Paratonzillar abscess (paratonzillitis)

The designation of the disease with the term "paratonlesillar abscess" is valid only for the final stage of the pathological process, accompanied by suppuration. The use of the previously used term "phlegmononasin angina" to describe the inflammatory process in paratonsillar tissue is essentially incorrect, since it refers to the purulent melting of the amygdala parenchyma with the formation of an intrathonylar abscess.

Paratonzillit (paratonsillar, peritonsillar abscess) is an inflammatory process in the tissues surrounding the palatine tonsil.

ICD-10 code

J36. Peritonsillar abscess.

Epidemiology of paratonzillitis

Paratonzillitis occupies one of the first places among purulent processes of the pharynx in terms of severity and occurs in people of any age, but more often paratonsillitis is sick at the age of 15 to 30 years; in a younger, older age, he is diagnosed less often. The disease equally often affects both men and women. Many authors note the seasonality of the disease: more often paratonsillitis is observed in late autumn and early spring. However, it happens in the summer, especially during a hot time; in most such cases local cooling (cold drinks, ice cream, etc.) is important.

Prevention of paratonzillitis

Individual prevention consists in strengthening the general resistance of the organism, increasing its resistance to infectious effects to unfavorable environmental conditions. Of great importance are the general and local hardening of the body, systematic training in physical culture and sports, air and water procedures, ultraviolet irradiation.

Timely sanation of the oral cavity and nose contributes to the elimination of foci of chronic infection. Carious teeth, chronic gingivitis, adenoids and similar conditions contribute to the development of pathogenic flora, which can become more active under adverse factors. In most cases, paratonsillitis is diagnosed as a complication of angina, so it is very important to assign a rational treatment to the patient and adhere to the prescribed regimen. The dosage and duration of antibiotic treatment should not be affected by rapid (within 2-3 days) normalization of body temperature and subjective improvement of the patient's well-being.

Public prevention is, to a large extent, a social problem, primarily related to improving the ecological situation, as well as working and living conditions; compliance with sanitary and hygienic requirements aimed at reducing microbial contamination of the environment.

Screening

Patients with complaints of sore throat, difficulty swallowing, difficulty in opening the mouth, submandibular lymphadenitis, increased body temperature should be sent to a consultation with the otorhinolaryngologist,

Classification of paratonzillitis

There are clinico-morphological forms of paratonzillitis: edematous, infiltrative and abscessing. Each of these forms can exist separately, or be only a stage, a phase, which then passes into another.

Depending on the place of formation and location, the paratonzillitis may be anterior (anterior), posterior, lower and lateral (external).

Causes of paratonzillitis

The disease occurs as a result of penetration into the paratonzillar space of a virulent infection in the presence of favorable conditions for spread and development. Streptococcus group A (Streptococcus pyogenes) is most often the causative agent, with the participation of non-pathogenic and opportunistic strains. Similarly, Staphylococcus aureus (Staphylococcus aureus), and, more rarely, Escherichia colli, Haemophilus Influenzae, Klebsiella, yeast fungi of the genus Candida , are often the causative agents of the infection . In recent years, an important role in the development of paratonsillitis of anaerobic infection has been shown, especially in the group of patients who had pathogens with anaerobic properties: Prévotella, Porphyro, Fusobacterium, Peptostreptococcus spp. - the most severe clinical course of the disease was noted.

Paratonsillar abscess (paratonzillitis) - Causes and pathogenesis

Symptoms of paratonsillar abscess (paratonzillitis)

In most cases, the process is one-sided; bilateral paratonsillitis, but according to different authors, it happens in 1-10% of cases. Tonsilogenous paratonzillitis usually develops a few days after the end of the sore throat or another exacerbation of chronic tonsillitis.

The disease begins with the appearance of a sharp, often one-sided pain in the throat when swallowing, which then becomes permanent and intensifies when you try to swallow saliva. It is possible to irradiate the pain in the ear, the teeth of the corresponding side.

The patient's condition is usually severe and continually worsens: there is a headache, weakness, weakness; The temperature of the tat increases to a febrile figure. There is a bad smell from the mouth. There arises a tonic spasm of the masticatory musculature expressed in varying degrees. The appearance of trismus, according to most authors, indicates the formation of a paratonsillar abscess.

Paratonsillar abscess (paratonzillitis) - Symptoms

Diagnosis of paratonsillar abscess (paratonzillitis)

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.

Paratonzillar abscess (paratonzillitis) - Diagnosis

Treatment of paratonsillar abscess (paratonzillitis)

The isolated pathogens show the greatest sensitivity to such drugs as amoxicillin in combination with clavulanic acid, ampicillin in combination with sulbactam, cephalosporin II-III generations (cefazolin, cefuroxm), lincosamides (clindamycin); effectively their combination with metronidazole, especially in cases where the participation of anaerobic flora

At the same time, detoxifying and anti-inflammatory therapy is prescribed antipyretic drugs and analgesics.

Taking into account the deficit of all links of the immune status revealed in patients with paratonzillitis, the use of drugs with immunomodulating effect (azoxime, sodium deoxyribonucleinate) is shown.

Paratonsillar abscess (paratonzillitis) - Treatment

[1], [2], [3], [4], [5], [6]