Paratonsillar Abscess - Symptoms, Treatment, Autopsy, Diagnosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Paratonsillar abscess

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Symptoms of a paratonsillar abscess
4. Diagnostics of the paratonsillar abscess
5. Treatment of paratonsillar abscess
6. Possible complications and consequences
7. Forecast
8. Prevention

Paratonsillar abscess is an inflammatory disease in which the pathological process is localized in the peri-mendal tissue. Most often, the disease is diagnosed in children, as well as in adolescents and young people.

Paratonsillar abscess - a complication of inflammation in the oropharynx

Causes and risk factors

A paratonsillar abscess occurs against the background of an inflammatory process in the oropharynx (it is often a complication of angina, less often it develops against the background of dental and other diseases).

Risk factors for the development of paratonsillar abscess include:

• throat injury;
• decreased immunity;
• metabolic disorders;
• tobacco smoking.

Tobacco smoking is a risk factor for the development of paratonsillar abscess

Infectious agents in paratonsillar abscess are often staphylococci, group A streptococci (non-pathogenic and / or opportunistic strains may also be involved), somewhat less often - hemophilic and E. coli, yeast-like fungi of the genus Candida, etc.

Forms of the disease

The disease can be unilateral (more often) or bilateral.

Depending on the localization of the pathological process, the paratonsillar abscess is subdivided as follows:

• posterior (the area between the palatine-pharyngeal arch and the gland is affected, there is a high probability of the transition of inflammation to the larynx);
• anterior (the most common form, the inflammatory process is localized between the upper pole of the tonsils and the palatine-lingual arch, often opens independently);
• lower (localized at the lower pole of the tonsils);
• external (the most rare form, the inflammatory process is localized outside the tonsils, there is a possibility of a breakthrough of pus into the soft tissues of the neck with the subsequent development of serious complications).

Symptoms of a paratonsillar abscess

Symptoms of a paratonsillar abscess, as a rule, appear 3-5 days after an infectious disease, primarily tonsillitis.

Typically, patients complain of severe sore throat, which is usually localized on one side and may radiate to the teeth or ear. One of the characteristic signs of the disease is trismus of the masticatory muscles, i.e. limitation of movement in the temporomandibular joint - difficulty or inability to open the mouth wide. In addition, patients may feel the presence of a foreign object in the throat, which leads to difficulty in swallowing and eating. The lymph nodes under the jaw enlarge, making head movements painful. These symptoms in patients with paratonsillar abscess are accompanied by general weakness, headaches, an increase in body temperature to febrile values (39-40 ° C). With the progression of the pathological process, breathing becomes difficult, shortness of breath occurs, bad breath appears,the voice often changes (becomes nasal). The patient's tonsils on the affected side are hyperemic, edematous.

With paratonsillar abscess, patients complain of a sore throat on one side, radiating to the ear and teeth

In the case of self-opening of an abscess, a spontaneous improvement in general well-being occurs, general and local symptoms usually disappear within 5-6 days. However, the disease is prone to recurrence.

Diagnostics of the paratonsillar abscess

Diagnosis of paratonsillar abscess is based on data obtained from the collection of complaints and anamnesis, as well as pharyngoscopy and laboratory tests. When examining the pharynx, hyperemia, protrusion and infiltration are observed over the tonsil or in other parts of the palatine arches. The posterior arch of the amygdala is displaced to the midline, the mobility of the soft palate is usually limited. Pharyngoscopy (especially in children) can be difficult due to trismus of the masticatory muscles.

A bacteriological culture of the pathological discharge is prescribed with the determination of the sensitivity of the infectious agent to antibiotics.

In the general analysis of blood in patients with paratonsillar abscess, leukocytosis (about 10-15 × 10 ⁹ / l) is noted with a shift of the leukocyte formula to the left, a significant increase in the erythrocyte sedimentation rate.

A general blood test for a paratonsillar abscess shows leukocytosis and an increase in ESR

Ultrasound and magnetic resonance imaging can be used to confirm the diagnosis.

Differential diagnosis is carried out with tonsillitis, diphtheria, scarlet fever, erysipelas of the pharynx, and malignant neoplasms.

Treatment of paratonsillar abscess

Depending on the severity of the course of the disease, treatment is carried out on an outpatient basis or in an otorhinolaryngological hospital.

In the initial stages, the treatment of paratonsillar abscess is usually conservative. Antibacterial drugs of the group of cephalosporins or macrolides are prescribed.

With the progression of the pathological process, conservative methods are insufficient. In this case, the most effective treatment is surgical opening of the paratonsillar abscess. Surgery is usually performed under local anesthesia (anesthetic is applied by lubrication or spraying), general anesthesia is used in children or in anxious patients. Surgery can be performed using the following methods:

• puncture of a paratonsillar abscess with removal of a purulent infiltrate;
• opening the abscess with a scalpel followed by drainage;
• abscessonsillectomy - removal of the opening of the paratonsillar abscess by removing the affected tonsil.

At the initial stages of paratonsillar abscess, the patient is prescribed antibiotic therapy

When a paratonsillar abscess is opened, an incision is made in the area of greatest bulging. If such a landmark is absent, the incision is usually made in the area where there is frequent spontaneous opening of the paratonsillar abscess - at the intersection of the line that runs along the lower edge of the soft palate from the healthy side through the base of the uvula, and the vertical line that goes up from the lower end of the anterior arch affected side. Then Hartmann forceps are inserted through the incision for better drainage of the abscess cavity.

With a paratonsillar abscess of external localization, opening it can be difficult, spontaneous opening of such an abscess usually does not occur, therefore, in this case, an abscess stonsillectomy is indicated. In addition, indications for an abscess stonsillectomy may be a history of recurrence of a paratonsillar abscess, no improvement in the patient's condition after opening the abscess and removing purulent contents, and the development of complications.

In addition to the surgical treatment of paratonsillar abscess, the patient is prescribed antibacterial drugs, analgesics, antipyretic and decongestants.

The main treatment is complemented by rinsing the throat with antiseptic solutions and decoctions of medicinal herbs. In some cases, with paratonsillar abscess, physiotherapy can be used, primarily UHF therapy.

After discharge from the hospital, dispensary observation is indicated for patients with paratonsillar abscess.

Possible complications and consequences

With the development of a paratonsillar abscess, there is a possibility of pus entering the deeper tissues of the neck with the subsequent development of a pharyngeal abscess, diffuse purulent inflammation of the soft tissues of the neck (phlegmon of the periopharyngeal space), inflammation of the mediastinum (mediastinitis), a significant decrease or complete closure of the larynx lumen (acute stenosis of the larynx), necrosis of nearby tissues, sepsis. All these conditions are life threatening.

Forecast

With timely diagnosis and adequate treatment, the prognosis is favorable. Relapses occur in about 10-15% of patients, 90% of relapses occur within a year.

Prevention

In order to prevent paratonsillar abscess, it is recommended:

• timely and adequate treatment of diseases that can lead to the development of paratonsillar abscess, refusal of self-medication;
• strengthening immunity;
• rejection of bad habits.

YouTube video related to the article:

Anna Aksenova Medical journalist About the author

Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!