Peritonsillar Abscess

(Quinsy)

Preethi Jagannath
Ramaiah Medical College
Learning Objectives
● Definition
● Aetiology
● Clinical Features
● Examination
● Treatment
● Complications

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What is Quinsy?
It is the collection of pus in the peritonsillar space which lies
between the capsule of tonsil and superior constrictor
muscle.

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Aetiology?
Acute tonsillitis

● Infection of the tonsillar crypts, usually the CRYPTA

MAGNA
● It gets sealed off and forms intratonsillar abscess
● Abscess bursts through the tonsillar capsule
● Setting up of peritonsillitis
● Peritonsillar abscess
★ Culture of pus - pure growth of Streptococcus pyogenes,
S.aureus or anaerobic organisms. Most often - mixed
growth. 5
● Taking the
advantage of the
DEPTH of the crypta
magna - infection
reaches the
peritonsillar space.
● Loose areolar tissue
- between the
capsule and the bed
of tonsil - Site of
collection of pus. 6
Clinical features:
General:

● Fever (upto 104 °F)

● Chills and rigors
● General malaise
● Body aches
● Headaches
● Nausea and
Constipation
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Local:

● Severe throat pain (unilateral)

● Odynophagia (marked- cannot swallow his own saliva and
it dribbles from the angle of his mouth)
● Muffled and thick speech “hot potato voice”
● Foul breath
● Ipsilateral earache (referred pain via CN IX)
● Trismus (spasm of pterygoid muscle)

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Examination:
● Tonsils, pillars, soft palate - Congested and swollen
● Uvula - Oedematous, swollen and pushed to the opposite
side
● Bulging of soft palate and anterior pillar
● Mucopus covering tonsillar region
● Cervical lymphadenopathy - jugulodigastric lymph nodes
● Torticollis - neck tilted to the side of the abscess

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● Bulge of soft palate
● Uvula pushed towards opposite side due to large, red,
smooth surfaced globular swelling near the upper pole of
the tonsil 10
Medical Treatment:
● Hospitalization
● Intravenous fluids (to combat dehydration)
● Antibiotics- large i.v doses to cover aerobic and anaerobic
organisms
● Analgesics- like paracetamol for relief of pain and lower
the temperature. Pethidine- stronger. Aspirin- avoided
because of bleeding.
● Oral hygiene- Hydrogen peroxide/saline mouthwashes
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Surgical Treatment:
● Incision and drainage- At the point of maximum
bulge above the upper pole of the tonsil

or

just lateral to the point of junction of anterior pillar with

the line drawn through the base of uvula

● Guarded knife- small stab incision

● Sinus forceps
● Suction 12
● Putting the sinus forceps the following day may also be
necessary to drain any reaccumulation
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● Interval tonsillectomy-
Tonsils removed 4-6 weeks
following an attack of
quinsy
● Abscess or hot
tonsillectomy- Risk of
rupture of the abscess
during anaesthesia and
excessive bleeding at the
time of operation 14
Complications:
● Parapharyngeal abscess
● Edema of larynx
● Septicaemia. Other complications like endocarditis,
nephritis, brain abscess
● Pneumonitis or Lung abscess- due to aspiration of pus by
spontaneous rupture of abscess
● Jugular vein thrombosis
● Spontaneous hemorrhage
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Thank you

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