Did you know that George Washington, the father of our country, probably died from a peritonsillar abscess? They think that a splinter off of his wooden denture stuck between the tonsil and side of the throat, abscessed, and spread. After all the wartime he saw during our nation’s fight for independence, it is pretty interesting to think that he was taken down by a piece of wood smaller than a tooth pick!
A peritonsillar abscess (PTA) is a trapped pocket of purulence between the tonsil and the side of the throat. They usually appear in younger people who have never really had any tonsil problems in the past. Once the infection starts, the throat hurts terribly. Since over 90% of the abscesses are unilateral, the pain and swelling are just on one side. The pain radiates to the ear on the side of the infection. If the abscess gets large enough, the muscles that open your mouth could go into spasm, causing it to be difficult to open your mouth. Your doctor refers to this as trismus.
The microorganisms most frequently involved in a PTA are anaerobes, which are bacteria that don’t like air and are killed predictably by Penicillin. Abscesses have been known to travel down the neck and even invade the mediastinum, the space between the lungs near the heart.
If you do get a peritonsillar abscess, there are a couple of treatment options. One of these options is to prescribe oral steroids and antibiotics. This will sometimes successfully manage a relatively small abscess. It rarely fixes a large abscess, however. Small to medium-sized abscesses can be aspirated with a needle, followed by the medicines suggested for treatment above. Medium to very large abscesses can be incised and drained, using a scalpel and curved hemostats, the latter to break up loculations within the abscess cavity itself. Lastly, removing the tonsil will provide a definitive cure, and will assure that this problem never occurs again. If you don’t have a tonsil, you can’t get anything trapped between your tonsil and the side of the throat.