Quinsy

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.