What is a peritonsillar abscess?
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Quinsy, also known as a peritonsillar abscess, is a complication of tonsillitis that is left untreated.
The abscess (collection of pus) forms between one of your tonsils and the wall of your throat. This can happen when an infection spreads from an infected tonsil to the surrounding area.
Read more information about the causes of quinsy.
Symptoms of quinsy can include:
- a worsening sore throat, usually on one side
- a high temperature of 38C (100.4F) or above
- difficulty opening your mouth
- pain when swallowing
- difficulty swallowing, which may lead to drooling saliva
- changes to your voice or difficulty speaking
- bad breath
- earache on the affected side
- headache and feeling generally unwell
- swelling around your face and neck
When to see your doctor
You should see your doctor if you have:
- a bad sore throat, or one that gets worse very quickly
- severe tonsillitis (infection of the tonsils)
Your doctor will ask you about your symptoms and examine your throat and tonsils. Your tonsils are the two small glands found at the back of your throat, behind your tongue.
If quinsy is suspected, you will be referred immediately to an ear, nose and throat specialist who will carry out further investigations. You may be admitted to hospital immediately if you have severe quinsy.
It is important that quinsy is diagnosed and treated quickly to prevent the infection from spreading.
If the abscess grows large enough, it can block your airways and cause breathing difficulties. Therefore, it is important treatment is started as soon as possible.
Antibiotics will be recommended to clear the infection and painkillers used to deal with any pain. Pus from the abscess may need to be drained. This may involve having a minor surgical procedure carried out under anaesthetic in hospital.
Read more information about how quinsy is treated.
The best way to prevent tonsillitis is to avoid close contact with people who have the viral or bacterial infections that cause the condition.
For example, do not share a toothbrush with someone who has tonsillitis and avoid using the same eating and drinking utensils. Maintain a high level of hygiene by washing your hands regularly with soap and hot water.
Smoking could also possibly increase your risk of quinsy. Read about quitting smoking for information and advice about giving up smoking.
How common is quinsy?
Quinsy is not common. This is because most people with tonsillitis have effective treatment early enough to prevent quinsy from developing. For every 100,000 people with a sore throat, 96 may develop quinsy.
Quinsy most commonly occurs in teenagers and young adults.
Peritonsillar abscess causes
Quinsy, also known as a peritonsillar abscess, is caused by an infection. Several bacteria can cause quinsy, but the most common are Haemophilus influenzae and streptococcus bacteria, particularly Streptococcus pyogenes.
It is not clear why the infection that leads to quinsy occurs, but the most commonly accepted theory is that the abscess (collection of pus) forms after a bout of severe, untreated tonsillitis, or tonsillitis that is not fully treated.
Another theory about the causes of quinsy involves the Weber glands. The Weber glands produce secretions and are located just above the tonsils. They clear debris, such as dead tissue, from the tonsils and surrounding area.
If the Weber glands malfunction and cannot clear the build-up of debris from the area around the tonsils, tubes that drain the glands may become swollen. This can cause an infection to develop, which gets worse and causes an abscess to form.
Factors that may increase your risk of developing quinsy after having a sore throat include:
- having diabetes
- having an immune system that is less able to fight infections, for example if you have HIV
Treatment for a peritonsillar abscess
Quinsy, also known as a peritonsillar abscess, is usually treated with a combination of medication and surgery.
If you are diagnosed with quinsy, you will be prescribed a course of antibiotics to treat the infection. The antibiotics will usually be given directly into a vein (intravenously). This method is more effective than taking antibiotics tablets.
Antibiotics often used to treat quinsy include:
- phenoxymethylpenicillin, also called penicillin V - a type of penicillin
- clarithromycin, if you are allergic to penicillin
Several different antibiotics are available. The choice will depend on the type of bacteria causing your infection and what medicines suit you best. For example, some types of medication may not be suitable if you have another medical condition, such as liver or kidney problems.
Some types of antibiotics may interact with some types of contraception, such as the combined contraceptive pill. If this affects you, the healthcare professionals treating you will advise about which other contraception is suitable to use during this time.
Corticosteroids are medicines that contain steroids, a type of hormone. They help reduce swelling and may be used to treat quinsy. If you have a severe sore throat or severe difficulty swallowing, corticosteroids may be considered.
Studies have found that corticosteroids are a safe and effective method of treating quinsy.
In most cases of quinsy, antibiotics alone are not an effective treatment, and a surgical procedure is also required. Procedures that may be used include:
- needle aspiration
- incision and drainage
These are briefly described below.
Needle aspiration may be used to drain the build-up of fluid from the abscess. The procedure involves using a long, fine needle to draw out the pus. If you have needle aspiration, you will usually be given medication called a sedative to help you relax, or a local anaesthetic may be used to numb the area so you do not feel any pain.
After the procedure, fluid removed from the abscess will be sent to a laboratory to identify the bacteria that caused the infection.
Incision and drainage
In some cases, a cut will be made in the affected area to drain the fluid from the abscess. This is called incision and drainage.
Incision and drainage is performed either under sedation to relax you, local anaesthetic to numb the area, or general anaesthetic to put you to sleep.
A tonsillectomy is an operation to remove your tonsils. These are the two small glands found at the back of your throat, behind your tongue. A tonsillectomy may be recommended in severe cases of quinsy or if you have recurring bouts of sore throats.
Read about how tonsillitis is treated for more information about tonsillectomies.
Depending on how severe your infection is, you may need to spend two to four days being treated for quinsy in hospital.
During this time, medicines and fluids will be given to you through a drip in your arm.
After leaving hospital, you may need to rest at home for up to a week. You will probably be given antibiotics and painkillers to take at home.