Peritonsillar abscess (mechanism of disease)

This is a flowchart for peritonsillar abscess, covering the etiology, pathophysiology, and manifestations.

ADDITIONAL TAGS:
Often in a poly- microbial environment
Most accepted theory
Tonsillar crypts are normal physiology, provide sentry role for immune system by allowing early exposure to infectious organisms
Risk factors / SDOH
Cell / tissue damage
Structural factors
Peritonsillar abscess
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Neurology pathology
Genetic / hereditary
Flow physiology
Pathophysiology
Etiology
Manifestations
Infection develops in crypta magna
Infection spreads beyond the confines of the tonsillar capsule
Peritonsillitis
WBCs respond to inflammation → nearby tissue dies
Creates hole that fills with pathogen and/or pus to form abscess
Fever
Malaise
Severe sore throat
Dysphagia
Odynophagia
“Hot potato” voice (muffled speech)
Drooling
Halitosis
Also symptoms of tonsillitis
Inability to open jaw (trismus)
Tonic spasms of jaw musculature
More specific to PTA (to differentiate from tonsillitis)
Mass effect
Uvula shifted to the contralateral side
Inferior / medial displacement of tonsil
Unilateral fluctuant, swollen, erythematous tonsil with exudates
Ipsilateral bulging of the palatine arch
Ipsilateral ear pain
Ipsilateral cervical lymphadenopathy
Neck swelling
Airway compromise
Rupture
Infxn of para- pharyngeal space
Infxn of retro- pharyngeal space
Mediastinitis
Necrotizing fasciitis
Bacteremia
Sepsis
Aspiration pneumonia
Internal jugular vein thrombosis
Thrombophlebitis
Physical exam
Complications
Streptococcus pyogenes
Streptococcus anginosus
Viridans streptococci
Staphylococcus aureus
Haemophilus species
Acute bacterial tonsillitis
Infxn spreads to potential space between tonsils and pharyngeal muscles
CT with contrast: hypodense lesion in the nasopharynx
Adults aged 20-40