When to Seek Medical Care for a Peritonsillar Abscess
Discuss any sore throat with fever or other symptoms with your doctor by phone or with an office visit to see if you have a peritonsillar abscess.
If you have a sore throat and trouble swallowing, trouble breathing, difficulty speaking, drooling, or any other signs of potential airway obstruction, you should go to the nearest emergency room.
Exams and Tests for a Peritonsillar Abscess
A peritonsillar abscess is usually diagnosed based on history and a physical exam. A peritonsillar abscess is easy to diagnose when it is large enough to see. The doctor will look into your mouth using a light and, possibly, a tongue depressor. Swelling and redness on one side of the throat near the tonsil suggests an abscess. The doctor may also gently push on the area with a gloved finger to see if there is pus from infection inside.
- Lab tests and X-rays are not used often. Sometimes an X-ray, CT scan, or an ultrasound will be performed, typically to make sure other upper airway illnesses are not present. These conditions may include the following:
- Epiglottitis, an inflammation of the epiglottis (the flap of tissue that prevents food from entering the windpipe)
- Retropharyngeal abscess, a pocket of pus that forms behind the soft tissue in the back of the throat (like a peritonsillar abscess but in a different location)
- Peritonsillar cellulitis, an infection of the soft tissue itself (a peritonsillar abscess forms beneath the surface of the tissue)
- Your doctor may test you for mononucleosis, a virus. Some experts suggest that mono is associated with up to 20% of peritonsillar abscesses.
- Your doctor also may send pus from the abscess to the lab so the exact bacteria can be identified. Even so, identifying the bacteria rarely changes treatment.
Peritonsillar Abscess Treatment and Care at Home
There is no home treatment for peritonsillar abscess. Call your doctor for an immediate appointment to check your symptoms.
Medical Treatment for a Peritonsillar Abscess
If you have a peritonsillar abscess, the doctor's primary concern will be your breathing and airway. If your life is in danger because your throat is blocked, the first step may be to insert a needle in the pus pocket and drain away enough fluid so you can breathe comfortably.
If your life is not in immediate danger, the doctor will make every effort to keep the procedure as painless as possible. You will receive a local anesthetic (like at the dentist) injected into the skin over the abscess and, if necessary, pain medicine and sedation through an IV inserted in your arm. The doctor will use suction to help you avoid swallowing pus and blood.
- The doctor has several options for treating you:
- Needle aspiration involves slowly putting a needle into the abscess and withdrawing the pus into a syringe.
- Incision and drainage involves using a scalpel to make a small cut in the abscess so pus can drain.
- Acute tonsillectomy (having a surgeon remove your tonsils) may be needed if, for some reason, you cannot tolerate a drainage procedure, or if you have a history of frequent tonsillitis.
- You will receive an antibiotic. The first dose may be given through an IV. Penicillin is the best drug for this type of infection, but if you are allergic, tell the doctor so another antibiotic can be used (other choices may be erythromycin or clindamycin).
- If you are healthy and the abscess drains well, you can go home. If you are very ill, cannot swallow, or have complicating medical problems (such as diabetes), you may be admitted to the hospital. Young children, who often need general anesthesia for drainage, frequently require a hospital stay for observation.