February 03, 2007

Peritonsillar Abscess (Quinsy)


The peritonsillar space lies between each tonsil and the wall of the throat. An infection can cause a pus-filled swelling (abscess) to develop in this space. Peritonsillar abscesses, also called quinsy, usually occur as a complication of tonsillitis. They are most often caused by "strep throat" bacteria (group A beta-hemolytic streptococci).

If a peritonsillar abscess is not treated promptly, the infection can spread to the neck, roof of the mouth and lungs. Swelling can push the tonsil into the center of your throat and move the uvula (the flap of tissue hanging in the back of your throat) from the center toward the unaffected side of your throat. In severe cases, swelling can make breathing difficult or can close your airway.

Peritonsillar abscesses are most often found in older children, adolescents and young adults. They are less common than in the past because tonsillitis is now often treated with antibiotics, which destroy the infection-causing bacteria.

Symptoms include:

A very sore throat
Difficulty swallowing or opening the mouth wide
Swollen glands in the neck
Chills or fever
Swelling of the face
Specific changes in speech, sometimes called "hot potato voice" because it sounds as if you're talking around a mouthful of hot mashed potatoes

Your doctor will examine your throat, mouth and neck, and swab your throat. Material on the swab is sent to the laboratory, which can identify the type of bacteria causing the infection. Your doctor may look at your throat by using a small telescope on flexible lighted tube, called an endoscope. He or she may order an X-ray or computed tomography (CT) scan to better see the extent of infection in the soft tissues of the neck.

Expected Duration
After treatment, symptoms should disappear within five to seven days.

Tonsillitis should be diagnosed and treated as soon as possible to help prevent a peritonsillar abscess from developing.

Your doctor will prescribe antibiotics to treat the infection. In severe infections, antibiotics may be given intravenously (into a vein). Usually, you will need to take antibiotics for at least 10 days. It is important to take all the medication prescribed, even if you start feeling better.

Many abscesses do not respond to antibiotics alone and need to be drained. This can be done with a needle or by making a small incision in the abscess and suctioning out the fluid. This can be done in a doctor's office or emergency room, but occasionally may need to be done in an operating room, especially if the infection has extended down into your neck. Your doctor will provide sedation and pain medication to make you comfortable during this procedure. Because the symptoms make it difficult to eat or drink, some people need intravenous fluids (injected into a vein) to treat or prevent dehydration.

If tonsillitis or a peritonsillar abscess keeps coming back, you may need to have your tonsils surgically removed in a procedure called a tonsillectomy.

When To Call A Professional
Call your doctor if:

You have a severe sore throat, especially with a fever, or have been exposed to someone with strep throat
You have a sore throat combined with difficulty swallowing, a change in voice or swelling of the face
If you have been treated for a peritonsillar abscess, but you still have symptoms after two to three days, visit your doctor again.

Adapted from: Harvard Medical School, InteliHealth