Peritonsillar Abscess

A peritonsillar abscess — also called quinsy — is a swollen, pus-filled pocket that forms near one of your tonsils. It’s often a complication of tonsillitis but can also occur on its own. It usually causes an extremely painful sore throat and can make it hard to open your mouth.

A peritonsillar abscess is rare overall, occurring in about 1 in every 10,000 people. But it’s still one of the most common head and neck infections. Abscesses can affect anyone. But they’re most common in older children, adolescents and young adults.

A peritonsillar abscess can be serious, especially if it grows so large that it blocks your throat. This can make it difficult to speak, swallow or breathe. Left untreated, it can become a life-threatening infection.

This is why it’s essential to seek care as soon as possible if you have symptoms.

Symptoms of a peritonsillar abscess

In most cases, a severe sore throat — usually on one side — is the first sign of a peritonsillar abscess. Additional symptoms often develop over the next few days. Other symptoms include:

• Fever
• Chills
• Trouble opening your mouth
• Swelling of your face and neck
• Headache
• Earache on the same side as your sore throat
• Drooling
• Difficulty swallowing
• Bad breath
• Muffled voice or hoarseness
• A tonsil that’s pushing your uvula (the fleshy, hanging ball in the back of your throat)

The tissue in the back of your throat can become so swollen that it blocks your airway. If you’re having trouble breathing, seek emergency care right away.

Peritonsillar abscess causes

In most cases, bacteria cause peritonsillar abscesses. And they’re usually a complication of tonsillitis. This happens when the infection spreads from your tonsil to the tissue around it.

There are also certain factors that can increase your risk for peritonsillar abscesses, like smoking and gum disease. Having a history of peritonsillar abscesses can put you at risk of getting more in the future.

Complications of this condition

Usually, peritonsillar abscesses are treatable. But the condition can be fatal if swollen tissue blocks your airway. Another concern is that the infection can spread to nearby tissue and even your bloodstream.

It’s essential to see a healthcare provider before things progress to this point.

How doctors diagnose this condition

Your healthcare provider will examine your throat, neck and mouth. Often, they can diagnose a peritonsillar abscess just by looking. They may also do blood tests or take a throat culture. The culture helps them identify the bacteria causing the infection. Most are the same bacteria that cause strep throat.

Your provider may do imaging tests, like an ultrasound or a CT scan. Imaging helps them rule out other conditions that may be causing your symptoms. It also helps pinpoint the location of the pus-filled pocket, so they can get rid of it.

How are peritonsillar abscesses treated?

In most cases, a peritonsillar abscess needs surgical drainage and antibiotics. If you still have your tonsils, you might need surgery to remove them. Treatments include:

• Antibiotics: Your healthcare provider will prescribe antibiotics to kill the bacteria. You may get them through a vein (as an IV) or as a pill. Common ones include penicillin, amoxicillin, cephalosporin and clindamycin.
• Peritonsillar abscess drainage: In most cases, providers drain the peritonsillar abscess. They may insert a needle to drain it. This is called needle aspiration. Or they’ll make a cut (incision) in the abscess to release the fluid inside it.
• Tonsillectomy: This surgery removes your tonsils. It allows the abscess to drain completely and prevents it from coming back.

Other treatments depend on how severe your condition is. For example, if your throat hurts so much that you’re unable to swallow liquids, you may need IV fluids to treat dehydration.

Recovery time

Most people start to feel better within the first 24 hours of treatment. Full recovery usually takes about a week after surgical drainage.

You’ll likely take antibiotics by mouth for about two weeks. You’ll need to take your meds exactly as prescribed until you finish them. It’s important to take them even if you start to feel better.

When should I see my healthcare provider?

You’ll likely have a follow-up appointment shortly after treatment or after being discharged from the hospital. Your provider will check to see if your symptoms are improving. In the meantime, let them know about new or worsening symptoms.

What can I expect if I have a peritonsillar abscess?

If you have a peritonsillar abscess, you may only need treatment during an office visit with your healthcare provider. But if you have severe swelling that blocks your airway, you may have the abscess drained in the hospital. Although it’s uncommon, you may need an emergency tonsillectomy (quinsy tonsillectomy). If so, you’ll probably need to stay in the hospital for a few days.

Your provider may use a combination of treatments to ensure you feel better as soon as possible.

Is there anything I can do to feel better?

There are lots of ways to support the healing process and feel better during recovery:

• Drink plenty of fluids. Your throat may hurt at first. It may hurt to drink. But water helps your body heal. Sports drinks and soup are also good options.
• Try soft foods. You may not want to eat, either. But it’s important to give your body the nutrition it needs. If it helps, try soft foods — like mashed potatoes and shakes — at first.
• Use pain medications as directed. Let your healthcare provider know how bad the pain is. They can recommend medicines that can help.

Can this be prevented?

The best way to prevent peritonsillar abscess is to treat oral infections promptly. This includes tonsillitis. Early treatment can keep the infection from spreading.

You can also reduce your risk with good oral hygiene and by not smoking, vaping or using tobacco, in general.

Peritonsillar abscess vs. tonsillitis: What’s the difference?

Tonsillitis is an infection of your tonsils. A peritonsillar abscess is an area of pus-filled tissue next to your tonsils. A peritonsillar abscess is often a complication of tonsillitis. But this isn’t always the case.

What are the red flags of peritonsillar abscess?

A severe sore throat can be a red flag of a peritonsillar abscess. You may feel dread when your mouth waters because you know swallowing will hurt. Your throat may be so swollen that you can’t open your mouth all the way.

These symptoms may be a sign of peritonsillar abscess or other serious conditions affecting your throat. Regardless, if it takes effort to breathe or feels like you’re not getting enough air, seek emergency care immediately.