Retropharyngeal Abscess: What You Need to Know

Medically reviewed by Beth Holloway, RN, MEd on January 3, 2016Written by Marjorie Hecht

Is this common?

A retropharyngeal abscess is a serious infection deep in the neck, generally located in the area behind the throat. In children, it usually starts in the lymph nodes in the throat.

A retropharyngeal abscess is rare. It typically occurs in children under age eight, though it can also affect older children and adults.

This infection may come on quickly, and can lead to serious complications. In severe instances, a retropharyngeal abscess can lead to death.

What are the symptoms?

This is an unusual infection that can be difficult to diagnose.

The symptoms of retropharyngeal abscess include:

  • difficulty or noisy breathing
  • difficulty swallowing
  • pain when swallowing
  • drooling
  • fever
  • cough
  • severe throat pain
  • neck stiffness or swelling
  • muscle spasms in the neck

If you experience any of these symptoms, or observe them in your child, consult with your doctor. Seek immediate medical attention if you’re having difficulty breathing or swallowing.

What causes a retropharyngeal abscess?

In children, upper respiratory infections usually occur before the onset of a retropharyngeal abscess. For example, your child may first experience a middle ear or sinus infection.

In older children and adults, a retropharyngeal abscess typically occurs after some type of trauma to the area. This may include an injury, medical procedure, or dental work.

Different bacteria may cause your retropharyngeal abscess. It’s common for more than one type of bacteria to be present.

In children, the most common bacteria in the infection are Streptococcus, Staphylococcus, and some other respiratory bacterial species. Other infections, like, HIV and tuberculosis may also cause the retropharyngeal abscess.

Some researchers have linked the rise in cases of retropharyngeal abscess to the recent increase in MRSA, the antibiotic-resistant staph infection.

Who’s at risk?

Retropharyngeal abscess occurs most commonly in children between the ages of two and four.

Young children are more susceptible to this infection because they have lymph nodes in the throat that can become infected. As a young child matures, these lymph nodes begin to recede. The lymph nodes are typically much smaller by the time a child is eight years old.

Retropharyngeal abscess is also slightly more common in males.

Adults who have a weakened immune system or a chronic disease are also at an increased risk for this infection. These conditions include:

  • alcoholism
  • diabetes
  • cancer
  • AIDS

How is retropharyngeal abscess diagnosed?

In order to make a diagnosis, your doctor will ask you about your symptoms and immediate medical history.

After performing a physical exam, your doctor may order imaging tests. The tests may include an X-ray or a CT scan.

In addition to imaging tests, your doctor may also order a complete blood count (CBC), and a blood culture. These tests will help your doctor determine the extent and cause of the infection, and rule out other possible causes of your symptoms.

Your doctor may consult with an ear, nose, and throat (ENT) doctor or another specialist to assist with your diagnosis and treatment.

Treatment options

These infections are usually treated in the hospital. If you or your child is having trouble breathing, your doctor may provide oxygen.

In severe situations, intubation may be necessary. For this process, your doctor will insert a tube into your windpipe through your mouth or nose to help you breathe. This is only necessary until you’re able to resume breathing on your own.

During this time, your doctor will also treat the infection intravenously with broad-spectrum antibiotics. Broad-spectrum antibiotics work against many different organisms simultaneously. Your doctor will likely administer either ceftriaxone or clindamycin for this treatment.

Because swallowing is compromised with a retropharyngeal abscess, intravenous fluids are also part of the treatment.

Surgery to drain the abscess, especially if the airway is blocked, may also be necessary.

Are there any potential complications?

If left untreated, this infection can spread to other parts of the body. If the infection spreads to your bloodstream, it can result in septic shock and organ failure. The abscess may also block your airway, which can lead to respiratory distress.

Other complications may include:

  • pneumonia
  • blood clots in the jugular vein
  • mediastinitis, or inflammation or infection in the chest cavity outside of the lungs
  • osteomyelitis, or bone infection

What’s the outlook?

With proper treatment, you or your child can expect a full recovery from a retropharyngeal abscess.

Depending on the severity of the abscess, you may be on antibiotics for two or more weeks. It's important to watch for recurrence of any symptoms. If symptoms do recur, seek immediate medical care in order to reduce your risk of complications.

Retropharyngeal abscess recurs in an estimated 1 to 5 percent people. People with retropharyngeal abscess are 40 to 50 percent more likely to die due to abscess-related complications. Death is more prevalent in affected adults than children.

How to prevent retropharyngeal abscess

Prompt medical treatment of any upper respiratory infection will help prevent the development of a retropharyngeal abscess. Be sure to complete the full course of any antibiotic prescriptions to make sure your infection is fully treated.

Only take antibiotics when prescribed by a doctor. This can help prevent antibiotic-resistant infections such as MRSA.

If you or your child has had trauma to the area of infection, make sure to follow all treatment instructions. It’s important to report any problems to your doctor and to attend all follow-up appointments.

CMS Id: 21023