Paratonsillar abscess (paratonsillitis)

The designation of the disease by the term "peritonsillar abscess" is legitimate only for the final stage of the pathological process, accompanied by suppuration. The use of the previously used term "phlegmonous angina" to designate the inflammatory process in the paratonsillar tissue is essentially incorrect, since it designates purulent melting of the parenchyma of the tonsil with the formation of an intratonsillar abscess.

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

ICD-10 code

J36. Peritonsillar abscess.

Epidemiology of paratonsillitis

Paratonsillitis is one of the most severe purulent processes of the pharynx and occurs in people of any age, but most often paratonsillitis affects people aged 15 to 30 years; at a younger and older age, it is diagnosed less often. The disease equally often affects both men and women. Many authors note the seasonality of the disease: paratonsillitis is most often observed in late autumn and early spring. However, it also occurs in the summer, especially in hot weather; in most such cases, local cooling (cold drinks, ice cream, etc.) is important.

Prevention of paratonsillitis

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

Timely sanitation of the oral cavity and nose helps eliminate foci of chronic infection. Carious teeth, chronic gingivitis, adenoids and similar conditions contribute to the development of pathogenic flora, which can become active under unfavorable factors. In most cases, paratonsillitis is detected as a complication of tonsillitis, so it is of great importance to prescribe rational treatment to the patient and adherence to the prescribed regimen. The dosage and duration of the course of antibacterial treatment should not be affected by rapid (within 2-3 days) normalization of body temperature and subjective improvement in the patient's well-being.

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

Screening

Patients with complaints of sore throat, difficulty swallowing, difficulty opening the mouth, submandibular lymphadenitis, increased body temperature should be referred for consultation to an otolaryngologist,

Classification of paratonsillitis

There are clinical and morphological forms of paratonsillitis: 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, paratonsillitis can be anterior-upper (front), posterior, lower and lateral (external).

Causes of paratonsillitis

The disease occurs as a result of penetration of a virulent infection into the paratonsillar space in the presence of favorable conditions for spread and development. The causative agent is most often group A streptococci (Streptococcus pyogenes), while non-pathogenic and opportunistic strains may participate. Staphylococcus aureus is approximately as common a causative agent of infection, and somewhat less often Escherichia colli, Haemophilus Influenzae, Klebsiella, and yeast fungi of the genus Candida. In recent years, an important role of anaerobic infection in the development of paratonsillitis has been shown, and it was in the group of patients in whom pathogens with anaerobic properties were isolated: Prеvotella, Porphyro, Fusobacterium, Peptostreptococcus spp. - that the most severe clinical course of the disease was noted.

Peritonsillar abscess (paratonsillitis) - Causes and pathogenesis

Symptoms of peritonsillar abscess (paratonsillitis)

In most cases the process is unilateral; bilateral paratonsillitis, but according to various authors, occurs in 1-10% of cases. Tonsillogenic paratonsillitis usually develops several days after the end of tonsillitis 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 later becomes constant and intensifies when trying to swallow saliva. Irradiation of pain to the ear, teeth of the corresponding side is possible.

The patient's condition is usually severe and continuously worsens: headache, fatigue, weakness appear; the temperature rises to febrile numbers. Bad breath is noted. Trismus, a tonic spasm of the masticatory muscles, occurs to varying degrees. The appearance of trismus, according to most authors, indicates the formation of a peritonsillar abscess.

Peritonsillar abscess (paratonzillitis) - Symptoms

Diagnosis of peritonsillar abscess (paratonsillitis)

When an abscess is forming, usually by the 3rd to 5th day, a fluctuation is observed at the site of the greatest protrusion, and spontaneous opening of the abscess often occurs, most often through the anterior arch or supratindalar fossa. Posterior paratonsillitis is localized in the tissue between the posterior palatine arch and the tonsil: the inflammatory process can spread to the posterior arch and tissues of the lateral pharyngeal ridge. Collateral edema may spread to the upper part of the larynx, which can lead to its stenosis and scarring. Lower paratonsillitis is characterized by less pronounced pharyngoscopic signs: edema and infiltration of the lower part of the anterior palatine arch. Sharp pain when pressing on the area of the tongue close to the infiltrated arch attracts attention. When examining with a laryngeal mirror, swelling of the lower pole of the tonsil is determined; Often hyperemia and infiltration spread to the lateral surface of the root of the tongue; collateral edema of the lingual surface of the epiglottis is possible.

Peritonsillar abscess (paratonsillitis) - Diagnostics

Treatment of peritonsillar abscess (paratonsillitis)

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

At the same time, detoxification and anti-inflammatory therapy are carried out; antipyretics and analgesics are prescribed.

Taking into account the deficiency of all links of the immune status identified in patients with paratonsillitis, the use of drugs with an immunomodulatory effect (azoximer, sodium deoxyribonucleate) is indicated.

Peritonsillar abscess (paratonsillitis) - Treatment

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