What to know about peritonsillar abscesses

Children
A peritonsillar abscess is a painful, pus-filled collection of tissue that forms in the back of the throat near one of the tonsils.

Peritonsillar abscesses, also called quinsy, often appear as a result of tonsillitis. These abscesses are uncommon because doctors tend to treat strep throat and tonsillitis with antibiotics.

In this article, we provide an overview of peritonsillar abscesses, including their causes, symptoms, and treatment options.

What causes a peritonsillar abscess?

Man having his throat inspected by a doctor
Peritonsillar abscesses form near the tonsils.

Peritonsillar abscesses are usually caused by Streptococcus pyogenes, the same bacteria that causes strep throat and tonsillitis. If the infection spreads beyond the tonsil, it can create an abscess around the tonsil.

Peritonsillar abscesses usually occur in young adults during the winter and spring, when strep throat and tonsillitis infections are most common.

Rarely, people can develop peritonsillar abscesses without tonsillitis. Tonsillitis is most prevalent among children, while peritonsillar abscesses are most common in young adults.

These abscesses are rare after a person has had their tonsils removed, though they can still occur.


Symptoms

Symptoms of a peritonsillar abscess may be similar to those of tonsillitis and strep throat, but they are often more severe.

A person is sometimes able to see the abscess toward the back of the throat, and it may look like a blister or a boil.

People usually experience:

  • painful swallowing, called odynophagia
  • an inability to swallow saliva
  • fever and chills
  • pain that causes trismus, which is a difficulty or inability to open the mouth
  • a muffled voice
  • a headache
  • swelling of the neck and face

Treatment

A person cannot treat a peritonsillar abscess at home. Contact a doctor to discuss appropriate options. The best treatment will depend on how severe the abscess is and how well the person reacts to antibiotics.

A doctor may try treating a peritonsillar abscess with antibiotics first. If they have no effect, the doctor may remove the pus from the abscess to help it heal.

Medical procedures to treat a peritonsillar abscess include:

  • removing the pus with a needle and a syringe
  • lancing the abscess with a scalpel to release and drain the pus
  • surgically removing the tonsils, in a procedure called an acute tonsillectomy, which a doctor may recommend if a person has recurring peritonsillar abscesses

Complications

When a person receives treatment, a peritonsillar abscess usually goes away without causing further problems. However, in the absence of treatment, an abscess can cause serious issues.

Complications of a peritonsillar abscess include:

Diagnosis

Ultrasound scan of throat
A doctor may recommend an ultrasound to diagnose a peritonsillar abscess.

A doctor will examine the mouth and throat to diagnose a peritonsillar abscess. They can usually identify this condition with a visual inspection.

To aid in the examination, the doctor will likely use a small light and a tongue depressor. Swelling and redness on one tonsil may suggest an abscess. They may prod the swollen area to determine if there is pus inside.

If pus is present, the doctor may collect a sample to send to a lab for further testing.

A healthcare provider may, in some cases, request X-ray images or ultrasounds of the mouth or neck to rule out other conditions, such as peritonsillar cellulitis, epiglottitis, or other upper airway infections.


Prevention

It is not possible to prevent peritonsillar abscesses, but a person can lower the risk by:

  • refraining from smoking
  • treating bacterial tonsillitis before it worsens
  • treating oral infections
  • practicing good dental hygiene

Outlook

The long-term outlook for a peritonsillar abscess is good when a person has appropriate treatment, such as antibiotics or a procedure to drain the pus.

Without treatment, a peritonsillar abscess may develop into a more serious issue, such as sepsis or blockage of the airway.

Summary

A peritonsillar abscess is a painful, pus-filled pocket of tissue that forms in the back of the throat, near a tonsil. It is usually a complication of strep throat or tonsillitis.

The best treatment for a peritonsillar abscess depends on how severe the abscess is and how well it responds to antibiotics. Some treatments involve draining the abscess or performing an acute tonsillectomy.

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