bilateral intratonsillar abscesses: a first case report in an adult patient

There have not been any cases of bilateral tonsillar involvement previously reported. The clinical presentation of intratonsillar abscess are similar to peritonsillar abscess. Negative aspiration of pus from a case of intratonsillar abscess presumed to be peritonsillar abscess can lead to misdiagnosis and subsequent delay in treatment.

Full Answer

What is Intratonsillar abscess?

Intratonsillar abscesses, or simply tonsillar abscesses, are uncommon complications of tonsillitis in which pus accumulates focally in the parenchyma of the tonsil (within the capsule).

What causes Intratonsillar abscess?

The exact etiology of intratonsillar abscess is obscure. Two major mechanisms postulated in previous studies are extension of a crypt abscess directly into the tonsillar tissue & bacterial seeding into the tonsil through lymphatic or blood borne spread [4].

What is bilateral Quinsy?

Peritonsillar abscess, or quinsy, is a rare complication of acute tonsillitis. It usually presents with odynophagia, trismus, and muffled voice, reflecting the space-occupying lesion in the oral cavity.

Can peritonsillar abscess be bilateral?

Peritonsillar abscess typically occurs in adolescents and young adults. It is one of the most common complications of acute tonsillitis; there are about 45 000 instances annually in the United States and Puerto Rico. It is usually unilateral, and clinically evident bilateral presentation is uncommon.

Can adults get Quinsy?

Quinsy can occur at any age, but most commonly affects teenagers and young adults. It's possible to get it more than once.

Is a peritonsillar abscess serious?

Swollen tissues can block the airway. This is a life-threatening medical emergency. The abscess can break open (rupture) into the throat. The content of the abscess can travel into the lungs and cause pneumonia.

Is a quinsy life threatening?

Dangers of quinsy If left untreated it will worsen over time to the extent that it could become life threatening. The worst case scenario is that the infected abscess on the tonsil bursts which causes pus to be inhaled. If this reaches the lungs then it can cause a condition called 'aspiration'.

What is the difference between tonsillitis and quinsy?

The key signs that differentiate quinsy from tonsillitis are: There is frequently a degree of trismus. On the affected side, the anterior arch will be pushed medially. On the affected side, the palate will bulge towards you ie the normally concave palate becomes convex.

What causes bilateral tonsillitis?

Viruses are the most common cause of tonsillitis. The viruses that cause the common cold are often the source of tonsillitis, but other viruses can also cause it, including: rhinovirus. Epstein-Barr virus.

What can cause an abscess in the throat?

Peritonsillar abscesses are usually caused by a bacterial infection. The bacteria are usually either Streptococci (strep throat, most common) or Staphylococci. Peritonsillar abscess is most commonly seen to occur as a complication of tonsillitis (untreated or chronic).

Can antibiotics cure peritonsillar abscess?

Peritonsillar cellulitis may respond to oral antibiotics. Antibiotics, either orally or intravenously, are required to treat peritonsillar abscess (PTA) medically, although most PTAs are refractory to antibiotic therapy alone.

Is peritonsillar abscess contagious?

Yes. The germs that cause viral and bacterial peritonsillar abscess are contagious. To prevent the spread of a bacterial or viral infection to others: Stay at home when you are ill.

What are the symptoms of intratonsillar abscess?

Intratonsillar abscess is rare. Clinical symptoms may include one or combination of sore throat, dysphagia, odynophagia and referred otalgia. Examination may reveal trismus, asymmetrical tonsil, uvular deviation, cervical lymphadenopathy and voice changes. Although external neck swelling has been reported it is a less common clinical sign. CT is often utilised to aid in diagnosis and localisation of the abscess. In particular it will help to rule out a parapharyngeal asbcess as the cause. To achieve a more rapid recovery patients should be managed procedurally. We advocate for incision and drainage followed by intravenous antibiotics targeting the expected organisms.

Is intratonsillar abscess rare?

Intratonsillar abscess is rare. Although the distinction between tonsilitis, intratonsillar abscess and peritonsillar abscess is difficult there are symptoms and signs that may help the clinician make the differentiation. Imaging is often utilised to localise the abscess. To achieve a more rapid recovery procedural management seems to be necessary.

Is tonsillitis a bacterial infection?

Tonsillitis is a common infection occurring in children and adolescents, but also in adults. Peritonsillar abscess is a well-recognised complication of acute bacterial tonsillitis, whereas intratonsillar abscess is a rarely reported and known clinical entity. The current literature does not provide any new insights on the pathogenesis of intratonsillar abscess and 2 prevailing mechanisms first postulated by Childs et al. [ 1] are still quoted in the published literature. The first is contiguous involvement of the tonsillar parenchyma in suppuratives inflammation of the tonsillar crypts. Subsequent occlusion of the crypt leads to a contained intratonsillar abscess. The second postulated mechanism is haematogenous or lymphatic spread. Blair et al. [ 2] examined intratonsillar abscess in 2 cases and found there was erosion of overlying stratified squamous epithelium with sheets of polymorphonuclear cells within the tonsillar crypts. They found deep parenchymal abscess separate to the epithelial changes. They infer that the reason intratonsillar abscess are so rare, is that the normal rapid transit of lymphatic flow within the tonsil of about 30 minutes prevents accumulation of bacteria within the tonsil and hence intratonsillar abscess formation. Alteration in this normal lymphatic transit is therefore thought to cause intratonsillar abscess.

What is an intratonsillar abscess?

Intratonsillar abscesses, or simply tonsillar abscesses, are uncommon complications of tonsillitis in which pus accumulates focally in the parenchyma of the tonsil (within the capsule).

Where does tonsillar abscess occur?

Intratonsillar abscesses, or simply tonsillar abscesses, are uncommon complications of tonsillitis in which pus accumulates focally in the parenchyma of the tonsil (within the capsule).