abscess, the doctor performs a diagnostic puncture. A general blood test confirms severe inflammation. In case of an atypical picture, suspicion of spread of pus to the neck or an abscess in a child, an ultrasound or computed tomography is prescribed.
- Examination of the pharynx by an otolaryngologist
- Diagnostic puncture
- General blood test
- Culture of pus with determination of sensitivity to antibiotics
- Ultrasound or computed tomography of the neck according to indications
- Blood glucose for suspected diabetes
Treatment
The basis of treatment is emptying the abscess. Under local anesthesia, the doctor opens the abscess and spreads the edges of the incision, after which the pain usually decreases sharply within the first hours. In subsequent days, the cavity is diluted again so that it does not close prematurely. At the same time, antibiotics, painkillers, plenty of warm drinks and rinses are prescribed. If abscesses recur or there is chronic tonsillitis, removal of the tonsils is routinely discussed, sometimes performed immediately.
- Opening and draining the abscess by a doctor
- Re-opening the wound edges in the following days
- Antibiotics course as prescribed by a doctor
- Painkillers and rinses
- Soft, warm food and plenty of fluids
- Tonsillectomy for recurrent abscesses
- Hospitalization for severe cases
