Peritonsillar Abscess - Upper Airway Infections

PERITONSILLAR ABSCESS

A peritonsillar abscess is a collection of purulent exudate between the tonsillar capsule and the surrounding tissues, including the soft palate. It is believed to develop after an acute tonsillar infec-tion, which progresses to a local cellulitis and abscess.

Clinical Manifestations

The usual symptoms of an infection are present, together with such local symptoms as a raspy voice, odynophagia (a severe sen-sation of burning, squeezing pain while swallowing), dysphagia (difficulty swallowing), otalgia (pain in the ear), and drooling. An examination shows marked swelling of the soft palate, often oc-cluding almost half of the opening from the mouth into the phar-ynx, unilateral tonsillar hypertrophy, and dehydration.

Assessment and Diagnostic Findings

Aspiration of purulent material (pus) by needle aspiration is re-quired to make the appropriate diagnosis. The aspirated material is sent for culture and Gram’s stain. A CTscan is performed when it is not possible to aspirate the abscess.

Medical Management

Antibiotics (usually penicillin) are extremely effective in control-ling the infection in peritonsillar abscess. If antibiotics are pre-scribed early in the course of the disease, the abscess may resolve without needing to be incised.

SURGICAL MANAGEMENT

If treatment is delayed, the abscess is evacuated as soon as possi-ble. The mucous membrane over the swelling is first sprayed with a topical anesthetic and then injected with a local anesthetic. Sin-gle or repeated needle aspirations are performed to decompress the abscess. The abscess may also be incised and drained. These procedures are performed best with the patient in the sitting po-sition to make it easier to expectorate the pus and blood that ac-cumulate in the pharynx. Almost immediate relief is experienced. Approximately 30% of patients with peritonsillar abscess have in-dications for tonsillectomy (Tierney et al., 2001).

Nursing Management

Considerable relief may be obtained by the use of topical anes-thetic agents and throat irrigations or the frequent use of mouth-washes or gargles, using saline or alkaline solutions at a temperature of 105°F to 110°F (40.6°C to 43.3°C). The nurse instructs the patient to gargle at intervals of 1 or 2 hours for 24 to 36 hours. Liquids that are cool or at room temperature are usually well tolerated.