The sun is shining, the birds are chirping, and that sore throat you have had for the last couple of days is finally ending. Waking up this morning, however, you feel lethargic and have a sharp stabbing pain on one side of your throat. Thinking it’s just another flare-up of your sore throat, you call out to your roommate, but notice how strange the words sound when you talk. Altogether, these symptoms lead to one diagnosis: the PTA.
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While a PTA conjures up the image of a group of parents who organize bake sales, in the world of otolaryngology (ENT), PTA refers to a peritonsillar abscess. PTAs are one of the most common ENT emergencies with an average of 45,000 cases per year in the Unites States alone. Also referred to as quinsy, the PTA is usually a unilateral abscess or pus pocket that forms beside the tonsil in the peritonsillar space. Along with the aforementioned symptoms of unilateral throat pain, discomfort, and distortion of voice, particularly with vowels, other symptoms such as unilateral otalgia (ear pain), odynophagia (pain when swallowing), dysphagia (difficulty swallowing), halitosis (bad breath), and fever may also occur.
PTAs commonly occur after acute episodes of tonsillitis, which is inflammation of the tonsils most commonly caused by a bacterial or viral infection. Untreated or partially treated tonsillitis may result in the infection spreading to the peritonsillar area, which comprises of loose connective tissue. With the formation of an abscess, the primary concern for ENTs is the obstruction of the airway, leading to respiratory distress and even asphyxia. This concern leads to an emergency incision and drainage (I&D) of the abscess to alleviate pressure. Local anesthesia is administered, and an incision is made with a scalpel. A tonsil suction is used to drain the fluid and cautery may be done for hemostasis if necessary. Antibiotics such as clindamycin or metronidazole are given since PTA infections are becoming increasingly resistant to penicillin-based medication.
Once incision and drainage occurs, immediate relief can be felt as the obstruction is cleared. If this is the first PTA for a patient, most ENTs prefer to observe for recurrence before recommending any further measures. According to Dr. Tsuan Li, an otolaryngologist at Summit ENT, a history of recurring PTAs, chronic tonsillitis, and frequent strep throats are indications for a tonsillectomy, which is the surgical removal of tonsils. Barring a tonsillectomy, there is no tried and true method for preventing PTAs outside of normal oral hygiene.
And there you have it, a PSA on the PTA. Stay tuned for more clinical fun on ENT Weekly.
Feature Image Source: Justin Chin
