Peritonsillar Abscess (Quinsy)
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An abscess between the tonsil capsule and the lateral wall of the pharynx
Cause
- Follows (often mild) tonsillitis attack
Clinical features
- Severe throat pain
- Fever, headache, malaise, rigors may occur
- Inability to open the mouth; salivation and dribbling
- Bad mouth odour
- Thickened muffled (unclear) speech
- Ear pain
- Enlarged cervical lymph nodes
- Tonsil and soft palate reddish and oedematous
- Swelling pushing the uvula to opposite side
- May be pointing (bulging collection of pus)
Differential diagnosis
- Tumour
- Tonsillitis
- Abscess in the pharynx
Investigations
- Carry out C&S on pus if present or after drainage
ManagementTreatment
Early stages: Disease of adolescents and adults
- Conservative management
- Bed rest
- Adult: Benzylpenicillin 2 MU IV or IM every 6 hours for 48 hours then switch to amoxicillin 500 mg every 8 hours to complete a total of 7 days
If not better in 48 hours
- Ceftriaxone 1g IV once daily for 7 days
- Child: 50 mg/kg IV
- Plus metronidazole 500 mg IV every 8 hours
- Child: 10 mg/kg IV every 8 hours
If unable to take oral fluids
- Set up an IV drip e.g. Normal saline
When swelling is marked
- Surgery (which should be done by a trained person)
- Suction facility will be needed
- Carry out incision and drainage at the most pointing area with the protected tip of no.11 surgical blade
- 6 weeks later: Refer for tonsillectomy as this condition might recur
Prevention
- Prompt and adequate treatment of tonsillitis