What causes a retropharyngeal abscess (RPA)?

Updated: Jan 08, 2021
  • Author: Joseph H Kahn, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Retropharyngeal abscess develops secondary to lymphatic drainage or contiguous spread of upper respiratory or oral infections. Pharyngeal trauma from endotracheal intubation, nasogastric tube insertion, [34] endoscopy, foreign body ingestion, and foreign body removal may cause a subsequent retropharyngeal abscess. Patients who are immunocompromised or chronically ill, such as persons with diabetes, cancer, alcoholism, or AIDS, are at increased risk for retropharyngeal abscess.

The aforementioned single-center Spanish study by Sanz Sánchez and Morales Angulo reported that medical histories among patients with retropharyngeal abscess most frequently involved not only alcoholism and diabetes, as mentioned above, but also smoking and obesity. [23]

A study by Kim et al indicated that in adolescents and adults, but not in children aged 14 years or younger, tonsillectomy raises the risk of retropharyngeal and parapharyngeal abscesses, with the post-tonsillectomy adjusted hazard ratio for deep neck infection being 1.43 (1.12 in children and 1.87 in patients aged 15 years or older). [35]

A study by Qureshi et al indicated that retropharyngeal abscess is occurring at an increasing rate among adult inpatients in the United States with peritonsillar abscess. The investigators, who used data from the National (Nationwide) Inpatient Sample, found that between 2003 and 2010 the annual rate at which retropharyngeal abscess occurred concurrently with peritonsillar abscess rose from 0.5% to 1.4% among inpatients aged 18 years or older. The study also indicated that patient age affects concurrence of the two conditions, with the likelihood that retropharyngeal abscess will complicate peritonsillar abscess increasing in patients aged 40 years or older. [36]

Buckley et al reported an increasing incidence of admissions for tonsillitis and RPAs in Wales between 1999 and 2014. The investigators questioned whether there is too great a threshold for tonsillectomy. [25]

Jain et al reported that children under age 5 years with RPA often have an antecedent upper respiratory infection causing suppurative cervical lymphadenitis. [37]

The most common organisms causing retropharyngeal abscesses include aerobes and anaerobes; gram-negative organisms also may be observed. Often, mixed flora is cultured. The incidence of RPA caused by methicillin-resistant Staphylococcus aureus (MRSA) is increasing. [16]

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