Quinsy

• Quinsy, also termed peritonsillar abscess, is a collection of pus in the peritonsillar space.
• Overview:

  • Bacterial infection with trapped puss - forming an abscess in the region of the tonsils
  • Occurs most commonly as a complication of bacterial tonsillitis (can occur without)
  • Tonsillitis is much more common in children, but quinsy occurs just as frequently in teenagers and adults
  • Group A beta-haemolytic streptococcus and haemophilus influenzae are most commonly implicated
• Symptoms:

  • Sore throat
  • Painful swallowing/dysphagia
  • Fever
  • Referred ear pain
  • Swollen tender lymph nodes - anterior triangle of neck
• Additional symptoms that can indicate a peritonsillar abscess include:

  • Trismus, which refers to when the patient is unable to open their mouth
  • Change in voice due to the pharyngeal swelling, described in textbooks as a “hot potato voice”
  • Swelling and erythema in the area beside the tonsils
• Signs

  • Peritonsillar swelling
  • Exudate
  • Drooling
  • Stertor (sound caused by upper airway obstruction)
  • Displacement of uvula (away from the side of abscess)
  • Fetid breath
• Quinsy tends to be a clinical diagnosis, intraoral ultrasound may be used to confirm it.
• Pus cultures may be sent but rarely impact management
• Management:

  • Urgent ENT review
  • IV fluids (reduced intake)
  • IV antibiotics - usually a broad spectrum antibiotic such as amoxicillin or co-amoxiclav
  • Some times steroids are given
  • Needle aspiration or surgical incision and drainage
• Severe complications are rare but can include sepsis, the spread of the infection through the deep spaces of the neck and airway obstruction.
• Complications:

  • Retro and parapharygeal abscess - deep neck space infections are an airway - needs drainage or airway obstruction will occur
  • Mediastinitis - untreated deep neck space infections can track down into the mediastinum. Life threatening complication which will require input from cardiothoracic surgeons
• Recurrent episodes of peritonsillar abscess (two or more) is an indication for tonsillectomy