Peritonsillar Abscess

Basics

Suppurative complication of tonsillitis where infection spreads outside the tonsillar capsule between the palatine tonsil and pharyngeal muscles
Most common deep infection of the head and neck (incidence of 30/100,000 per year)
In the U.S., 45,000 cases annually
Occurs in all ages, more commonly in young adults (mean age 20–40 yr)
Occurs most commonly November–December, April–May (coincides with highest incidence rates of streptococcal pharyngitis)
Complications:
- Airway compromise (uncommon)
- Sepsis (uncommon)
- Recurrence (12–15%)
- Extension to lateral neck or mediastinum
- Spontaneous perforation and aspiration pneumonitis
- Jugular vein thrombosis (Lemierre syndrome)
- Poststreptococcal sequelae (glomerulonephritis, rheumatic fever)
- Hemorrhage from extension and erosion into carotid sheath
- Severe dehydration
- Intracranial extension (meningitis, cavernous sinus thrombosis, cerebral abscess)
- Dural sinus thrombosis

2 theories explain the development of peritonsillar abscess (PTA):
- Direct bacterial invasion into deeper tissues in the patient with acute pharyngitis
- Acute obstruction and bacterial infection of small salivary glands (Weber glands) in the superior tonsil
Smoking may be a risk factor
Most common pathogens:
- Group-A Streptococcus
- Staphylococcal species, including methicillin-resistant Staphylococcus aureus (MRSA)
- Anaerobes (Prevotella, Peptostreptococcus, Fusobacterium)
- Polymicrobial

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