1. Quinsy / peritonsillar abscess

2. Definition
It is a collection of pus in the peritonsillar space which lies between the capsule of tonsil and the superior constrictor muscle Or
It is a localized accumulation of pus in the peritonsillar tissues that forms as a result of suppurative tonsillitis

3. Causes
It occurs as a complication of an untreated or partially treated tonsillitis
Organisms
Streptococcus - GAS
Staphylococcus
Heamophilus

4. Pathophysiology Tonsillitis or pharyngitis
Tonsilar crypt get infected and sealed off
Intra tonsillar abscess
It burst into peritonsillar space through tonsillar capsule
Peritonsillitis
Peritonsilar abscess

5. Peritonsillar abscess (if not treated) Laryngeal edema Parapharyngeal Abscess Spread through blood – septicemia – infection to heart (endocarditis), kidney (nephritis), brain (brain abscess), lungs (lung abscess and pneumonia), airway obstruction, cellulitis of the jaw, neck or chest, pleural effusion

6. Signs and symptoms More common in children
Symptoms start two to eight days before the formation of abscess
Unilateral sore throat and pain during swallowing (odynophagia)
Fever, malaise, headache
Distortion of voice – hot potato voice
Neck pain associated with tenderness, swollen lymph nodes
Referred ear pain, halitosis
Drooling of saliva

7. Trismus – limited ability to open the mouth
Redness and edema in the tonsils
Uvula may be displaced towards the unaffected side

8. Diagnosis History collection Physical examination
Aspiration of the abscess using a needle - culture
CT scan
Ultrasonography

9. Management – surgical management
Needle aspiration – low cost, and good patient tolerance
The mucous membrane over the swelling is first sprayed with a topical anesthetic and then injected with a local anesthetic
Single or repeated needle aspirations are performed to decompress the abscess

10. Position – sitting position to make it easier to expectorate the pus and blood that accumulate in the pharynx
Patient experiences almost immediate relief
If 3 ml or more of purulent material is aspirated then patient will likely need to be seen the next day for further aspiration

11. Surgical incision and drainage of the pus – this will relieve pain.
Tonsillectomy – for patients who are not relieved from needle aspiration or incision and drainage.
The risk for bleeding after surgery is more than normal removal of tonsils in tonsillectomy

12. Medical management Antibiotics – to treat infection
Clindamycin, metronidazole in combination with penicillin G