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Quinsy: An abscess in tonsils

What is quinsy?

Quinsy is a complication related to tonsillitis. It is also known as peritonsillar abscess, where pus collection in the area surrounding the tonsils is seen. While tonsillitis is common among smaller children, peritonsillar abscess is more common in older children, adolescents, and young adults. This may affect one or both of the tonsils. Delay in treatment may turn it into a life-threatening medical emergency.

While unilateral quinsy (abscess on one side of the throat) is very common, peritonsillar abscess on both sides is relatively rare.

quinsy

Causes and risk factors

Causes

The peritonsillar abscess is caused due to possible spread of infection by bacteria from infected tonsils. It is a complication arising out of tonsillitis.

Other risk factors that may trigger quinsy are:

  • Dental infection
  • Smoking
  • Chronic lymphocytic leukaemia – cancer that affects the white blood cells.
  • Stones or calcium deposits in tonsils

Viral infection such as mononucleosis

Symptoms and signs

The symptoms of Quinsy include:

  • Extremely painful sore throat with swelling, usually on one side
  • Fever
  • General body weakness
  • Difficulty in swallowing
  • Hoarseness of voice
  • Headache and earache on the affected side
  • Pus formation
  • Drooling due to inability to swallow saliva
  • Tender to the touch: jaw and throat
  • Enlarged lymph nodes
  • Foul breath
  • Difficulty in breathing due to constricted airways owing to the swelling

Diagnosis

The diagnosis of the peritonsillar abscess is usually through visual examination. The throat and the roof of the mouth are often swollen.

During the physical examination, the individual may present with difficulties of opening and closing his mouth (trismus) because of inflammation of the throat muscles.

A CT scan or ultrasonography may be used to identify the abscess formation and also to confirm the presence of a peritonsillar abscess. Your physician might opt to aspirate the abscess using a needle and send it for bacterial culture, to prescribe the right antibiotics.

Treatment and prevention

Treatment

Following are the treatment options that could be adopted to treat quinsy:

Following are the treatment options that could be adopted to treat quinsy:

Following are the treatment options that could be adopted to treat quinsy:

  • Antibiotics – The choice of the antibiotic depends on the culture of the fluid obtained during the needle aspiration. Earlier penicillin was the antibiotic of choice, now clindamycin or oral cephalosporin are preferred for treating the peritonsillar abscess.
  • Painkillers such as paracetamol and ibuprofen could be prescribed to bring down the pain and associated fever.
  • Incision and drainage – is done to provide immediate relief.
  • Needle aspiration – this method is used for both diagnostic as well as therapeutic purposes. This allows correct localization of the abscess cavity and aids in draining the pus.
  • Tonsillectomy – is recommended in cases where there is a frequent recurrence of a sore throat and infection. Tonsillectomy is also recommended in cases when the abscess is located in an area that’s hard to access.

Prevention

Quinsy usually occurs owing to untreated tonsillitis, hence, do not ignore frequent episodes of throat pain or sore throat. Good personal hygiene, including washing of hands, is essential to ensure that one will not use dirty hands to eat or drink. Avoid direct contact with people who have viral or bacterial infections as that may trigger tonsillitis.

Avoid smoking as it may increase the risk of quinsy. Avoiding any triggers of tonsillitis can help in preventing escalation of the same into a peritonsillar abscess. Finish the entire course of antibiotics prescribed to ensure thorough treatment.

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Complications

Patients with complications such as diabetes, weak immune system (cancer, AIDS, transplant recipients), or those who do not seek immediate medical intervention, a peritonsillar abscess can become life threatening.

Some of the serious complications of untreated peritonsillar abscess can be:

  • Blocked airways
  • Rupture of the abscess and drainage of the pus and fluid into the lungs could lead to pneumonia
  • Dehydration and weakness due to difficulty in swallowing
  • Meningitis
  • Sepsis

Next steps

If you have been suffering from frequent tonsillitis, it is important that you do not leave it untreated or self-treat it. If you have difficulty in opening and closing your mouth, swallowing your saliva, difficulty in breathing, fever, and general malaise, then you must visit your family physician immediately. Even after the abscess has been treated, it is important that you take measures to prevent recurrence and have adequate follow-ups.

Red Flags

Following are some of the red flags indicating that one may have peritonsillar abscess:

  • Sore throat (especially frequent episodes)
  • Pain on swallowing
  • Breathing difficulties
  • Change in the quality of voice – hoarse or croaky voice
  • Difficulty in opening and closing the mouth

Do not ignore these symptoms and seek immediate medical help.

Consult a top Ear-Nose-Throat (ENT) Specialist

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References

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  • Peritonsillar Abscess – US National Library of Medicine – Accessed on February 1, 2016 – https://www.nlm.nih.gov/medlineplus/ency/article/000986.htm
  • Bilateral peritonsillar abscesses – American Journal of Otolaryngology – Accessed on February 1, 2016 – http://www.sciencedirect.com/science/article/pii/S0196070906000597
  • Peritonsillar Abscess: Diagnosis and Treatment – American Academy of Family Physicians – Accessed on February 1, 2016 – http://www.aafp.org/afp/2002/0101/p93.html
  • Peritonsillar Abscess – PubMed Central – Accessed on February 1, 2016 – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099234/
  • Peritonsillar Abscess: Treatment and Management – Medscape – Accessed on February 1, 2016 – http://emedicine.medscape.com/article/194863-treatment

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