What is Neck Abscess?
Infections that occur deep within the neck can be challenging to diagnose and treat. This is due to the complex structure of the neck, which houses essential parts of our body like our airway, digestive system, and major blood vessels and nerves. Because these infections are deep within the neck, they can be difficult to feel or see from the outside. If not treated properly, the nearby structures can get inflamed leading to problems with nerves or blood vessels, bones, or airway. Therefore, it’s really important to understand the different types of neck abscesses (pockets of pus), how they appear, and the most effective ways to manage them.
What Causes Neck Abscess?
In the past, before antibiotics were invented, infections in the deep areas of the neck were often caused by tonsillitis and pharyngitis, which are inflammations of the tonsils and throat, respectively. These days, tonsillitis is still the most common cause of such infections in children, while in adults, these infections are usually caused by problems related to the teeth.
Other factors that can lead to deep neck space infections include dental procedures, infections or blockages in the saliva-producing glands, injuries to the mouth or throat, swallowing foreign objects, drug injection, and certain types of diseases such as cancer.
In some cases, it can be hard to pinpoint the exact cause of the infection, with no clear source found in 20% to 50% of cases.
People with weakened immune systems, such as those with HIV/AIDS, or patients undergoing chemotherapy or taking medicines to suppress their immune system, are also at higher risk of getting these infections.
Risk Factors and Frequency for Neck Abscess
Deep neck infections, which can involve several different conditions, are fairly common. It’s hard to say exactly how many of these infections occur in the United States or globally. However, it’s likely that fewer cases happen in the U.S. compared to countries lacking vaccinations or early treatment for simpler infections. According to a 2009 research, the U.S. sees more than 3,400 hospital admissions of children for these infections each year.
Among these conditions, the peritonsillar abscess mostly occurs in adults from 20 to 40 years old. It’s rare in kids but can occur in those with weaker immune systems. Both women and men are equally prone to this condition. Prolonged tonsillitis or repeated use of oral antibiotics may increase the chances of a peritonsillar abscess forming.
- Deep neck infections are relatively frequent and varied.
- The exact number of deep neck infections in the U.S or worldwide isn’t clear.
- There are probably fewer cases in the U.S compared to places without early treatment for simple infections.
- Each year, more than 3,400 hospital admissions of kids due to these infections are reported.
- Peritonsillar abscess usually affects adults between 20 and 40.
- Immune-compromised children can also suffer from peritonsillar abscess.
- Both genders are equally affected.
- Chronic tonsillitis or use of oral antibiotics could lead to peritonsillar abscess.
Parapharyngeal abscesses can occur at any age, they are most frequently seen in children and teenagers. Adults with weak immune systems are at a greater risk as well.
Signs and Symptoms of Neck Abscess
If you’re experiencing a severe throat pain, have recently had dental work, an upper respiratory infection, injury to your neck or mouth, trouble breathing, difficulty swallowing or speaking, or have a condition that weakens your immune system, you should consider the possibility of a deep neck space abscess. Other warning signs are a fast onset of symptoms and symptoms that last for a long time.
- Severe pain
- Recent dental procedures
- Upper respiratory infection
- Neck or mouth trauma
- Respiratory distress
- Difficulty swallowing or speaking (Dysphagia or Dysphonia)
- Weakened immune system (Immunosuppression)
- Rapid development of symptoms
- Prolonged duration of symptoms
More serious symptoms to look out for include a lump in the neck, swollen glands, difficulty opening your mouth, displacement of the side of your throat and tonsil, twisted neck, nerve issues, high temperature, and rapid breathing or shortness of breath.
Testing for Neck Abscess
In the event that a deep infection in the neck is suspected, a CT scan of the neck can be very useful to confirm the infection and pinpoint where it is located. However, sometimes it’s not possible to do a CT scan, especially if the patient is unstable or cannot lie flat on the CT scanner table. In such cases, a special type of neck x-ray, known as a portable lateral soft tissue neck x-ray, can be done. This test can indicate if a neck abscess or infection is present, but it doesn’t provide a lot of information about where it is located specifically.
If there is an early suspicion of a neck abscess, a type of doctor called an otolaryngologist might be brought in to do an examination procedure called a direct laryngoscopy. This procedure allows the doctors to look at the larynx or voice box to check for any swelling.
If the neck infection is thought to have come from an issue in the teeth, a panoramic view of the mouth and teeth might be necessary to discern this. This is basically a full picture of your teeth and jaws.
Additional blood tests will also be performed to help with the diagnosis. This could include electrolyte tests to understand the balance of minerals in the body, clotting profiles to assess how the blood is clotting, blood cultures to grow and identify any bacteria that might be present, and abscess cultures which is a procedure that involves taking a sample from the abscess to grow any potential bacteria in a lab.
Treatment Options for Neck Abscess
If you have an abscess, which is a collection of pus, doctors usually have to drain it in an operation. Along with this, they also give antibiotics to help fight the infection. Because they usually can’t tell which specific bacteria is causing your abscess right at the start, they begin with a broad-spectrum antibiotic that can fight a variety of bacteria. But don’t worry, they adjust your antibiotic later when the lab identifies the specific bacteria causing your infection.
In a study conducted in Iran in 2015, about half of the patients were given surgical treatment, while the rest were managed with medication alone. In rare cases, such as when an abscess is located near the windpipe (trachea), doctors might need to perform a tracheostomy, which is a surgical procedure to create a direct airway to the trachea. But this is uncommon and was only required in 5 of the 815 cases in the study.
If the abscess is not improving after 24 to 48 hours of medical treatment, or if it gets worse, doctors will typically recommend surgical treatment. Note that in all treatments, your doctor would always aim to address the root cause of the problem. For instance, if your abscess is due to a tooth infection, it’s crucial that the problematic tooth is dealt with early.
Lastly, it’s important to mention that, in cases of a deep neck infection, it is wise to notify experts in ear, nose and throat health (also known as otolaryngologists) and anesthesiologists for backup in case the airway becomes compromised. Your airway might become a concern anytime there’s swelling involved, as it can distort the normal anatomy of your throat, making it hard to breathe. In such serious scenarios, quick action to safely manage the airway, evaluate your condition, and administer the right treatment can save your life.
What else can Neck Abscess be?
When diagnosing neck abscesses, there are a number of other conditions that doctors need to rule out. These could include:
- Epiglottitis (inflammation of the tissue that covers the windpipe)
- Esophagitis (inflammation of the esophagus)
- Gastrointestinal foreign bodies (objects swallowed accidentally)
- Infectious mononucleosis (also known as mono or the “kissing disease”)
- Kawasaki disease (a rare children’s disease that impacts the blood vessels)
- Mediastinitis (inflammation in the area between the lungs)
- Meningitis (inflammation of the protective membranes covering the brain and spinal cord)
- Pharyngitis (inflammation of the back of the throat)
- Sinusitis imaging (inflammation of the tissue lining the sinuses)
- Tracheal foreign bodies (objects stuck in the windpipe).