Purulent inflammatory process in the oral cavity today is often diagnosed in medicine. One of these pathologies, which is characterized by a severe course, is the paratonsillar abscess of the tonsils. This disease is also called phlegmonous tonsillitis, it occurs in people of different sexes, most often between the ages of fifteen and thirty years. The risk group includes people who have a compromised immune system, metabolism, as well as those who have a long history of smoking. The appearance of purulent inflammation is caused by infection in the tonsils from the follicles that have festered, damage to the pharynx, inflammation of the gums and other dental diseases.
Problem Description
Paratonsillar abscess is an inflammation of the tissue of the tonsils of a purulent nature, the last stage of paratonsillitis, which is one of the most severe forms of pharyngeal damage. In 80% of cases, the cause of the development of the disease is chronic tonsillitis. The disease most often develops in autumn or spring. In the absence of treatment, it provokes the development of complications such as phlegmon of the neck, mediastinitis, sepsis.
The causative agents of the disease are streptococci, pneumococci or Candida fungi. When tonsils are affected, their depressions are filled with pus, usually the focus of inflammation is one-sided. After regular acute inflammation, the tissue of the tonsils is covered with scars, which contribute to the disruption of the outflow of purulent discharge from large recesses, so it is not completely cleaned. As a result, the infection spreads to the paratonsillar space, and a paratonsillar abscess of the throat develops. With a violation of the immune system, the infection penetrates deep into the tissue.
An abscess has the appearance of a round formation of red color, through the surface of which yellow contents are visible. On palpation, some part of the formation will be soft due to the content of pus in it. The pharynx is shifted in the opposite direction to the abscess.
Forms of the disease
In medicine, the following forms of pathology are distinguished:
- Anterior (anteroposterior) abscess, in which tissue damage occurs over the tonsils. Usually abscesses open independently. This form of the disease is most common.
- The posterior abscess is characterized by tissue damage between the posterior arch and the edges of the tonsils. Pathology is the second most common. In this case, there is a risk of inflammation moving to the larynx, which can cause breathing difficulties.
- The lower abscess is caused by the development of purulent inflammation at the lower pole of the tonsil. Pathology in most cases develops due to diseases of the gums and teeth.
- A lateral abscess forms between the pharyngeal wall and the lateral edge of the tonsil. This pathology is considered the most severe and occurs in 5% of patients. In this case, there is a risk of an abscess bursting in the neck tissue.
Causes of the disease
Paratonsillar abscess is provoked by the ingress of pathogenic microorganisms into the tissue of the tonsils. Usually, the disease acts as a secondary pathology, forming as a complication of chronic tonsillitis.
Common causes of the development of the disease include:
- infection of the pharynx with pathogenic bacteria as a result of the development of pharyngitis, tonsillitis or tonsillitis;
- dental diseases such as gingivitis, caries, gum disease;
- infection in the throat through the middle ear;
- the development of purulent inflammation in the salivary glands;
- damage to the oral cavity and neck, followed by infection of the wound.
These phenomena are possible only with a violation of human immunity.
Risk group
The risk group includes people who have the following pathologies:
- diabetes;
- anemia;
- oncological disease;
- HIV infection;
- obesity;
- congenital malformations of the tonsils and pharynx;
- nicotine abuse;
- hypothermia.
Symptoms of the disease
A paratonsillar abscess exhibits symptoms in the form of a strong unilateral pain syndrome that occurs when swallowing. In some cases, the pain can be bilateral. Over time, pain begins to spread in the ear and lower jaw. Along with this, a strong increase in body temperature occurs, weakness, headache develops, sleep is disturbed. Lymph nodes located on the neck increase, an unpleasant odor from the oral cavity appears. The progression of the disease leads to the development of spasm of the masticatory muscles, the person’s speech changes, the pain intensifies when the head is rotated.
Unlike sore throat, pain with this pathology is more acute, it is present even in a calm state. It tends to intensify when making any movements, gives in the ear and teeth.
Often on the sixth day, a paratonsillar abscess, the photo of which confirms the seriousness of the disease, leads to the purulent cavity opening. This phenomenon is accompanied by a relief of the human condition, a decrease in body temperature, the appearance of an impurity of pus in the saliva. In some cases, an abscess breakthrough is observed on the eighteenth day. If pus enters the periopharyngeal space, an abscess is not opened, so the person’s condition only worsens.
Paratonsillar throat abscess symptoms are as follows:
- severe sore throat;
- masticatory muscle spasm;
- violation of swallowing;
- enlargement of the cervical lymph nodes;
- a strong increase in body temperature;
- shortness of breath, shortness of breath;
- bad breath from the oral cavity;
- development of emotional stress;
- self-opening of the abscess.
Stages of the development of pathology
Paratonsillar throat abscess (photo of symptoms attached) has three stages of development:
- The first is an edematous stage, which is characterized by swelling of the tissues of the tonsils, there are no signs of inflammation and other symptoms of pathology. At this stage, the disease is rarely diagnosed.
- The second is the infiltration stage, which is caused by the appearance of hyperemia, the development of pain, and an increase in body temperature.
- The third is the abscessed stage, which develops on the fifth or sixth day of the disease. It is characterized by deformation of the pharynx and protrusion of a purulent formation of a large size.
Complications and consequences
A paratonsillar throat abscess, the symptoms and treatment of which will be discussed in detail in the article, usually ends with recovery with timely effective therapy. Otherwise, purulent inflammation spreads to the pharynx, which can cause damage to its walls during surgical intervention to open the abscess. Also, an autopsy of a paratonsillar abscess is sometimes observed, in which pus enters healthy tissues, which are located nearby.
These phenomena can provoke a number of complications:
- phlegmon of the neck and pharyngeal tissues;
- the development of sepsis;
- laryngeal stenosis leading to suffocation;
- purulent damage to the heart, aorta and veins;
- thrombophlebitis, brain abscess;
- meningitis, encephalitis;
- Ludwig's sore throat;
- tissue necrosis;
- jugular vein thrombosis;
- development of toxic shock;
- the appearance of bleeding from large vessels of the neck.
Some complications can be fatal, and therefore require immediate treatment.
Survey methods
It is not difficult to diagnose a paratonsillar throat abscess due to the presence of vivid symptoms of pathology. Diagnostic examination includes the following points:
- The study of the anamnesis and complaints of the patient. This pathology develops, mainly on the fifth day after acute sore throat. The otolaryngologist also draws attention to the presence of foci of infection in the oral cavity and possible damage.
- Examination of the patient, during which there is a restriction of head mobility, swollen lymph nodes, fever and bad breath.
- Pharyngoscopy is always used, as it is the most informative diagnostic method in this case. This technique makes it possible to identify the development of a spherical formation, which is covered with edematous mucosa. Inside this formation, purulent contents can be considered. Also, deformation of the pharynx, displacement of the tonsils.
- Laboratory blood tests.
- Bacteriological culture in order to identify the causative agent of the infection, as well as its sensitivity to antibiotics.
- Instrumental diagnostics: ultrasound and CT of the neck, radiography of the head. These methods are used to determine the spread of the abnormal process in healthy tissues and organs.
The doctor differentiates the pathology with diseases such as diphtheria, scarlet fever, cancerous tumors, carotid artery aneurysm, mediastinal abscess.
Disease therapy
A paratonsillar abscess treatment involves one that is aimed at eliminating the focus and pathogen, stopping inflammation, and reducing the risk of complications. Treatment of the disease is carried out in a hospital. To do this, apply surgical, medical and complex therapy.
Drug treatment is carried out at an early stage of the development of the disease. In this case, the following groups of drugs are prescribed:
- Broad-spectrum antibiotics. An effective drug in this case is Amoxicillin. Tetracycline antibiotics do not give a positive result.
- Macrolides are used when antibacterial drugs have not given the desired result. In this case, third-generation cephalosporins are prescribed.
The doctor, along with the above funds, prescribes painkillers, anti-inflammatory and antipyretic drugs, vitamins, immunomodulators. It is also recommended to gargle with antiseptic solutions.
Surgical intervention
In the second stage of the pathology, a paratonsillar abscess, the symptoms and treatment of which are now being considered, involves the use of surgical intervention. The doctor performs an autopsy of the abscess using an incision. But such a procedure does not always lead to the recovery of the patient, since in some cases the hole is glued with fibrin, so there is a need to expand the wound. In this case, drainage under local anesthesia is performed for five days.
In severe cases, an abscessotonsillectomy is performed, in which the abscess is emptied along with the removal of the affected tonsil. This makes it possible to completely eliminate the focus of infection. After this, the areas are cleaned with disinfecting solutions for several days. Also, the doctor prescribes an antibacterial drug. Perhaps the use of physiotherapy for the rapid healing of wounds.
Rehabilitation
During the rehabilitation period, the patient is prescribed drug therapy, which includes the following groups of drugs:
- Antibacterial agents in the form of intramuscular injections, such as Ceftriaxone or Penicillin. The choice of drug will depend on the causative agent of the infection.
- Introduction of "Hemodez" to detoxify the body.
- Gargling with antiseptic solutions.
- Prevention of candidiasis with antibiotics.
- Antihistamines.
- NSAIDs to eliminate pain and inflammation.
Typically, all drugs are prescribed as an injection due to the patient's acute sore throat. Recovery occurs in three weeks. With the development of complications, the prognosis worsens, a fatal outcome is possible.
Forecast
The prognosis of the disease is favorable subject to timely and effective treatment. In severe cases, sepsis can occur, which will lead to death. Due to the high risk of developing negative consequences, pathology therapy is carried out in a hospital.
Prevention
In order to prevent, first of all, it is necessary to restore the immune system. It is also recommended that timely treatment of diseases of the nose and throat, monitor oral hygiene, regularly visit the dentist, get rid of addictions. To strengthen immunity, physical activity, hardening, proper nutrition, and maintaining a healthy lifestyle are well suited.
Paratonsillar abscess is a serious disease that can be dangerous to human health and even life. Therefore, at the first manifestations of the pathology, it is immediately necessary to consult a doctor for diagnosis and treatment. If untreated, severe complications can develop that can often be fatal.