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Right sided peritonsillar abscess
Peritonsillar abscess (PTA), also known as a quinsy or quinsey, is a recognized complication of tonsillitis and consists of a collection of pus beside the tonsil in what is referred to as Peritonsilar space (Peri - meaning surrounding). It is a commonly encountered otorhinolaryngological (ENT) emergency. However, it has been shown to be safe to "wait and observe" as a mode of treatment.
Symptoms and signs
Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even age spread — from children to adults. Symptoms start appearing two to eight days before the formation of an abscess. Progressively worsening, unilateral sore throat and pain during swallowing usually are the earliest symptoms. As the abscess develops, persistent pain in the peritonsillar area, fever, malaise, headache and a distortion of vowels informally known as "hot potato voice" may appear. Neck pain associated with tender, swollen lymph nodes, referred ear pain and halitosis are also common. While these signs may be present in tonsillitis itself, a PTA should be specifically considered if there is limited ability to open the mouth (trismus). In short:
- Severe unilateral pain in the throat;
- Pyrexia above 103 degree F (39°C);
- Unilateral Earache;
- Odynophagia and difficulty swallowing saliva;
- Change in voice — muffled voice, “hot potato” voice;
- Intense salivation and dribbling,Thickened speech, Foetor oris, Halitosis;
- Pain in the neck;
- Malaise, Headache, Rigor.*
Trismus is common. Physical signs include redness and edema in the tonsillar area of the affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced towards the unaffected side. Odynophagia (pain during swallowing), and ipsilateral earache also can occur.
PTA usually arises as a complication of an untreated or partially treated episode of acute tonsillitis. The infection, in these cases, spreads to the peritonsillar area (peritonsillitis). This region comprises loose connective tissue and is hence susceptible to formation of abscess. PTA can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly involved species include streptococci, staphylococci and hemophilus.
Treatment is surgical incision and drainage of the pus, thereby relieving the pain of the pressed tissues. Antibiotics are also given to treat the infection. Internationally, the infection is frequently penicillin resistant, so it is now common to treat with clindamycin. Treatment can also be given while a patient is under anesthesia, but this is usually reserved for children or anxious patients. Tonsillectomy can be indicated if a patient has recurring peritonsillar abscesses or a history of tonsillitis. For patients with their first peritonsillar abscess most ENT-surgeons favour to "wait and observe" before surgery.
- Retropharyngeal abscess;
- Extension of abscess in other deep neck spaces leading to airway compromise. See Ludwig's angina;
- Possible necrosis of surrounding deep tissues;
- In rare cases, mediastinitis.
The condition Peritonsillar Abscess is also referred to as "quincy", "quinsy" or "quinsey". These terms are Anglicised versions of the French word esquinancie which was originally rendered as Squinsey and subsequently Quinsy.
- George Washington was believed to have died of complications arising from quinsy, but is now thought to have died from epiglottitis.
- James Gregory of the band The Ordinary Boys almost died from quinsy because it was left untreated for so long before emergency treatment was started.
- Eiichiro Oda, author of the best-selling One Piece manga, was hospitalized due to complications. .
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- "PERITONSILLITIS (PERITONSILLAR CELLULITIS AND PERITONSILLAR ABSCESS)". Marx: Rosen's Emergency Medicine, 7th ed. Mosby, An Imprint of Elsevier. 2009. Retrieved 8 July 2013.
- Richard Gleason Greene (1890). The International cyclopedia: a compendium of human knowledge, Volume 12. Dodd, Mead. pp. 355–6.
- Juvaini, Ala-ad-Din Ata-Malik (1997). History of the World Conqueror. Manchester U.K.: Manchester University Press. p. 314.
- Wickman, Patricia Riles (2006). Osceola's Legacy. University of Alabama Press. p. 144.
- Montaigne, Michel de, Essays of Michel de Montaigne, tr. Charles Cotton, ed. William Carew Hazlitt, 1877, "The Life of Montaigne" in v. 1. n.p., Kindle edition.
- Mount Vernon Plantation (2006). "Part 4. President and Back Home". Meet George Washington. Mount Vernon Ladies Association. Retrieved 2006.
- "Ordinary Boys reveal illness that caused V cancellation". August 21, 2006. Retrieved August 7, 2010.
- "NEWS: One Piece on Break". Viz Media. Retrieved 2013-05-21.
- Otolaryngology Houston (Pictures of Peritonsillar Abscess)
- Definition Cause Diagnosis And Treatment Of Peritonsillar Abscess