A peritonsillar abscess (PTA), often called quinsy, is a localized collection of pus that develops in the tissues adjacent to one of the tonsils. This condition is a complication of a throat infection, resulting in a severely painful, swollen area. The abscess frequently causes difficulties with swallowing and speaking.
Is the Abscess Itself Contagious
The abscess itself is not contagious, as it represents a localized, walled-off pocket of pus, dead white blood cells, and bacteria within the throat tissue. This material is a complication of a prior infection, not a primary contagious agent.
However, the underlying bacterial infection that led to the abscess often is contagious. PTAs typically arise from an inadequately treated case of tonsillitis or strep throat, most commonly caused by Streptococcus pyogenes (Group A Strep). This bacteria spreads through respiratory droplets from coughing, sneezing, or sharing utensils. While the abscess is a local complication, the infectious agent that created it poses a risk of transmission.
How a Peritonsillar Abscess Develops
PTA formation is usually a progression of an untreated or severe bacterial infection of the tonsils. When bacteria, such as Streptococcus pyogenes, infect the tonsil, the body’s immune response attempts to contain the spread. In some cases, the infection moves beyond the tonsillar capsule into the peritonsillar space, the loose connective tissue between the tonsil and the pharyngeal muscles.
Once in this space, the bacteria and immune cells cause local tissue death, resulting in a collection of pus. This collection forms the abscess cavity, physically separated from the general throat tissue. Another proposed mechanism involves the obstruction of minor salivary glands (Weber glands), leading to tissue death and pus formation. The resulting pocket expands, causing significant swelling and local symptoms.
Identifying the Key Symptoms
Symptoms of a peritonsillar abscess usually develop over a few days following the initial infection. The throat pain is pronounced and characteristically unilateral, meaning it is much worse on one side. Patients may also experience otalgia, which is referred pain felt in the ear on the affected side.
A distinctive symptom is dysphagia, or difficulty swallowing, which can become so severe that patients avoid swallowing their own saliva, leading to drooling. Another hallmark sign is trismus, a painful spasm of the jaw muscles that restricts mouth opening. A change in speech is also common, resulting in a muffled sound often described as a “hot potato” voice.
Medical Treatment and Resolution
Treatment focuses on eliminating the infection and draining the pus collection. Broad-spectrum antibiotics are administered to target the polymicrobial nature of the infection, which includes common bacteria like Group A Strep and anaerobic bacteria. These medications may be given intravenously at first if the patient is severely ill or dehydrated.
The pus must be removed to resolve the condition, as antibiotics alone are often insufficient to penetrate the walled-off abscess. This is typically accomplished through needle aspiration or by incision and drainage. Successful drainage often leads to immediate and significant relief of symptoms. Following the procedure, a course of oral antibiotics is prescribed for 7 to 10 days. Follow-up monitoring is sometimes necessary to ensure complete resolution and to discuss the potential need for tonsillectomy if the abscess becomes recurrent.