Peritonsillar abscesses are diagnosed based on a physical exam. It is quite easy to diagnose if it is large enough to see. Using a light and a tongue depressor, the doctor will look into your mouth. If there is any swelling and redness located on one side of the throat in the tonsil area it means that there is an abscess present.
It is possible that the doctor will gently push that area with a gloved finder to determine if there is pus inside. The best way of doing this is to have a perfect oral hygiene. This way you keep away the infection and do not allow it to develop in your mouth and spread to the tonsils. Brush your teeth daily at least twice a day and use string floss and mouthwash.
By removing the plaque correctly you lower the chances of ever suffering from gingivitis, bleeding gums, and periodontal disease.
In addition, you should visit the dentist periodically once every six months to resolve any newly appeared issues and remove plaque. The CT scan should be obtained with contrast to allow for optimal viewing of the abscess.
An area of low attenuation on a contrast-enhanced CT scan is suggestive of abscess formation. Other indications of a peritonsillar abscess that are present on CT scanning include diffuse swelling of the soft tissues with loss of the fat planes and the presence of edema in the surrounding area.
The gold standard for diagnosis of peritonsillar abscess remains the collection of pus from the abscess through needle aspiration. To obtain this sample, the area should be anesthetized with 0. Figure 3 illustrates this procedure being performed.
The fluid obtained should be sent to the laboratory for gram stain and culture to determine the appropriate treatment regimen. A needle aspiration of a peritonsillar abscess should only be performed by properly trained physicians. Complications of performing the aspiration can include aspiration of pus and blood, and hemorrhage. If the abscess is located in the distal part of the tonsil, puncture of the carotid artery can occur.
The treatment of peritonsillar abscess requires both the selection of appropriate antibiotics and the best procedure to remove the abscessed material. Individualized treatment modalities will result in more successful outcomes. The choice of antibiotics is highly dependent on both the gram stain and culture of the fluid obtained from the needle aspiration. Penicillin used to be the antibiotic of choice for the treatment of peritonsillar abscess, but in recent years the emergence of beta-lactamase-producing organisms has required a change in antibiotic choice.
Another study 1 recommends using penicillin as the first-line agent, and, if there is no response within the first 24 hours, adding mg of metronidazole administered twice daily to the regimen.
All specimens should be examined by culture for antibiotic sensitivity to ensure appropriate antibiotic coverage. Three main surgical procedures are available for the treatment of peritonsillar abscess: needle aspiration, incision and drainage, and immediate tonsillectomy.
Three recent studies have compared needle aspiration with incision and drainage for the treatment of peritonsillar abscess. In one study, 16 52 consecutive patients who had a positive needle aspiration of a peritonsillar abscess were randomized into two groups comparing needle aspiration alone with incision and drainage.
The results indicated that no further surgical management for peritonsillar abscess was required following the initial needle aspiration. Another study 17 conducted in reported similar results.
A retrospective study 18 of patients compared patients who received needle aspiration alone with patients who had undergone incision and drainage. In this study, only eight patients 0. The authors concluded that needle aspiration alone was an appropriate treatment regimen, but a higher rate of recurrence occurred that could ultimately require incision and drainage.
Controversy remains over the necessity of incision and drainage versus needle aspiration alone. However, most otolaryngologists consider incision and drainage to be the gold standard for treatment. An otolaryngologist should usually be consulted to perform this procedure unless the treating physician has the appropriate experience and training. A review of the incision and drainage technique for peritonsillar abscess is beyond the scope of this article.
Most experts agree that immediate tonsillectomy is not required for treatment of peritonsillar abscess. Tonsillectomy should be performed three to six months after the abscess in patients who have recurrent tonsillitis or peritonsillar abscess. If the family physician is inexperienced in treating peritonsillar abscess, an otolaryngologist should be consulted at the time of the diagnosis to determine the appropriate surgical treatment. Already a member or subscriber? Log in. Interested in AAFP membership?
Learn more. Address correspondence to Terrence E. Steyer, M. Box , Charleston, SC e-mail: steyerte musc. Reprints are not available from the author. The author wishes to thank Barbara Apgar, M. The author indicates that he does not have any conflicts of interest. Sources of funding: none reported. Hardingham M. Peritonsillar infections. Otolaryngol Clin North Am.
Recognition and emergency management of infectious causes of upper airway obstruction in children. Semin Respir Infect. Peritonsillar abscess. Why aggressive management is appropriate. Postgrad Med. Hollinshead WH. Anatomy for surgeons. Snell RS. Clinical embryology for medical students. Check if you have tonsillitis Tonsillitis can feel like a bad cold or flu.
The main symptoms in children and adults are: a sore throat problems swallowing a high temperature of 38C or above coughing a headache feeling sick earache feeling tired Sometimes the symptoms can be more severe and include: swollen, painful glands in your neck feels like a lump on the side of your neck white pus-filled spots on your tonsils bad breath What tonsils with pus-filled spots can look like Tonsils with pus-filled spots at the back of the throat.
Mix half a teaspoon of salt in a glass of warm water and stir until it has dissolved. Gargle with the salty water do not swallow it , then spit it out. Repeat as often as you like. Young children should not gargle with salty water. Find a pharmacy.
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