OVERVIEW

What is peritonsillar abscess?

Peritonsillar abscess (PTA) refers to an abscess in the tissues surrounding the tonsils caused by infection.

The tonsils are located in the tonsillar fossa, like a pearl embedded in half a shell. If tonsillitis is severe, bacteria can spread to the surrounding tissues, causing inflammation of the "shell," known as peritonsillitis. Further progression of peritonsillitis can lead to the fusion of inflammatory foci and the formation of pus, resulting in PTA.

PTA is usually unilateral. If the tonsils and surrounding tissues swell severely, the uvula (commonly called the "little tongue") may be pushed to the opposite side, accompanied by symptoms such as throat pain, difficulty swallowing, difficulty breathing, unilateral ear pain, and high fever.

The main treatments include anti-infection therapy and surgical drainage.

Is peritonsillar abscess common?

It is relatively common, most frequently occurring in adolescents and young adults, but it can also be seen in younger children.

SYMPTOMS

What are the symptoms and manifestations of peritonsillar abscess?

• Severe sore throat (usually unilateral), which may radiate to the ear on the same side, often accompanied by neck swelling and pain.

• Fever, accompanied by fatigue, irritability, and loss of appetite.

• Muffled voice, possibly with drooling and difficulty opening the mouth, leading to reduced food intake.

• Enlarged lymph nodes may be felt in the neck and jaw.

What complications can peritonsillar abscess cause?

Peritonsillar abscess (PTA) rarely causes complications, but when they occur, they can be life-threatening. Therefore, PTA should be treated promptly in a hospital.

Local complications of PTA mainly include parapharyngeal abscess and retropharyngeal abscess. This means the infection spreads to surrounding tissues, forming abscesses in broader areas. Both parapharyngeal and retropharyngeal abscesses are serious complications, as the swelling can cause restricted mouth opening, difficulty swallowing, breathing problems, or even life-threatening suffocation.

The systemic complication of PTA is mainly sepsis, where the infection spreads throughout the body via the bloodstream. In severe cases, it can lead to septic shock or death.

CAUSES

What are the causes of peritonsillar abscess?

The most fundamental cause of peritonsillar abscess (PTA) is severe infection, primarily bacterial infection.

If a person frequently suffers from recurrent acute tonsillitis, bacteria can easily remain in the tonsils. When the body's resistance weakens and the tonsils become inflamed again, it may develop into PTA.

Some people have "embedded" tonsils, where the "pearl" is too tightly wrapped in the "shell." Inflammation in such tonsils is more likely to spread to the surrounding tissues, causing peritonsillitis. If treated promptly and the infection is controlled, progression to PTA can be avoided. However, without timely treatment, or if the patient's immunity is very low, or the bacteria are resistant to common medications, peritonsillitis can easily develop into PTA.

Is peritonsillar abscess contagious?

Peritonsillar abscess (PTA) itself is not contagious. In other words, close contact with a PTA patient generally does not lead to PTA.

However, the pathogens causing PTA are often common pathogens of upper respiratory infections. These pathogens may spread through droplets from coughing or sneezing by the PTA patient into the surrounding air. If people nearby have weaker immunity, they may develop symptoms of upper respiratory infections, such as sore throat or fever. Therefore, when in contact with a PTA patient, both parties should ideally wear masks, and the PTA patient should avoid coughing or sneezing directly at others.

In fact, not just PTA patients, coughing or sneezing at others at any time carries the risk of transmitting pathogens (especially to those with weaker immunity). Hence, covering the mouth and nose when coughing or sneezing is important.

DIAGNOSIS

What tests are needed for peritonsillar abscess?

• Throat examination and abscess aspiration:

• An ENT specialist can preliminarily diagnose peritonsillar abscess (PTA) by examining the tonsils and throat, combined with typical medical history. A definitive diagnosis can be made by aspirating pus with a thick needle.

• Blood tests and pus culture:

• Blood tests are also necessary—not for diagnosing PTA but to assess the condition and guide treatment. These typically include complete blood count, C-reactive protein, electrolytes, and liver/kidney function tests. PTA patients usually show significantly elevated white blood cells, neutrophils, and C-reactive protein.

• If pus is obtained through needle aspiration or abscess incision, bacterial culture and antibiotic sensitivity testing should be performed to guide further treatment.

• CT scan:

• A CT scan is not essential for diagnosing PTA but may be needed to differentiate PTA from peritonsillitis or to check for complications like parapharyngeal or retropharyngeal abscesses.

Which conditions have symptoms similar to peritonsillar abscess?

Tonsillar tumor.

Tonsillar tumors may also present with unilateral tonsil enlargement, swelling, redness, and pain, but they typically do not form abscesses. Tumors progress slowly, unlike PTA, which develops rapidly. Symptoms of tumors are usually gradual and long-lasting. Additionally, no pus can be aspirated from a tonsillar tumor, and antibiotic treatment is ineffective—these factors help differentiate the two. A definitive diagnosis requires tonsillectomy and pathological examination.

TREATMENT

Which department should I visit for peritonsillar abscess?

Pediatric ENT, Otolaryngology, Pediatrics.

How is peritonsillar abscess treated? How long does treatment usually take?

• Antibiotic therapy

• Once diagnosed, peritonsillar abscess should be treated with antibiotics as soon as possible. There are many types of antibiotics, and doctors will initially choose one or more based on experience. After bacterial culture and sensitivity test results are available, the antibiotic regimen may be adjusted accordingly.

• Anti-inflammatory treatment

• If throat swelling is severe, causing difficulty breathing or swallowing, anti-inflammatory treatment is needed to reduce swelling and pain. Corticosteroids are commonly used.

• Drainage of pus

• Draining the pus from the abscess not only alleviates swelling, pain, and fever but also enhances the effectiveness of antibiotic therapy. There are two methods for draining pus—needle aspiration and incision drainage. Needle aspiration involves inserting a thick syringe needle into the most prominent area of the abscess to extract the pus, while incision drainage involves making a small cut with a scalpel to release the pus.

• Supportive treatment

• Includes fever reduction, fluid replacement, pain relief, and monitoring for complications.

Treatment duration varies from person to person, typically 1–2 weeks. Factors affecting treatment time include the patient's overall health and the type of infectious pathogen. Patients in good health with pathogens sensitive to common antibiotics will recover faster.

What are the common side effects of medications for peritonsillar abscess?

The main medications for peritonsillar abscess are antibiotics and corticosteroids, with the following side effects:

• Antibiotics

• When used as prescribed, antibiotics are generally safe. Possible side effects include nausea, vomiting, diarrhea, and other gastrointestinal reactions. For patients with preexisting liver or kidney dysfunction, certain antibiotics may worsen these conditions, so doctors will consider the patient's overall health when selecting antibiotics.

• Corticosteroids

• Long-term, high-dose corticosteroid use may cause weight gain, osteoporosis, stomach ulcers, worsened infections, elevated blood sugar, low potassium levels, and insomnia. However, for peritonsillar abscess treatment, corticosteroids are used in low doses for a short duration, so these side effects are unlikely. Patients with severe peptic ulcers, osteoporosis, uncontrolled diabetes, sleep disorders, or mental illness may experience aggravated symptoms, so doctors will avoid corticosteroids if possible.

What are the risks of surgical treatment for peritonsillar abscess?

The main surgical treatments for peritonsillar abscess—needle aspiration and incision drainage—are minor procedures with relatively low risks. Possible complications include local anesthetic allergy and bleeding.

• Local anesthetic allergy: Before needle aspiration or incision drainage, doctors usually apply a topical anesthetic (e.g., tetracaine spray). A small number of patients may be allergic, experiencing rapid heartbeat, difficulty breathing, or rashes. To prevent severe reactions, doctors may skip anesthesia for patients with known drug allergies.

• Bleeding: Minor bleeding is inevitable, and blood may be expelled along with pus. For patients with normal clotting function, this bleeding is insignificant and will stop naturally. However, patients with poor clotting function (e.g., menstruating women or those taking anticoagulants like warfarin or aspirin) may require compression to stop bleeding. In rare cases, injury to a larger blood vessel may cause significant bleeding, requiring immediate compression or sutures.

Does peritonsillar abscess require tonsillectomy?

Whether tonsillectomy is needed for peritonsillar abscess (PTA) remains debated in the medical community.

Generally, PTA patients with a history of recurrent tonsillitis or visibly enlarged, uneven tonsils after recovery often require tonsillectomy to prevent future abscess recurrence. However, the timing of surgery is controversial—some doctors recommend operating about 3 days after abscess formation, while others suggest waiting about a week after infection control.

Patients should discuss with their doctor whether and when to proceed with tonsillectomy.

Does peritonsillar abscess require hospitalization?

Yes, hospitalization is necessary.

Outpatient treatment is not recommended because it cannot ensure strict medication adherence. Additionally, supportive treatments like fluid replacement are less accessible if pain or inflammation causes nutritional issues. Most importantly, if complications arise (e.g., life-threatening conditions), timely intervention may be delayed.

Is follow-up needed after peritonsillar abscess treatment? How often?

After the doctor confirms recovery, a follow-up is recommended one week after stopping medication to check for recurrent inflammation. If no issues are found, no further follow-ups are needed.

Patients should return immediately if they experience difficulty breathing, worsening throat or neck pain, increased difficulty opening the mouth, fever, neck stiffness, or bleeding.

Can peritonsillar abscess be completely cured? Can it recur?

With early treatment at a proper hospital, most peritonsillar abscesses can be fully cured without lasting effects.

About 10%–15% of patients may experience recurrence. Those with a history of recurrent tonsillitis are at higher risk.

Tonsillectomy can prevent recurrence, but not everyone needs it. Maintaining oral hygiene, boosting immunity, and preventing colds or tonsillitis can reduce recurrence risk.

DIET & LIFESTYLE

What should patients with peritonsillar abscess pay attention to in their daily life after recovery?

Those who have had a peritonsillar abscess should pay special attention to avoiding upper respiratory tract infections, such as:

• Avoid close contact with people who have colds or coughs. If contact is necessary, wear a mask for self-protection.
• Strengthen dietary nutrition and physical exercise to enhance physical fitness and immunity.
• Seek medical attention promptly if symptoms like sore throat recur, so that peritonsillitis can be detected early if present.
• Timely use of sensitive antibiotics can effectively prevent the development of peritonsillar abscess.

What should patients with peritonsillar abscess pay attention to in their diet?

There are no specific dietary requirements. The main focus is on maintaining a balanced diet with a variety of healthy foods, which helps improve overall health. During episodes of tonsillitis or pharyngitis, avoid spicy or irritating foods to prevent worsening throat discomfort.

PREVENTION

How to prevent peritonsillar abscess?

• Seek medical treatment promptly when tonsillitis occurs.

• Maintain a regular routine, balanced diet, and exercise to strengthen the body's immunity.

• Pay attention to oral hygiene and develop good habits such as brushing teeth and rinsing the mouth after meals.