To explore a possible difference in the histology of the minor salivary glands in the peritonsillar space between patients with peritonsillar abscess, acute tonsillitis, or tonsillar hypertrophy. To compare if there were remnants of possible changes in elevated serum amylase and its isoenzymes between these three groups to clarify the ambiguous etiology of peritonsillar abscess.

This is a cross‐sectional study, in which we analyzed 75 tonsil and blood samples collected from patients with peritonsillar abscess, acute tonsillitis, or tonsillar hypertrophy prior to tonsillectomy. Histological findings of minor salivary glands in peritonsillar space were examined. Serum C‐reactive protein, serum amylase, and its isoenzymes (pancreatic type and the salivary type) were analyzed from blood samples collected in conjunction with tonsillectomy.

Minor salivary glands were present in 62 (82.7%) tonsil samples. Peritonsillar abscess group exhibited more periductal inflammation in the minor salivary glands (85.0%) than in the acute tonsillitis (70.6%) or hypertrophy group (28.0%) (p = 0.001). There was no difference in serum amylase (p = 0.864), pancreatic type amylase isoenzyme (p = 0.776), or salivary type amylase isoenzyme (p = 0.963) between the three groups.

Peritonsillar abscess patients had more periductal inflammation in the minor salivary glands than acute tonsillitis or hypertrophy patients, suggesting that peritonsillar abscess may originate from an infection of the minor salivary glands. Blood samples for amylase isoenzymes should be collected during the acute phase of the disease to obtain additional information about the link between peritonsillar abscess and minor salivary gland activity.