Fever, difficulty or inability to swallow, problems breathing, difficulty opening your mouth, and severe throat pain are common symptoms of a peritonsillar abscess. Symptoms typically develop in 3 – 5 days. It may be difficult to tell the difference between a peritonsillar abscess and a severe case of tonsillitis. Signs of a peritonsillar abscess can include red, enlarged tonsils with swelling of the soft palate, the area above the tonsil. Often, one tonsil looks much larger than the other. The tonsil may also appear to push the uvula (the teardrop-shaped piece of soft tissue that hangs down the back of your throat) towards the other side. The tonsil, abscess, and subsequent inflammatory changes can become so large that it can block the back of the throat. If you are drooling, unable to swallow, or having breathing difficulty due to a sore throat, seek medical attention immediately.
Diagnosis and treatment
Diagnosis of a peritonsillar abscess is typically based on a physical exam. Sometimes radiographic imaging, such as a CT scan, is obtained to evaluate the severity and extent of the abscess. If the abscess is small, typically less than 2 cm, or has not fully developed into a pus collection, antibiotics and steroids (IV and/or by mouth) are often used to treat the infection. If the pus collection is significant, or if it is causing airway obstruction or the inability to swallow, an incision and drainage or needle aspiration of the abscess is performed under local anesthesia. Pus obtained is usually sent to the lab for further evaluation. Very rarely is a tonsillectomy required to treat an actively infected peritonsillar abscess. The recurrence rate of a peritonsillar abscess is approximately 10 – 15 %. A tonsillectomy may be indicated for recurrent tonsillitis, peritonsillar abscesses, and/or complications from either chronic infections or a peritonsillar abscess.
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