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Tonsillar Cellulitis and Abscess

by Clarence T. Sasaki, MD

Tonsillar cellulitis is a bacterial infection of the tissues around the tonsils. A tonsillar abscess is a collection of pus behind the tonsils.

  • Sometimes, bacteria that infect the throat spread deep into surrounding tissues.

  • Typical symptoms include sore throat, pain when swallowing, fever, swelling, and redness.

  • The diagnosis is based on examination of the throat and sometimes the results of imaging studies.

  • Antibiotics help eliminate the infection.

  • An abscess is drained with a needle or through a small incision.

Sometimes, bacteria (usually streptococci and staphylococci) that infect the throat can spread deeper into the surrounding tissues. This condition is called cellulitis. If the bacteria grow unchecked, a collection of pus (abscess) may form. Abscesses may form next to the tonsils (peritonsillar) or in the side of the throat (parapharyngeal). A parapharyngeal abscess is more extensive and more dangerous than a peritonsillar abscess. Tonsillar cellulitis and tonsillar abscesses are most common among adolescents and young adults.

Symptoms

With tonsillar cellulitis or a tonsillar abscess, swallowing causes severe pain that often radiates into the ear. People have a severe sore throat, feel ill, have a fever, and may tilt their head toward the side of the abscess to help relieve pain. Spasms of the chewing muscles make opening the mouth difficult (trismus). Cellulitis causes general redness and swelling above the tonsil and on the soft palate. An abscess pushes the tonsil forward, and the uvula (the small, soft projection that hangs down at the back of the throat) is swollen and can be pushed to the side opposite the abscess. Other common symptoms include a "hot potato" voice (speaking as if a hot object is in the mouth), drooling, redness of the tonsils, white patches (exudates), swollen lymph nodes in the neck, and severe bad breath (halitosis).

Diagnosis

A doctor makes the diagnosis by viewing the throat. Tests are not usually performed, but if the doctor is not sure whether an abscess is present, computed tomography (CT) or ultrasonography can be used to identify one. Sometimes if an abscess is suspected, the doctor inserts a needle into the area and tries to draw out pus.

Treatment

Antibiotics, such as penicillin or clindamycin, are given by vein. If no abscess is present, the antibiotic usually starts to clear the infection within 48 hours. If an abscess is present, a doctor must insert a needle in it or cut into it to drain the pus. The area is first numbed with an anesthetic spray or injection. Treatment with antibiotics is continued by mouth.

Peritonsillar abscesses tend to recur. Recurrences can be prevented by removing the tonsils (tonsillectomy—see Tonsillectomy), which is usually performed 4 to 6 weeks after the infection has subsided or earlier if the infection is not controlled with antibiotics.

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  • CLEOCIN