Table of Contents

Signs and symptoms
Complications
Causes
Diagnosis
Treatment
Medication
Surgery
Epidemiology
Etymology
Notable cases
Notes
References
External links

peritonsillar abscess

NamePeritonsillar abscess
Image
CaptionRight-sided peritonsillar abscess
FieldOtorhinolaryngology
SynonymsQuinsy, quinsey
SymptomsFever, throat pain, trouble opening the mouth, change to the voice
ComplicationsBlockage of the airway, aspiration pneumonitis
CausesMultiple types of bacteria
RisksStreptococcal pharyngitis
DiagnosisBased on the symptoms
DifferentialRetropharyngeal abscess, infectious mononucleosis, epiglottitis, cancer
TreatmentRemove pus, antibiotics, fluids, pain medication, steroids
Frequency~3 per 10,000 per year (USA)

A peritonsillar abscess (PTA), also known as a quinsy, is an accumulation of pus due to an infection behind the tonsil. Symptoms include fever, throat pain, trouble opening the mouth, and a change to the voice. Pain is usually worse on one side. Complications may include blockage of the airway or aspiration pneumonitis.

PTA is typically due to infection by several types of bacteria. Often, it follows streptococcal pharyngitis. They do not typically occur in those who have had a tonsillectomy. Diagnosis is usually based on the symptoms. Medical imaging may be done to rule out complications.

Treatment is by removing the pus, antibiotics, sufficient fluids, and pain medication. Steroids may also be useful. Hospital admission is generally not needed. In the United States, about 3 per 10,000 people per year are affected. Young adults are most commonly affected.

Signs and symptoms

Physical signs of a peritonsillar abscess include redness and swelling in the tonsillar area of the affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced towards the unaffected side.

Unlike tonsillitis, which is more common in children, PTA has a more even age spread, from children to adults. Symptoms start appearing two to eight days before the formation of an abscess. A progressively severe sore throat on one side and pain during swallowing (odynophagia) are usually the earliest symptoms. As the abscess develops, persistent pain in the peritonsillar area, fever, a general sense of feeling unwell, 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 foul breath 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 (trismus).

Complications

While most people recover uneventfully, a wide range of possible complications may occur. These may include:


Difficulty swallowing can lead to decreased oral intake and dehydration.

Causes

PTA is usually a complication of an untreated or partially treated episode of acute tonsillitis. The infection, in these cases, spreads to the peritonsillar area (peritonsillitis). This region comprises loose connective tissue and is hence susceptible to the formation of an 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 Bacteroides.

Diagnosis

Peritonsillar abscess on the person's right as seen on CT imaging

Diagnosis is usually based on the symptoms. Medical imaging may be done to rule out complications. Medical imaging may include CT scan, MRI, or ultrasound is also useful in diagnosis.

Treatment

Medical treatment with antibiotics, volume repletion with fluids, and pain medication is usually adequate, although in cases where airway obstruction or systemic sepsis occurs, surgical drainage may be necessary. Corticosteroids may also be useful. Hospital admission is generally not needed.

Medication

The infection is frequently penicillin resistant. There are several antibiotics options including amoxicillin/clavulanate, ampicillin/sulbactam, clindamycin, or metronidazole in combination with benzylpenicillin (penicillin G) or penicillin V. Piperacillin/tazobactam may also be used.

Surgery

The pus can be removed by several methods, including needle aspiration, incision and drainage, and tonsillectomy. Incision and drainage may be associated with a lower chance of recurrence than needle aspiration, but the evidence is very uncertain. Needle aspiration may be less painful, but again, the evidence is very uncertain.

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 prefer to "wait and observe" before recommending tonsillectomy.

Epidemiology

It is a commonly encountered otorhinolaryngological (ENT) emergency.

The number of new cases per year of peritonsillar abscess in the United States has been estimated at approximately 30 cases per 100,000 people. In a study in Northern Ireland, the number of new cases was 10 cases per 100,000 people per year.

In Denmark, the number of new cases 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 airway obstruction.

Etymology

The condition is often referred to as "quincy", "quinsy", or "quinsey", anglicised versions of the French word esquinancie which was originally rendered as squinancy, squinzey and subsequently quinsy.

Notable cases


The ancient Roman goddess Angerona was claimed to cure quinsy (Latin angina) in humans and sheep.

Notes


References


External links

Category:Bacterial diseases
Category:Tonsil disorders
Category:Upper respiratory tract diseases
Category:Wikipedia medicine articles ready to translate
Category:Otorhinolaryngology