TEST YOUR MEDICAL I.Q.:
You have a sore throat and it’s oddly only on your left side. Your voice is muffled, you can barely talk. You have a fever, left ear pain, you can’t
swallow a thing, not even your own saliva.
In fact, you can barely open your mouth at all (which, depending on whom
you ask, might be a blessing in disguise).
What do you do?
a. Take a bunch of
lozenges, sip beer slowly through a straw until you’re thoroughly inebriated and
fall asleep.
b. Call your crazy
brother-in-law Charlie who’s really into all things medieval (especially with
his large and scary collection of knives and swords) and ask him for a good
old-fashioned blood-letting.
c. Seek medical
attention immediately. Go to your
doctor, and if she/he is unavailable, then go to an emergency room (E.R.).
d. Wait a day or two
more and then when it gets really bad to where you’re having problems
breathing, go to the E.R. at 2 A.M., since you know that the ENT doctor on-call
has nothing better to do than waste his/her time sleeping.
e. Choice “a” first
and if that fails, then choice “d.” Avoid
choice “b” since blood-letting might be denied through your insurance (and the
pre-authorization would take weeks) and Charlie might charge an enormous
co-pay.
f. Choice “b” first, but
if Charlie can’t stop the uncontrolled bleeding, resort to choice “a.” Once you wake up and you’re still bleeding
and everyone around is panicking, then you might want to consider choice “c.”
g. None of the above.
If you answered anything but choice “c”, you’ve got problems
or perchance partook in a few too many pre-test beers. Read on and re-take the test.
As the title of this post implies, you might have a peritonsillar abscess, and you ought to
see a medical professional immediately. This
can be a potentially life-threating problem particularly if it prevents you
from breathing, which is not a good thing according to the doctor books.
An abscess is a collection of pus—a “pus pocket” if you will—that
traps bacteria and inflammatory cells trying to kill those bacteria. It’s the body’s way of confining an
infection. However, when the abscess is
sizeable, and in this case next to a tonsil—hence peritonsillar—it causes
a bunch of problems such as:
-Rather intense
throat pain (what docs call odynophagia)
-Difficulty
swallowing (dysphagia) due to the
mass-effect of the abscess.
-Drooling, since saliva
can be difficult to choke down, so some people simply let it drool out of their
mouths.
-Difficulty
opening the mouth (trismus) due to inflammation of the soft tissue and muscles
around the abscess.
-Ear pain, which
is referred from the site of the
infection, since there are nerves that supply the throat that also sends a
branch to the ear.
-A “hot-potato”
voice, characterized by a muffled quality of voice that apparently sounds like
someone with a hot potato in their throat (and no, please don’t try this at
home).
-Neck pain, due to enlarged and inflamed lymph
nodes that drain that side of the throat.
-Fevers and
sometimes chills
-If it really
gets bad, then airway compromise—i.e., you’re having problems breathing—can occur.
Most people go to the E.R. when this occurs due to many or
all of the above symptoms, which is a the right thing to do for immediate
assessment and treatment. On exam, the
abscess causes a bulge around the tonsil, pushing the tonsil away along with the
uvula to the other side. This causes the pain and difficulty swallowing and the
trismus. The doctor will often start
antibiotics, sometimes a steroid to reduce the inflammation and fluids all
through an i.v. since many people become dehydrated. If there are questions about the diagnosis, a
CT (computed tomography) will be done.
The attached CT image shows the abscess via an axial view—think of a
slice through the neck and throat and viewing it from below.
So you have it, a short synopsis. For those who failed the test, go ahead and
do it over. If you fail it a second
time, immediately contact your Common Sense Therapist.
Randall S. Fong, M.D.
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