Still have your tonsils? Then you are at risk for peritonsillar abscess—an abscess, or a walled-off collection of pus in the area around the tonsils called peritonsillar space, warns board-certified otolaryngologist David W. A. Forner, MD. While you can rarely get a peritonsillar abscess if you’ve had your tonsils removed, it’s much more likely if you still have them—and many of us do these days—because the abscess’s origins are related to the condition tonsillitis. Just a few decades ago, tonsils were removed at the slightest sign of infection, but now tonsillectomy usually is reserved for people who get numerous bouts of tonsillitis per year or over several consecutive years as well as for adults and children who have sleep apnea or another sleep disorder.
Peritonsillar abscess usually stems from tonsillitis or pharyngitis, and it takes bacteria to create the pus that walls itself off to form the abscess. This does not always occur, and not everyone with tonsillitis will develop an abscess.
Think of peritonsillar abscess as the far end of a spectrum that starts with an infection of the soft tissues around the tonsils (called cellulitis) and can progress to early formation of pus (called phlegmon) and, ultimately, an abscess. Symptoms include a sore throat often just on the side of the infection…fever…trouble swallowing or the sensation that food is getting stuck or going down the wrong way because of swelling…and a change in speech with a muffled voice often called “hot potato voice” because it sounds like you’re talking with too-hot mashed potatoes in your mouth.
If the infection moves into the nearby chewing muscles, you may have difficulty opening your mouth…and since the nerves in this area communicate with each other, you also can get ear pain. The peritonsillar space connects with other spaces within the neck, so a severe infection can lead to difficulty breathing and even suffocation.
Your doctor will make the diagnosis based on your symptoms and a physical examination that indicates swelling on one side of the throat. The swelling can be so severe that it displaces the uvula, the fleshy hanging ball in the back of your throat. Sometimes imaging such as a CT scan or blood work is used to help make the diagnosis.
Peritonsillar abscess treatments typically start with intravenous medications, including steroids, antibiotics and fluids. Powerful anti-inflammatory corticosteroids reduce pain and inflammation so you can eat and drink again, which allows the antibiotics to work better. A course of oral antibiotics often will follow.
In most cases, the peritonsillar abscess must be drained to prevent the spread of the infection and possible complications (if the jugular vein gets infected, for instance, this can lead to blood clots that can make their way to the lungs). Options for draining include needle aspiration…making an incision to allow for drainage…and, rarely, draining the abscess along with a tonsillectomy.
Peritonsillar abscess can recur. In fact, having one abscess increases the risk for a second one. Tonsillectomy may be advised if you’ve had two abscesses because a third one may come eventually. If you’ve never had an abscess but have recurrent tonsillitis or strep throat, talk to your doctor about having your tonsils removed to stop the infections and prevent an abscess from occurring.
