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Peritonsillar Abscess//QUINSY

1. Introduction
• Quinsy = peritonsillar abscess
• It is a collection of pus in the peritonsillar space — between the tonsillar capsule and the superior constrictor muscle.
• Usually a complication of acute tonsillitis.
• Common in young adults (15–35 years).

2. Anatomy Review
• Peritonsillar space lies:
• Medially → tonsillar capsule
• Laterally → superior constrictor muscle
• Contains loose areolar tissue, which facilitates pus collection.


3. Etiology

A. Primary Cause
• Complication of acute tonsillitis — infection spreads beyond capsule.

B. Common Organisms
• Aerobic:
• Streptococcus pyogenes (most common)
• Staphylococcus aureus
• Haemophilus influenzae
• Anaerobes:
• Fusobacterium, Peptostreptococcus
• Mixed flora is common.

4. Pathogenesis
1. Acute tonsillitis → infection spreads to peritonsillar space.
2. Cellulitis stage → inflammatory oedema without pus.
3. Abscess stage → pus collection forms → quinsy.

5. Clinical Features

A. Symptoms
• Severe unilateral throat pain
• Odynophagia → pain on swallowing
• Trismus → spasm of medial pterygoid due to inflammation
• Muffled “hot potato” voice
• Fever, malaise, dehydration
• Sometimes referred ear pain via glossopharyngeal nerve.

B. Signs
• Tonsil displaced medially.
• Uvula pushed to opposite side.
• Peritonsillar swelling — usually superior pole.
• Cervical lymphadenopathy.
• Fetid breath (halitosis).


6. Complications

Local
• Parapharyngeal abscess
• Retropharyngeal abscess
• Airway obstruction

Systemic
• Septicemia
• Aspiration pneumonia
• Rarely, jugular vein thrombosis (Lemierre’s syndrome)

7. Investigations
• Diagnosis is mainly clinical.
• Blood tests: CBC (↑WBC), ESR/CRP
• Needle aspiration: confirms pus, helps culture.
• Imaging: rarely needed, but contrast-enhanced CT neck if parapharyngeal extension suspected.

8. Treatment

A. Medical Management
• IV antibiotics (cover aerobes + anaerobes):
• Amoxicillin–clavulanate / Ceftriaxone + Metronidazole.
• Analgesics + antipyretics.
• IV fluids if dehydrated.

B. Surgical Management

There are three options:

1. Needle Aspiration
• Done under local anaesthesia.
• Quick, simple, less invasive.

2. Incision and Drainage (I&D)
• Gold standard in most first episodes.
• Incision made at the superior pole of tonsil where bulge is maximum.

3. Tonsillectomy
• Abscess Tonsillectomy:
• Done during acute stage if recurrent tonsillitis or bilateral disease.
• Interval Tonsillectomy:
• Done 4–6 weeks later after resolution.



9. Differential Diagnosis
• Severe acute tonsillitis
• Parapharyngeal abscess
• Retropharyngeal abscess
• Infectious mononucleosis (EBV)
• Diphtheria (rare)

10. Prognosis
• With prompt treatment → excellent recovery.
• Recurrence risk: 10–15%.
• Tonsillectomy recommended in recurrent cases.

11. Key Points for Viva
• Quinsy is peritonsillar abscess.
• Streptococcus pyogenes → most common cause.
• Trismus + hot potato voice + uvular deviation = classic triad.
• Treatment: IV antibiotics + drainage ± tonsillectomy.
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