Peritonsillar Abscess in Singapore

Peritonsillar abscesses develop when bacteria invade the peritonsillar space, typically following acute tonsillitis or pharyngitis. The common causative organisms include Group A Streptococcus, Staphylococcus aureus, and various anaerobic bacteria. The infection usually begins as tonsillitis, then progresses to cellulitis before forming an abscess. Weber glands, which are minor salivary glands located in the peritonsillar space, may become blocked during infection, contributing to abscess formation. Poor dental hygiene can also introduce bacteria that seed the peritonsillar space through direct spread.

• Recurrent tonsillitis or chronic tonsil infections
• Smoking, which impairs local immune defences
• Poor oral hygiene and untreated dental infections
• Immunosuppression from diabetes or medications
• Previous peritonsillar abscess
• Young adult age group
• Infectious mononucleosis (glandular fever)
• Recent upper respiratory tract infections
• Chronic sinusitis or post-nasal drip

• Intravenous Antibiotics: Intravenous antibiotics form the foundation of peritonsillar abscess treatment. Broad-spectrum coverage targeting both aerobic and anaerobic bacteria is typically used, such as combinations like amoxicillin-clavulanate or penicillin with metronidazole. Treatment duration may range from intravenous followed by oral antibiotics. Early-stage cellulitis without formed abscess may respond to antibiotics alone.
• Pain Management: Adequate analgesia is important for patient comfort and maintaining oral intake. Multi-modal approaches combining paracetamol, NSAIDs, and sometimes opioid medications can provide relief. Topical anaesthetic sprays or gargles offer additional localised pain relief. Adequate pain control may improve swallowing ability, helping prevent dehydration.
• Corticosteroid Therapy: Short courses of corticosteroids like dexamethasone can reduce inflammation and trismus, improving mouth opening and swallowing. Studies suggest steroids may decrease recovery time and reduce pain scores. Single doses or short courses are typically used. Steroids can be particularly helpful when significant trismus limits drainage procedures.
• Supportive Care: Intravenous fluid hydration corrects dehydration from poor oral intake. Antiseptic mouth rinses help maintain oral hygiene when normal brushing is difficult. Soft diet recommendations prevent trauma to inflamed tissues. Humidified air can soothe throat irritation during recovery.

• Needle Aspiration: Needle aspiration involves inserting a large-bore needle into the abscess to withdraw pus. This procedure can be performed in the clinic under local anaesthesia with symptom relief. This approach can be effective when combined with antibiotics, though some patients require repeat aspiration. The procedure takes only minutes and allows culture sampling.
• Incision and Drainage: Incision and drainage creates a larger opening for pus evacuation and is considered definitive treatment. The procedure involves making a small incision in the abscess wall after local anaesthesia infiltration. Pus drainage can provide symptom relief. The incision typically heals within days without suturing. This approach may have lower recurrence rates than needle aspiration alone.
• Quinsy Tonsillectomy: Immediate tonsillectomy during the acute infection removes both the abscess and infected tonsil. This approach aims to prevent recurrence and treat the abscess simultaneously. Reserved for patients with recurrent abscesses or those already planned for tonsillectomy. Recovery is longer than drainage alone but may eliminate future peritonsillar abscess risk on that side.
• Interval Tonsillectomy: Tonsillectomy performed weeks after abscess resolution aims to prevent recurrence. Recommended for patients with recurrent tonsillitis, previous peritonsillar abscess, or abscess complications. Surgery in the non-acute phase has lower bleeding risk and easier tissue dissection. Both tonsils are typically removed even with unilateral abscess.