Peritonsillar abscess (Quinsy)
Peritonsillar abscess (quinsy) is the commonest deep infection of the head and neck in acute practice. It is a collection of pus between the tonsillar capsule and the superior pharyngeal constrictor, usually arising as a complication of acute tonsillitis.
Prompt recognition, early ENT involvement, drainage and appropriate antibiotics are the cornerstones of management. The principal emergency concern is airway compromise; secondary risks include spread into deep neck spaces, sepsis and vascular injury.
Pathophysiology and microbiology
- Most cases result from extension of tonsillitis through the tonsillar capsule (peritonsillitis → abscess).
- Infection of supratonsillar (Weber’s) glands is an alternative mechanism.
- Typical organisms are mixed aerobic and anaerobic flora:
- Streptococcus pyogenes (group A streptococcus) - most frequent.
- Staphylococcus aureus.
- Haemophilus influenzae.
- Anaerobes such as Prevotella spp. and Fusobacterium spp.
- Infectious mononucleosis can predispose to extensive tonsillar disease and quinsy and affects management considerations.
Typical presentation
- Rapidly progressive unilateral severe sore throat over 24-48 hours.
- Severe odynophagia with reduced oral intake and drooling.
- Muffled “hot potato” voice.
- Unilateral referred otalgia.
- Trismus with reduced mouth opening.