Retropharyngeal Abscess

A retropharyngeal (pronounced “reh-tro-fah-RIN-jee-ul”) abscess is a collection of pus deep in the back of your child’s throat. It’s a serious condition that happens when bacteria infect the lymph nodes there. Usually, the bacteria are the same as those that cause common upper respiratory infections, like strep throat and tonsillitis.

Retropharyngeal abscesses most often affect children younger than 5 years old. But they can occur at any age, including adults.

No matter who’s impacted, this condition can be fatal without immediate care. This is why you should see a healthcare provider at the first sign of a retropharyngeal abscess in yourself or your child.

Symptoms of a retropharyngeal abscess

Having trouble swallowing or experiencing pain when you swallow are the most common symptoms of a retropharyngeal abscess. Other symptoms to look for include:

• Severe sore throat
• Swollen lymph nodes
• Difficulty breathing or speaking
• Noisy breathing
• Severe headache
• Stiff neck
• Coughing
• Fever

Children with a retropharyngeal abscess may seem anxious or irritable. They may have so much trouble swallowing that they drool. A child who positions their head oddly (as if to clear their airway) may be struggling to get enough air.

Retropharyngeal abscess causes

A retropharyngeal abscess forms when lymph nodes get infected. Lymph nodes are pea-sized tissues inside your neck that swell when you get sick. With an abscess, the swollen or inflamed tissue forms a pocket of pus. Causes are different for children and adults.

• Children: Abscesses usually form after upper respiratory infections, like sinus or ear infections. The original infection spreads from where it started to the lymph nodes in the back of your child’s throat.
• Adults: Abscesses usually form after an injury. For instance, an object like a fish bone may puncture the back of your throat. Sometimes, injuries happen after procedures, like dental work, upper endoscopy or intubation.

Cases have increased in both children and adults over the past 20 years. It’s possible that the rise is related to increased cases of tonsillitis. Another potential reason is the rise in infections involving antibiotic-resistant bacteria called MRSA.

Risk factors

Retropharyngeal abscesses most often affect children between ages 2 and 4. Lymph nodes are larger at this age, making them more susceptible to infection. Lymph nodes in your throat shrink as you age. This decreases the risk of an abscess.

Retropharyngeal abscesses are slightly more common in males.

Complications of this condition

A retropharyngeal abscess is serious largely because of its location. Without treatment, it can grow so big that it blocks your child’s airway. The infection can spread to their organs and blood. These complications are serious and can be fatal without treatment.

Complications include:

• Blocked airway
• Aspiration pneumonia
• Swelling and inflammation in your child’s chest
• Blood clots in the major veins in your child’s neck
• Infection that spreads to nearby tissues and organs, like your child’s lungs
• Infection that spreads to their blood (septic shock)

How doctors diagnose this condition

A healthcare provider (likely an otolaryngologist, or “ENT”) will assess your child’s symptoms and do a physical exam. An imaging test, like an X-ray or a CT scan, can show the abscess. Your child may also need blood tests, like a complete blood count (CBC) and a bacteria culture test.

High levels of white blood cells in the CBC are signs of an infection. The culture can show which types of bacteria are causing it.

How is a retropharyngeal abscess treated?

Your child will likely need treatment in a hospital. Their healthcare team will work to clear the infection and, in some cases, drain the abscess. Treatments include:

• Antibiotics: Your child will get broad-spectrum antibiotics through an IV to treat the infection. These medicines kill many types of bacteria. They may get antibiotics that target specific bacteria once the culture reveals which strains are causing the infection.
• Surgery: Their provider may drain the abscess by cutting it open so the pus can escape. They may access the abscess through your child’s mouth. Or they may make an incision (cut) in their neck. Your child will be under general anesthesia (asleep) the whole time.
• Corticosteroids: Steroids may help reduce inflammation from the infection. But this treatment isn’t as common as antibiotics and surgery.

Your child may need oxygen support in the hospital if the abscess blocks their airway. Their care team may give them fluids through an IV to prevent dehydration.

Your child will need to continue taking antibiotics after they leave the hospital. Instead of an IV, the medicine comes in pill form. It’s important for your child to take all their meds, even if they feel better. Retropharyngeal abscesses can return. Taking all medicines as directed can reduce the chance of this happening.

What medications are used?

Antibiotics used to treat retropharyngeal abscesses include:

• Ampicillin sulbactam
• Clindamycin
• Vancomycin
• Linezolid
• Amoxicillin-clavulanate

When should I see my healthcare provider?

See a healthcare provider as soon as you notice signs of this condition. A retropharyngeal abscess can block your child’s throat to the point that they have trouble breathing. It can become life-threatening.

This is why it’s so important to seek care well in advance of things worsening to this degree.

What can I expect if I have a retropharyngeal abscess?

The outlook is excellent with treatment. Treating the infection and draining the pus can cure the condition. Still, you should be aware of any symptoms that the abscess has returned.

A retropharyngeal abscess comes back in about 1 to 5 out of every 100 people. See your child’s healthcare provider immediately if you notice signs that the abscess has returned. Symptoms are often like those that occurred before they were diagnosed.

What’s the difference between a retropharyngeal abscess and a peritonsillar abscess?

A retropharyngeal abscess is a collection of pus in the back of your throat. It’s more common in young children. A peritonsillar abscess is a collection of pus that forms near your tonsils. It’s more common in older children and adults.

Both result from an infection and require similar treatment approaches, including antibiotics and draining the abscess.