Vo
lu
m
e
5,
Ju
ne
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
MODERN APPROACHES TO THE TREATMENT AND PREVENTION OF
COMPLICATIONS OF PERITONSILLAR ABSCESS
Tokhirjon Abdunazarov
Assistant, Department of Surgical Diseases, Central Asian Medical University, Fergana,
Uzbekistan
Kamoldinov Bobur
Assistant, Department of Surgical Diseases, Central Asian Medical University, Fergana,
Uzbekistan
Otaqulov Otabek
Assistant, Department of Surgical Diseases, Central Asian Medical University, Fergana,
Uzbekistan
Abstract:
Peritonsillar abscess (PTA) is a purulent inflammatory process in the peritonsillar
space, commonly occurring as a complication of acute bacterial tonsillitis or chronic
tonsillar decompensation. It remains one of the most frequent ENT emergencies. This article
presents a detailed review of the etiopathogenesis, clinical presentation, modern diagnostic
methods, treatment algorithms, and strategies for preventing complications associated with
PTA. The importance of early diagnosis and timely surgical drainage combined with rational
antibiotic therapy is emphasized. Immunological status, recurrence risk, and indications for
tonsillectomy are also discussed. Preventive approaches such as public awareness, infection
control, and vaccination are proposed as key tools in reducing the burden of PTA.
Keywords:
Peritonsillar abscess; Complications; Antibiotic therapy; Surgical treatment;
Immunity; Diagnosis; Preventive measures; Purulent infection; Otorhinolaryngology;
Tonsillectomy
Introduction
Peritonsillar abscess (PTA) is a serious, potentially life-threatening ENT condition
characterized by the accumulation of pus in the peritonsillar space. It is most commonly a
complication of untreated acute tonsillitis. Epidemiological data indicate an incidence of 30–
45 cases per 1,000,000 population per year in Western countries, with a higher prevalence
among males aged 20 to 40.
Etiology and Pathogenesis
Microbiological Factors:
- Streptococcus pyogenes (GABHS) – 60–75%
- Mixed infections: Staphylococcus aureus, Haemophilus influenzae, anaerobes
(Fusobacterium necrophorum, Prevotella spp.)
Pathogenesis:
The development typically follows cryptic tonsillitis leading to blockage and deep-seated
infection of the tonsillar crypts. Immune dysfunction, including reduced local
Vo
lu
m
e
5,
Ju
ne
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
immunoglobulin A and G production, contributes to disease progression. Predisposing
factors include smoking, diabetes mellitus, and immunosuppressive therapy.
Clinical Presentation
Symptoms:
- Severe unilateral throat pain (90–100%)
- Trismus (limited mouth opening) (80–90%)
- Fever (≥ 38.5°C) (85%)
- “Hot potato” voice (60–70%)
- Uvula deviation (60–75%)
- Cervical lymphadenopathy (50–65%)
Physical Findings:
- Unilateral swelling and erythema of the soft palate
- Uvula pushed toward the unaffected side
- Bulging of the peritonsillar area
- Palpable fluctuation in advanced stages
Diagnostics
Laboratory Tests:
- CBC: Leukocytosis (12–18×10⁹/L), Neutrophilia, ESR > 40 mm/h
- C-reactive protein > 50 mg/L
- ASO titer may support GABHS diagnosis
Imaging:
- Needle aspiration is the gold standard for diagnosis
- CT scan or MRI of the neck in suspected deep space involvement
- Ultrasound for evaluating adjacent deep neck spaces
Complications
- Parapharyngeal abscess: carotid artery erosion, septic thrombophlebitis
- Retropharyngeal abscess: airway compromise
- Mediastinitis: high mortality (25–40%)
- Sepsis: multi-organ failure
- Recurrent PTA: indication for tonsillectomy if >2 episodes per year
Treatment Algorithm
I. Antibiotic Therapy:
- Amoxicillin-clavulanate: 1.2 g IV twice daily
- Ceftriaxone: 1–2 g IV once daily
- Clindamycin: 600 mg IV every 8 hours
- Metronidazole: 500 mg IV every 8 hours
II. Surgical Intervention:
Vo
lu
m
e
5,
Ju
ne
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
- Needle aspiration, I&D, or tonsillectomy
III. Supportive Therapy:
- IV fluids, NSAIDs, antipyretics, immunomodulators, oral rinses
Prevention Strategies
1. Treatment of chronic tonsillitis
2. Antibiotic stewardship
3. Oral hygiene and dental care
4. Boosting immunity (vitamins, lifestyle)
5. Regular ENT checkups
6. Prophylactic measures during flu season
Conclusion
Peritonsillar abscess is a potentially serious ENT emergency requiring rapid recognition and
appropriate intervention. Early diagnosis, prompt drainage, and targeted antibiotic therapy
form the cornerstone of effective management. In recurrent cases, tonsillectomy
significantly reduces relapse risk. Public health awareness and preventive strategies are
crucial to decreasing the incidence and complications of PTA.
References
1. Brook I. "Microbiology and management of peritonsillar, retropharyngeal, and
parapharyngeal
abscesses."
J
Oral
Maxillofac
Surg,
2004.
2. Klug TE et al. “Management of peritonsillar abscess: a systematic review.” Eur Arch
Otorhinolaryngol,
2020.
3. Dhingra PL, Dhingra S. Diseases of Ear, Nose and Throat, 7th ed. Elsevier, 2021.
4. Vlasov A.N., Sinyakova L.A. "Purulent diseases of the pharynx", Moscow, 2020.
5. UpToDate. "Peritonsillar abscess: Clinical features, diagnosis, and management", 2024.
