Peritonsillar abscess

Peritonsillar abscess, also called PTA or Quinsy, is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil (peritonsillar space).

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Causes

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.

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 2-8 days before the formation of 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 change in voice (commonly called "hot potato voice", as it may sound that the patient is attempting to talk with a mouth half-full of mashed potatoes) may appear. Neck pain associated with tender, swollen lymph nodes, referred ear pain and breath odour are also common. Whilst these signs may be present in tonsillitis itself, a PTA should be specifically considered if there is limited ability to open the mouth (trismus).

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.

Treatment

Treatment is, as for all abscesses, through surgical incision and drainage of the pus, thereby relieving the pain of the stretched tissues. The drainage can often be achieved in the Outpatient Department using a guarded No. 11 blade in an awake and co-operative patient. Sometimes, a needle aspiration can suffice. Antibiotics are also given to treat the infection.

Peritonsillar abscesses are widely considered one of the most painful complications, primarily the surgical draining of the abscess itself. The patient is often operated on awake, surgically slicing open the abscess and clearing the drainage with suction.

Treatment can also be given while a patient is under anesthesia, but this is usually reserved for children or increasingly agitated or anxious patients.

Complications Associated With Peritonsillar Abscess

• Parapharyngeal abscess
• Extension of abscess in other deep neck spaces leading to airway compromise
• Septicaemia
• Possible Necrosis of surrounding deep tissues
• In rare cases, Mediastinitis

Notable Peritonsillar Abscess (Quinsy) sufferers

• George Washington is believed to have died of complications arising from Quinsy.^[1]
• Michel de Montaigne's quinsy brought about the paralysis of his tongue.
• Georges Bizet
• James Gregory of the band The Ordinary Boys was almost killed by quinsy because it was left untreated
• Brian Sweeney
• Alan Burrows
• Laurence Llewelyn-Bowen described suffering from quinsy as a young man on the BBC programme A Grumpy Guide to Teenagers

Dan Gee

References

1. ^ Mount Vernon Plantation (2006). Part 4. President and Back Home. Meet George Washington. Mount Vernon Ladies Association.

• (Detailed description with video clipping)