Peritonsillar abscess, also known as quinsy, is a serious disease associated with a sore throat. It is the most common deep throat and neck infection in the US, with about 30 cases per 100,000 people per year.[1] It develops when strep throat or bacterial tonsillitis is not treated, which might well be the case when antibiotic supplies are limited and we don’t want to waste antibiotics on what is very likely a viral infection, or even a bacterial infection that will usually resolve on its own anyway. Peritonsillar abscess has become a rare disease due to the use of antibiotics to treat strep throat and tonsillitis.
When antibiotic use becomes much more conservative, peritonsillar abscess will become more common. Peritonsillar abscess is usually a result of a group-A strep bacterial infection that forms a collection of pus near or around the tonsils.[2] An untreated peritonsillar abscess can result in an obstructed airway and death. And it can be treated in austere situations relatively easily.
As peritonsillar abscesses can progress very quickly, any patient suspected of having a peritonsillar abscess must be monitored every two hours around the clock. It can progress from peritonsillar cellulitis so quickly that lymph nodes don’t even have time to swell.
Signs and Symptoms
The first symptom of a peritonsillar abscess is usually a sore throat (tonsillitis). However, this tonsillitis is bacterial in origin, not viral (which is more common). There may be no fever or any other symptoms as the abscess develops, for a period of two to five days.
- The mouth and throat may become swollen, usually on just one side.
- This may cause the uvula (the little finger of tissue that hangs down at the back of the throat) to be pushed away from the swollen side.
- Lymph glands in the neck may be enlarged and tender.
Subsequent signs and
symptoms include:
- A severe sore throat on the affected side of the throat
- Pain and difficulty in swallowing
- Fever and chills
- Muscle spasms in the muscles of the jaw and neck
- Ear pain on the same side as the abscess
- Difficulty swallowing saliva
- A muffled “hot potato” voice (sounds as if patient is talking with a mouthful of hot potato)
Treatment
The peritonsillar abscess must be drained. There are two options. The utmost caution must be exercised because
the carotid artery is very close.
- Wrap tape around the base of a #11 scalpel blade, leaving only 3 mm of the tip protruding for cutting. Make a nice slice.
- Another option is to use a large bore needle, with the needle cap still on. Cut the cap so that only 5 mm of the needle protrudes. This ensures that the needle will only penetrate a short distance to reduce the risk of puncturing the carotid artery.[3]
Penicillin is the antibiotic most commonly prescribed following the drainage procedure. Erythromycin and clindamycin are other options.[4]
Risk factors
Peritonsillar abscess is relatively common in adults, especially in the 20-40 year age range, but rare in infants and young children.[5]
Other risk factors include:
- Dental infections, including gingivitis
- Chronic tonsillitis
- Infectious mononucleosis
- Smoking
Links to related posts:
Penicillin Primer for Preppers
References:
https://medlineplus.gov/ency/article/000986.htm
[1] Nicholas J. Galioto, “Peritonsillar Abscess,” American Family Physician, 15 April 2017, https://www.aafp.org/afp/2017/0415/p501.html (accessed 5 January 2021).
[2] “Peritonsillar Abscess,” https://medlineplus.gov/ency/article/000986.htm (accessed 5 January 2021).
[3] Survival and Austere Medicine, 3rd Edition, 187.
[4] Jeffrey S. Rubin, et al., “Facts You Should Know about Peritonsillar Abscess,” eMedicineHealth.com, 12 November 2020, https://www.emedicinehealth.com/peritonsillar_abscess/article_em.htm (accessed 5 January 2021).
[5] Jeffrey S. Rubin, et al., “Facts You Should Know about Peritonsillar Abscess,” eMedicineHealth.com, 12 November 2020, https://www.emedicinehealth.com/peritonsillar_abscess/article_em.htm (accessed 5 January 2021).
6.22.23
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