Throat Abscess - Causes, Symptoms and Treatments

Abscess of the throat may be peritonsillar (quinsy) or retropharyngeal. Peritonsillar abscess forms in the connective tissue space between the tonsil capsule and constrictor muscle of the pharynx.

Retropharyngeal abscess, or abscess of the potential space, forms between the posterior pharyngeal wall and prevertebral fascia. With treatment, the prognosis for both types of abscesses is good.

Causes of Throat Abscess:

Peritonsillar abscess is a complication of acute tonsillitis, usually after streptococcalor staphylococcal infection. It occurs more often in adolescents and young adults than in children.

Acute retropharyngeal abscess results from infection in the retropharyngeal lymph glands, which may follow an upper respiratory tract bacterial infection. Because these lymph glands, present at birth, begin to atrophy after age 2, acute retropharyngeal abscess most commonly affects infants and children under age 2.

Chronic retropharyngeal abscess may result from tuberculosis of the cervical spine (Pott's disease) and may occur at any age.

Signs and symptoms of Throat Abscess:

Peri tonsillar abscess and retropharyngeal abscess have different signs and symptoms.

Peritonsillar abscess

Key symptoms of peritonsillar abscess include severe throat pain, occasional ear pain on the same side as the abscess, and tenderness of the submandibular gland. Dysphagia causes drooling. Trismus may occur as a result of edema and infection spreading from the peritonsillar space to the pterygoid muscles.

Other effects include fever, chills, malaise, rancid breath, nausea, mumed speech, dehydration, cervical adenopathy, and localized or systemic sepsis.

Retropharyngeal abscess

Clinical features of retropharyngeal abscess include pain, dysphagia, fever and, when the abscess is located in the upper pharynx, nasal obstruction; with a low­positioned abscess, dyspnea, progressive inspiratory stridor (from laryngeal obstruction), neck hyperextension and, in children, drooling and muffled crying.

A very large abscess may press on the larynx, causing edema, or may erode into major vessels, causing sudden death from asphyxia or aspiration.

Diagnosis of Throat Abscess:

Diagnosing peritonsillar abscess is based on a patient history of bacterial pharyngitis. Examination of the throat shows swelling of the soft palate on the abscessed side, with displacement of the uvula to the opposite side; red, edematous mucous membranes; and tonsil displacement toward the midline. Culture may reveal streptococcal or staphylococcal infection.

Peritonsillar abscess can also be caused by an aerobic microorganism such as bacteroides.

Diagnosis of retropharyngeal abscess is based on patient history of nasopharyngitis or pharyngitis, and on physical examination revealing a soft, red bulging of the posterior pharyngeal wall. X-rays show the larynx pushed forward and a widened space between the posterior pharyngeal wall and vertebrae.

If neck pain or stiffness occurs, look for extension to epidural space or cervical vertebrae. Culture and sensitivity tests isolate the causative organism and determine the appropriate antibiotic.

Treatment of Throat Abscess:

For early-stage peritonsillar abscess, large doses of penicillin or another broad­spectrum antibiotic are necessary. If the patient is immunocompromised or has been repeatedly hospitalized, antibiotic therapy should include coverage for staphylococci and gram-negative organisms.

For late-stage peritonsillar abscess, with cellulitis of the tonsillar space, primary treatment is usually incision and drainage under a local anesthetic, followed by antibiotic therapy for 7 to 10 days. Tonsillectomy, scheduled no sooner than 1 month after healing, prevents recurrence but is recommended only after several episodes.

In acute retropharyngeal abscess, the primary treatment is incision and drainage through the pharyngeal wall. In chronic retropharyngeal abscess, drainage is performed through an external incision behind the sternomastoid muscle. During incision and drainage, strong, continuous mouth suction is necessary to prevent aspiration of pus. Postoperative drug therapy includes antibiotics (usually penicillin) and analgesics.

Special considerations of Throat Abscess:

• Be aware that these infections can extend to the mediastinum, worsening sepsis and chest pain, and increasing breathing difficulty.
• Explain the drainage procedure to the patient or his parents. Because the procedure is generally done under a local anesthetic, the patient may be apprehensive.
• Perform incision and drainage. To allow easy expectoration and suction of pus and blood, place the patient in a semirecumbent or sitting position.

After incision and drainage:

• Give antibiotics, analgesics, and antipyretics. Stress the importance of completing the full course of prescribed antibiotic therapy.
• Monitor vital signs, and watch for any significant changes or bleeding. Assess pain and treat accordingly.
• If the patient is unable to swallow, ensure adequate hydration with I.V. therapy. Monitor fluid intake and output, and watch for dehydration.
• Provide meticulous mouth care. Apply petrolatum to the patient's lips. Promote healing with warm saline gargles or throat irrigations for 24 to 36 hours after incision and drainage. Encourage adequate rest.