74 - Quinsy -peritonsilar abscess

KYJ 74 - Quinsy (peritonsilar abscess).

Looking in throats is an in exact science, but with some understanding of some basic terms, it can be a simple part of an ENT assessment.

In the walls of the back of the mouth, beneath the uvula and adjacent to the tongue, lay the tonsils.  These structures are lymphatic tissue with a unique capacity to filter lymph fluid.  The tonsils harbour mature and immature lymphocytes and neutrophils.  When deep caverns in their surface called "crypts" fill with pus, the patient is diagnosed with follicular  tonsillitis.  Usually bacterial, follicular tonsillitis differs from inflammation alone seen in URTI.

While tonsils frequently become inflamed (tonsillitis), it is only when pus forms (follicular tonsillitis) that it is usually considered bacterial.  It is only then, that antibiotics are considered as an adjunct to management.

Inflamed tonsils swell and as they do, they occasionally meet in the oropharynx, threatening airway obstruction.

Occasionally an abscess forms in behind one of the tonsils, this is called a peritonsilar abscess (PTA) or Qunisy .  It is considered a surgical emergency.

Recognising this potentially life threatening condition and being able to differentiate it from tonsillitis is important.  The fundamental difference is speed of presentation.  Quincy develops fast; in hours.

In Quinsy, the throat pain is usually unilateral, and much worse if the patient tries to open their mouth. Sometimes they have earache on the affected side.
The breath is foetid, and other lymph nodes in the neck are often tender (lymphadenopathy).  The patient's voice is often muffled and has been described as "hot potato voice", or "mouth full of marbles"
They often can't swallow (even saliva), and will often drool.
They will be febrile above 39.5C.

The management, like any abscess is Cut n drain.
Incision and drainage followed up with antibiotics.  As many PTAs are resistant to penicillins, a macrolide like Clindamycin are used post op.

Rarely is tonsillectomy used these days. This goes for tonsillitis also.

Quinsy is an emergency, and airway patency is the top priority.

Remember :  FLU SHAVE

Febrile
Lymphadenopathy
Unilateral pain

Swallowing difficulty
Halitosis
Acute onset
Voice change
Energy depleted (lethargic)