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.
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.
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.
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.
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).
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.
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