Peritonsillar abscess (Quinsy)

Question 1

What are the symptoms of Quinsy?

Answer 1

Constitutional -> fever, malaise, chills, rigors

Local

• Sore throat (worse on one side)
• Odynophagia
• Muffled ‘hot potato’ voice (tongue cannot be moved at palate properly, imagine hot food in back of throat)
• Halitosis
• Referred otalgia
• ***Trismus (inflammation has spread to muscles of mastication; trismus results due to spasm of pterygoid muscles which are close to superior constrictor)

Question 2

What are the signs of Quinsy?

Answer 2

• Swollen tonsillar pillar and soft palate above tonsil
• Tonsil may not appear enlarged as it may be buried in oedematous pillars
• Uvula pushed to opposite side
• Purulent discharge/exudate from tonsils
• Cervical lymphadenopathy

Question 3

How is Quinsy managed?

Answer 3

Nasendoscopy to assess rest of upper airway for extension (deep neck abscess) which may cause airway compromise TRO airway obstruction, by blocking oropharynx

IV fluid for rehydration

IV Augmentin

Analgesia, mouth gargle

Surgical drainage

• I&D of abscess under LA (or GA for children). Pain improves significantly immediately after drainage
• Needle aspiration – if abscess small (not so much to drain), not multi-lobulated (easier to ensure adequate drainage). Can recur if incomplete drainage 🡪 I&D is preferred
• Hot tonsillectomy (tonsillectomy together with I&D) – rarely done. Consider this option if the tonsil is blocking the abscess; “hot” refers to the fact that there is ongoing infection

Re-exploration 1/7 after I&D, and then re-examine at 1/52