Peritonsillar Abcess (Quinsy)

Question 1

Definition

Answer 1

Pus between tonsil capsule and superior constrictor muscle

Question 2

Aetiology

Answer 2

Follow acute tonsillitis
May be without history of sore throat
Crypta magna (crypt) gets infected + sealed off.

Forms intratonsillar abscess
Burst through tonsillar capsule
Peritonsillitis
Abscess

Strep.pyogenes,
Staph aureus

Question 3

Clinical features (unilateral / bilateral)

Answer 3

General
Septicaemia
Fever
Chills
Rigor
Malaise
Body ache
Headache
Nausea
Constipation
Local
Throat pain (severe)
Odynophagia (dehydration)
Muffled/thick speech (hot potato voice)
Foul breath
Ipsilateral earache (referred pain)
Trismus (pterygoid muscle spasm)

Question 4

Examination

Answer 4

Tonsil + pillars + soft palate (swollen + congested)
Uvula (swollen + edematous +pushed aside)
Soft palate + ant. Pillars (bulging)
Mucopus cover region
Cervical lymphadenopathy (jugulodigastric lymph nodes)
Torticollis (tilted neck)

Question 5

Investigations

Answer 5

Contrast CT
MRI
Needle aspiration (culture + sensitivity)

Question 6

Treatment

Answer 6

Hospitalisation
Iv fluids (dehydration)
Antibiotics
Analgesics (paracetamol / pethidine)
Aspirin avoided (danger of bleeding)
H2O2 / saline mouth wash

Incision and drainage in frank abscess.
Interval tonsillectomy (after 4-5 weeks)
Abscess / Hot tonsillectomy (risk rupture + high bleeding)

Question 7

Complications

Answer 7

Parapharyngeal abscess
Edema of larynx
Septicaemia (edocarditis, nephritis, brain abscess)
Pneumonitis / lung abscess (pus aspiration+ spontaneous rupture)
Jugular vein thrombosis
Spontaneous haemorhhage (carotid artery / jugular vein)