Paratonsillar abscess (paratonsillitis): diagnosis

Physical examination

Mesopharyngoscopy in a patient with paratonsillitis is often very difficult, because because of severe trism the patient opens his mouth not pain than 1-3 cm. The picture observed here depends on the location of the paratonzillite.

In the anteroposterior or anterior paratonsillitis, a sharp swelling of the upper pole of the tonsil along with the palatine arch and soft palate toward the midline is noted.

When an abscess is formed, usually by the 3rd-5th day, a fluctuation is indicated at the site of the greatest protrusion and spontaneous dissection of the abscess often occurs, often through the anterior arch or supramundary fossa. Posterior tons of tonsillitis is located in the cellulose between the posterior palatine arch and amygdala: the inflammatory process can spread to the posterior arch and the tissue of the pharyngeal lateral cushion. It is possible to spread collateral edema to the upper larynx, which can lead to its stenosis scarring. Lower paratonsillitis is characterized by less pronounced pharyngoscopic signs of edema and infiltration of the lower part of the anterior palatine arch. Attention is drawn to the sharp soreness when pressing on a portion of the tongue close to the infiltrated arch. When viewed with a glottal mirror, the swelling of the lower pole of the amygdala is determined; often hyperemia and infiltration extend to the lateral surface of the root of the tongue, a collateral edema of the lingual surface of the epiglottis is possible.

External, or lateral, paratonzillitis is observed less often than other forms, one to it is among the heaviest in the prognostic ratio. The process develops in the cellulose that fills the tonsillar niche outside of the amygdala, so the conditions for spontaneous dissection with a breakthrough of the pus cavity of the pharynx are the least favorable.

Inflammatory changes on the side of the pharynx appear to a lesser extent, there is only a slight bulging of the amygdala in the medial side. The pain in the throat during swallowing is usually inconspicuous, but the triasm of the masticatory muscle develops earlier than with other localizations of the paratonsillitis. And can be pronounced. At the same time, puffiness and infiltration of the soft tissues of the neck develop on the side of the lesion, expressed cervical lymphadenitis, torticollis.

Laboratory research

In the blood there is leukocytosis (10-15x10 ⁹ / l), a blood formula with a shift to the left; significantly increased ESR. It is necessary to carry out a microbiological study of pathological flora and sensitivity to antibiotics.

Instrumental research

Ultrasound, CT.

Differential diagnostics

One-sided swelling in the pharynx, with bright hyperemia and mucosal edema, similar to paratonzillitis, can be observed in diphtheria and scarlet fever, with which differential diagnosis is carried out. Diphtheria, as a rule, has throats in the pharynx and there is no trisus, and the smear is determined by Corynobacterium diphtheriae . For scarlet fever are characterized by a rash and certain epidemiological data. Sometimes it is necessary to differentiate the paratonzillitis and erysipelatous inflammation of the pharynx, at which characteristic diffuse hyperemia and swelling of the mucous membrane can be observed, which appears to be shiny, strained. However, for erysipelatous inflammation, the course without trism is characteristic and the absence of a characteristic forced position of the head; sore throat is usually less intense; Often, at the same time with a woman's mouth, a face mug is swallowed.

To a certain extent, tumor diseases-cancer, sarcoma, pharyngeal lymphoepithelioma, glomus tumor, etc., are similar to paratonsillitis. The slow flow, absence of a temperature reaction and severe pain in the throat, as well as severe soreness in the palpation of regional lymph nodes allow the pharyngeal tumors to be differentiated to paratonzillitis. In rare cases, swelling in the pharynx may be associated with a near-surface location of the carotid artery or aneurysm. The presence of pulsation, determined visually and with palpation, allows you to put the right diagnosis.

Indications for consultation of other specialists

• Surgeon - with suspicion of phlegmon, mediastinitis; for differential diagnosis and surgical treatment.
• Infectionist - in carrying out differential diagnosis with diphtheria, scarlet fever, erysipelas,
• The oncologist - at suspicion on a malignant neoplasm of pharynx.
• The endocrinologist - at a combination of a paratonzillita with a diabetes and other infringements of a metabolism.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]