Peritonsillar abscess, also known as a quinsy
or quinsey, is a recognized complication of tonsillitis and consists of a collection of
pus beside the tonsil in what is referred to as peritonsilar space. It is a commonly
encountered otorhinolaryngological emergency. Symptoms and signs
Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even
age spread, from children to adults. Symptoms start appearing two to eight days before the
formation of an abscess. Progressively worsening, unilateral sore throat and pain during swallowing
usually are the earliest symptoms. As the abscess develops, persistent pain in the peritonsillar
area, fever, malaise, headache and a distortion of vowels informally known as “hot potato
voice” may appear. Neck pain associated with tender, swollen lymph nodes, referred ear
pain and halitosis are also common. While these signs may be present in tonsillitis
itself, a PTA should be specifically considered if there is limited ability to open the mouth.
In short: Severe unilateral pain in the throat;
Pyrexia above 39 °C; Unilateral earache;
Odynophagia and difficulty swallowing saliva; Change in voice;
Intense salivation and dribbling, foetor oris; Pain in the neck;
Malaise, headache, stiffness. Trismus is common. Physical signs include
redness and edema in the tonsillar area of the affected side and swelling of the jugulodigastric
lymph nodes. The uvula may be displaced towards the unaffected side. Odynophagia, and ipsilateral
earache also can occur. Causes
PTA usually arises as a complication of an untreated or partially treated episode of
acute tonsillitis. The infection, in these cases, spreads to the peritonsillar area.
This region comprises loose connective tissue and is hence susceptible to formation of abscess.
PTA can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly
involved aerobic pathogens include Streptococcus, Staphylococcus and Haemophilus. The most common
anaerobic species include Fusobacterium necrophorum, Peptostreptococcus, Prevotella species and
Treatment is surgical incision and drainage of the pus, thereby relieving the pain of
the pressed tissues. Antibiotics are also given to treat the infection. Internationally,
the infection is frequently penicillin resistant, so it is now common to treat with clindamycin
or metronidazole in combination with penicillin G benzathine. Treatment can also be given
while a patient is under anesthesia, but this is usually reserved for children or anxious
patients. Tonsillectomy can be indicated if a patient has recurring peritonsillar abscesses
or a history of tonsillitis. For patients with their first peritonsillar abscess most
ENT-surgeons favour to “wait and observe” before recommending tonsillectomy.
Complications Retropharyngeal abscess;
Extension of abscess in other deep neck spaces leading to airway compromise. See Ludwig’s
Possible necrosis of surrounding deep tissues; In rare cases, mediastinitis.
Epidemiology The incidence of peritonsillar abscess in
the United States has been estimated approximately at 30 cases per 100,000 people per year. In
a study in Northern Ireland, the incidence was 10 cases per 100,000 people per year.
In Denmark, the incidence is higher and reaches 41 cases per 100,000 people per year. Younger
children who develop a peritonsillar abscess are often immunocompromised and in them, the
infection can cause significant airway obstruction. Naming
The condition Peritonsillar Abscess is also referred to as “quincy”, “quinsy” or “quinsey”.
These terms are Anglicised versions of the French word esquinancie which was originally
rendered as Squinsey and subsequently Quinsy. Notable cases
Sultan Tekish of Kwarezm; Osceola;
Michel de Montaigne; Pope Adrian IV.
George Washington was believed to have died of complications arising from quinsy, but
is now thought to have died from epiglottitis. James Gregory of the band The Ordinary Boys
almost died from quinsy because it was left untreated for so long before emergency treatment
was started. Eiichiro Oda, author of the best-selling One
Piece manga, was hospitalized due to complications. References External links
Otolaryngology Houston Definition Cause Diagnosis And Treatment Of