Peritonsillar abscess

Under a peritonsillar abscess formation is understood in the loose connective tissue surrounding the tonsil. The peritonsillar abscess is the most common complication of inflammatory diseases of almond.

The onset and progression

In the history of peritonsillar abscess, there are often several previous angina.

The peritonsillar abscess usually appears directly in the wake of acute tonsillitis (angina ) that he can develop but also without prior acute symptoms of chronic tonsillitis. While angina the inflammatory process is confined to the tonsils, peritonsillar abscess penetrates the inflammation through the capsule of the tonsil into the surrounding loose connective tissue, where it leads to an accumulation of pus. Mostly take the abscesses from the upper Almond section its output, which is why they usually spread above the almond. In addition to the usually causative streptococci found in the pus regularly and anaerobic bacteria, which are responsible for the foul odor of the pus. Untreated breaks the peritonsillar after five to ten days by the anterior palatal arch in front of the almond or the soft palate above the Almond through it and empties plenty of stinking pus, what is important in the case of uncomplicated healing occurs.

A peritonsillar abscess can also be the starting point of serious complications such as abscesses of the cervical lymph nodes, spread of inflammation along the vascular sheath of the neck with the development of thrombophlebitis and the risk of sepsis and the Lemierre syndrome. Especially feared a spread of inflammation in the parapharyngeal space, because this is no limit to the mediastinum in combination and the inflammation may spread easily in this way into the chest cavity.

Symptoms and Diagnosis

If, as usual, angina ahead, it comes after initial improvement to a resurgence of fever and extremely violent sore throat on the side of the developing abscess. Particularly swallowing is nearly impossible and leads to large, emitting in the ear pain area so frequently denied ingestion. Mostly occurs also an inflammatory trismus, so that the mouth can still be only slightly open. Also typical are a bad breath and a " kloßige " language. The regional lymph nodes in the angle of the jaw are swollen and painful.

The investigation is complicated because of trismus, we see a strong redness protrusion of the anterior palatal arch and the soft palate. The suppository is typically swollen and displaced from the center line to the opposite side. The almond itself is often hidden by the swollen palatine arch.

The diagnostic results from the typical symptoms and the typical local findings.

Treatment

In a peritonsillar an individual decision based on the Erstauftretens, recurrence and general symptoms should be taken. A Inzisionsdrainage or needle puncture is the first event uncomplicated after Herzon a low complication therapy variant dar., Johnson took place in 2003 in its evidence-based literature review no superiority of one of the two methods incision or tonsillectomy. Wind Fuhr (2005) initially recommended due to a meta-analysis of trials in uncomplicated picture an incision, otherwise an immediate tonsillectomy, in both methods a antibiotics over at least 1 week ..