Abscess of the back of the throat: Signs, symptoms and treatment

The article was professionally consulted by Specialist Doctor I Le Van Quang - Ear, Nose Throat Doctor - Department of General Surgery - Vinmec Nha Trang International General Hospital. BSCKI. Le Van Quang is an expert in the field of ENT with 15 years of experience.

An abscess in the back of the throat is an inflammation and pus-filled condition in the back of the throat. The disease can progress to a serious, life-threatening condition with a high mortality rate. If treated correctly, the disease will heal gradually, without causing dangerous complications for the patient.

A posterior pharyngeal wall abscess is an infected area between the posterior wall of the oropharynx and the anterior vertebral fascia. The disease is classified in the group of deep neck infections, which is a serious disease that cannot be cured on its own, and can threaten the patient's life. Although it is a rare emergency in otorhinolaryngology, the mortality rate is quite high, accounting for about 15% of all causes of death in children under 5 years of age in ear, nose and throat emergency. .
Regarding the mechanism of death, if not treated promptly, patients with posterior pharyngeal abscess will die due to severe toxic infection, the abscess spreads through the posterior visceral space into the mediastinum or ruptures pus into the mediastinum, airway compression. However, if handled correctly, the disease will progress well after 7 to 10 days after injecting the abscess.

Abscess of the posterior pharyngeal wall in children: Abscess is localized in Gillette's lymph nodes (in children under 2 years of age, then the lymph nodes gradually recede). The cause of the disease is due to complications from ear - nose - throat infections such as rhinosinusitis, VA, tonsillitis, ... untreated or because the toxicity of bacteria is too high. From the foci of infection, the inflammatory process invades the lymph nodes in the posterior pharynx, causing an abscess of the posterior pharynx; Abscesses of the posterior pharynx in adults: Caused by trauma to the pharynx, by foreign bodies deeply embedded in the back wall of the pharynx, or by specific bacteria such as tuberculosis.

Typical symptoms in children under 2 years of age with posterior pharyngeal abscess:
Initial symptoms: stuffy nose, yellow-green runny nose, sore throat, neck, difficulty swallowing, cough with phlegm; The following symptoms: Very high fever, about 39-40oC accompanied by chills, dry lips, dirty tongue, small rapid pulse, pale skin. Children show signs of not being able to suckle, stop sucking, cry a lot, have difficulty turning the neck; Symptoms when the abscess is too large, spreading deep into the lower throat - larynx: Shortness of breath, stridor, salivation in the mouth, bad breath. Adults with similar symptoms: stuffy nose, greenish-yellow runny nose, sore throat and neck pain, difficulty swallowing, cough with phlegm, high fever, dry lips, difficulty turning the neck, voice changes such as sucking on seeds, shortness of breath, wheezing, salivation in the mouth, bad breath,...

Based on clinical symptoms; Throat examination: Throat mucosa, red nose, many yellow-green secretions, bulging mass in the back wall of the throat (large or small depending on the stage of the disease); Blood tests: Including total blood cell analysis, erythrocyte sedimentation rate and blood chemistry, showing elevated polymorphonuclear leukocytes in the blood; Neck X-ray: Observe the bulge in the oropharynx, spreading to the lower throat; Computed tomography with contrast and magnetic resonance imaging: Helps accurately assess the location, size and severity of the abscess; Aspiration of the bulge: Take pus from the bulge to culture, make antibiotics for the treatment of the disease. The bacteria detected were mainly pneumococcus, streptococcus, staphylococcus, Hemophilus influenzae and anaerobes. In children, ultrasound is preferred because it does not involve radiation and can be performed conveniently. In the hands of an experienced physician, ultrasound can help determine the size and location of the abscess. Note: Need to differentiate the disease from the conditions of angioedema, eating or drinking corrosive food, cervical subdural abscess, esophagitis, epiglottitis, epidural abscess neck, mediastinitis, meningitis, oral infection, sinusitis, pharyngitis, peritonsillar abscess, fever in children, foreign body in the esophagus, pharynx or trachea,...

All patients with a confirmed diagnosis of retropharyngeal infection required hospitalization, intravenous antibiotics, and specialist otolaryngology consultation. Antibiotic therapy should be broad-spectrum of upper respiratory tract microorganisms, including anaerobes. Patients with airway compression should be operated on and drained immediately. In patients who do not present with severe respiratory failure or airway compromise, management usually begins with a trial of 24- to 48-hour intravenous antibiotic therapy. After 24 to 48 hours of antibiotic therapy, incision drainage or not should be re-evaluated by an otolaryngologist. There is no evidence that patients with an abscess larger than 3 cm2 benefit from surgical intervention 24 to 48 hours prior to antibiotic therapy. All patients must have their airways monitored carefully when treating an oropharyngeal abscess, especially during the first 24 to 48 hours.

Take good care of oral hygiene. Routine dental care. Abscess of the posterior pharynx is a dangerous, potentially life-threatening condition, so the diagnosis should be considered for all patients presenting with a sore throat, fever, neck pain, difficulty swallowing, swelling of the wall of the mouth and throat. back of the throat, ... until the exact pathology that the patient is experiencing in order to have a suitable treatment plan.
Vinmec International General Hospital examines and treats common nasopharyngitis diseases, head and neck tumors, congenital malformations of the ear, nose and throat area with the most optimal internal and surgical methods for patients, both children and adults. Coming to Vinmec International General Hospital, patients will receive a direct, dedicated and professional examination from a team of qualified and experienced medical staff.