Section 19. Ear, Nose, and Throat Disorders

Chapter 222. Throat Disorders

Topics: Introduction | Tonsillar Cellulitis and Abscess | Epiglottitis | Laryngitis | Vocal Cord Nodules and Polyps | Contact Ulcers of the Vocal Cords | Vocal Cord Paralysis | Laryngoceles

Tonsillar Cellulitis and Abscess

Tonsillar cellulitis is a bacterial infection of the tissues around the tonsils; a tonsillar abscess is a collection of pus in the area of the tonsils.

Sometimes, bacteria, usually streptococci, that infect the throat can spread deeper into the surrounding tissues. This condition is called cellulitis. If the bacteria grow unchecked, a collection of pus (abscess) may form. Abscesses may form next to the tonsils (peritonsillar) or in the side of the throat (parapharyngeal). Abscesses occur in children but are more common in young adults.

Symptoms

With tonsillar cellulitis or an abscess, swallowing causes severe pain. A person feels ill, has a fever, and may tilt his head toward the side of the abscess to help relieve pain. Spasms of the chewing muscles make opening the mouth difficult (trismus). Cellulitis produces general redness and swelling above the tonsil and on the soft palate. An abscess pushes the tonsil forward, and the uvula (the small, soft projection that hangs down at the back of the throat) is swollen and can be pushed to the side opposite the abscess.

Diagnosis and Treatment

A doctor makes the diagnosis by viewing the throat. Tests are not usually performed, but if the doctor is not sure whether an abscess is present, computed tomography (CT) can be used to identify one. Sometimes if the doctor suspects an abscess, he inserts a needle into the area and tries to draw out pus.

Antibiotics, such as penicillin or clindamycin, are given intravenously. If no abscess is present, the antibiotic usually starts to clear the infection in 24 to 48 hours. If an abscess is present, a doctor must insert a needle in it or cut into it to drain the pus. The area is first numbed with an anesthetic spray or injection. Treatment with antibiotics is continued by mouth.

Peritonsillar abscesses tend to recur; recurrences can be prevented by removing the tonsils (tonsillectomy (see Section 23, Chapter 276)), which is usually performed 4 to 6 weeks after the infection has subsided or earlier if the infection is not controlled with antibiotics.