A severe throat infection known as quinsy can cause more than just pain.
In short: Often following a bout of strep throat, a peritonsillar abscess is a collection of pus behind the tonsil that can make swallowing and even opening your mouth difficult. While most recover with standard care, this ENT emergency requires attention to prevent serious complications like airway blockage or systemic infection.
A peritonsillar abscess, historically called quinsy, occurs when an infection spreads from the tonsils into the surrounding loose connective tissue. While it frequently arises as a complication of untreated or partially treated acute tonsillitis, it can also emerge de novo. The condition is caused by a mix of aerobic and anaerobic bacteria, including Streptococcus, Staphylococcus, and Fusobacterium necrophorum. Patients typically experience a progressively severe sore throat on one side, fever, foul breath, and a distinct distortion of vowels often described as a hot potato voice. A key clinical indicator that distinguishes this from simple tonsillitis is trismus, or a limited ability to open the mouth.
Diagnosis is primarily clinical, based on physical symptoms such as redness, swelling, and the displacement of the uvula toward the unaffected side. While medical imaging like CT scans or ultrasound can help rule out complications, they are not always required. Treatment focuses on removing the pus through needle aspiration, incision and drainage, or in recurring cases, a tonsillectomy. Antibiotics are essential, though clinicians must account for penicillin resistance by using options like amoxicillin/clavulanate or clindamycin. Steroids and pain medication are also commonly employed to manage symptoms.
Though most people recover uneventfully, the condition is considered an ENT emergency. Potential complications are severe, ranging from dehydration due to difficulty swallowing to life-threatening issues like airway compromise or hemorrhage caused by erosion into the carotid sheath. Incidence rates vary globally, with estimates of 30 cases per 100,000 people annually in the United States, 10 per 100,000 in Northern Ireland, and 41 per 100,000 in Denmark. While young adults are most commonly affected, the condition can strike anyone, including children, who may be at higher risk for airway obstruction if immunocompromised.
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Sources
- Summary by Intellect · source: Peritonsillar abscess
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