What is the treatment for a tonsil abscess?

Treatment of Tonsil Abscess

The treatment of a peritonsillar abscess requires drainage of the abscess, appropriate antibiotic therapy, and supportive care including hydration and pain control. 1

Diagnosis

• Peritonsillar abscess is the most common deep infection of the head and neck 1
• Clinical presentation typically includes fever, severe sore throat, dysphagia (difficulty swallowing), trismus (limited mouth opening), and a "hot potato" voice 1
• Physical examination reveals edema and erythema of the affected tonsil with displacement of the uvula toward the opposite side 2
• Fine needle aspiration of the affected tonsil can confirm diagnosis in cooperative patients 2

Treatment Algorithm

1. Drainage Options

• Needle aspiration: Initial drainage approach in outpatient setting 1
• Incision and drainage: Alternative approach for abscess drainage 1
• Immediate tonsillectomy (Quinsy tonsillectomy): Definitive treatment that both drains the abscess and prevents recurrence 2

2. Antibiotic Therapy

• Peritonsillar abscesses are polymicrobial infections 1
• First-line antibiotics should be effective against:
  • Group A streptococcus
  • Oral anaerobes 1
• Cephalosporins are recommended due to high tissue concentration in inflamed peritonsillar tissue 2

3. Supportive Care

• Maintain hydration 1
• Pain control with appropriate analgesics 1
• Consider corticosteroids to reduce symptoms and speed recovery 1

Immediate vs. Delayed Tonsillectomy

• Immediate tonsillectomy benefits:

  • Provides prompt and complete drainage of the abscess 3
  • Eliminates potential for occult inferior pole or contralateral abscess 2
  • Avoids a second hospitalization and surgical procedure 2
  • Results in dramatic relief of symptoms within days 4
  • Has been shown to be safe with low morbidity 5

• Traditional approach (less preferred):

  • Incision and drainage with antibiotics followed by tonsillectomy weeks later 5
  • Requires two hospitalizations 5
  • Risks recurrence of tonsillitis or peritonsillar abscess during waiting period 5

Special Considerations

• Most patients can be managed in outpatient settings 1
• Prompt recognition and treatment are essential to avoid serious complications such as:
  • Airway obstruction
  • Aspiration
  • Extension of infection into deep neck tissues 1

Indications for Tonsillectomy

• History of >1 peritonsillar abscess is a modifying factor that may favor tonsillectomy even in patients who don't meet standard frequency criteria for recurrent throat infections 6
• According to the American Academy of Otolaryngology-Head and Neck Surgery guidelines, tonsillectomy should be considered in patients with a history of peritonsillar abscess 7

Clinical Pitfalls to Avoid

• Delaying treatment, which can lead to extension of infection 1
• Inadequate drainage of the abscess 4
• Failure to recognize the high incidence of anaerobes in these infections, requiring appropriate antibiotic coverage 4
• Overlooking the possibility of peritonsillar abscess in children (though it's more common in young adults) 2