This article is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

What is Peritonsillar abscess (quinsy)?

Peritonsillar abscess (also known as Quinsy) is an uncommon complication where a collection of pus (abscess) develops deep to the tonsil. This is caused by a bacterial infection. It usually only involves one side and it often follows a bout of tonsillitis (see tonsillitis link).

Therefore, the tonsil on the side of the collection may look swollen, and is often “pushed” toward the midline. This condition can be very uncomfortable and can make people feel very unwell.

Peritonsillar abscess (Quinsy)

 

Who gets Peritonsillar abscess?

Peritonsillar abscess usually affects teenagers and young adults but can occur in younger children.

 

Causes/Risk Factors

Peritonsillar abscess is a bacterial infection and is often a complication of tonsillitis (see tonsillitis link). It can sometimes occur despite adequate treatment of tonsillitis with antibiotics.

 

Symptoms of Peritonsillar abscess

People with peritonsillar abscess have severe throat pain, pain with swallowing (odynophagia) and may drool if it is too painful to swallow their saliva. They may also have fever, bad breath, difficulty opening the mouth (trismus), change in voice (“hot potato voice”), painful ear, neck pain and stiffness ( if deep space abscess forms )

 

Diagnosis of Peritonsillar abscess:

The diagnosis of peritonsillar abscess is clinical and generally no scans are required. Diagnosis is usually made largely based on the symptoms and a characteristic unilateral swelling of the soft palate with or without tonsillitis (see Figure 1).

CT scan should be performed if a deep neck abscess is suspected.

 

Treatment and Management

Treatment of peritonsillar abscess usually involves transoral drainage, antibiotics, and supportive care.

Drainage: There are usually two options on how to drain this abscess. Option one is to use a needle and drain the pus with syringe. There is however a higher risk of recurrence in the next day or two with this technique particularly if the abscess is large.

Option two includes making a small cut over the swelling on the soft palate and allowing for the pus to drain out. This is done under local anaesthetic. If the above options have not resolved the abscess, then the next option is surgical removal of the tonsil (tonsillectomy).

Antibiotics: Penicillin is the first choice of treatment. Anaerobic cover with Metronidazole can be considered if the response to Penicillin is not satisfactory.

Supportive care: As many people have not been eating or drinking well because of their sore throat, most patients will require intravenous fluid to correct the dehydration. They will also require adequate pain relief as this condition can be very painful. A stat dose of steroid should also be considered after drainage to help ease the pain and improve swallowing.

If there is recurrence of the peritonsillar abscess or background of recurrent or chronic tonsillitis, then removal of tonsils can be arranged at a later date to prevent recurrence. Tonsillitis and Tonsillectomy are discussed in more detail in a separate page (please see link for tonsillitis and tonsillectomy).

 

Complications of Peritonsillar abscess

Early diagnosis and management of peritonsillar abscess is important to avoid complications. Complications of peritonsillar abscess, while rare, can be life threatening.

Complications may include narrowing or blockage of airway, aspiration and chest infection (aspiration pneumonia) and deep neck infections which can be life threatening (necrotising fasciitis).

 

What is the prognosis?

Early and appropriate treatment of peritonsillar abscess usually means most infections resolve without a complication. There is however a risk of recurrence of the peritonsillar abscess at a later date (estimated to be around 9-22%).

Following tonsillectomy (e.g. for recurrent peritonsillar abscess), recurrence of peritonsillar abscess is rare.

 

Further reading:

1. https://patient.info/doctor/peritonsillar-abscess
2. https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Peritonsillar-abscess
3. https://emedicine.medscape.com/article/194863-overview

 

References:
1. Galioto NJ. Peritonsillar Abscess. Am Fam Physician. 2017 Apr 15;95(8):501-506
2. Powell J, Wilson JA. An evidence-based review of peritonsillar abscess. Clin Otolaryngol. 2012 Apr;37(2):136-45.
3. Hur K, Zhou S, Kysh L. Adjunct steroids in the treatment of peritonsillar abscess: A systematic review. Laryngoscope. 2018 Jan;128(1):72-77.

 

Author + Affiliation:
Dr Omid Ahmadi – ENT registrar, Waikato hospital

Date of Publication +/- Review: July 2021
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Peritonsillar abscess (Quinsy)

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