Definition Cause Diagnosis And Treatment Of Peritonsillar Abscess

Peritonsillar Abscess is also commonly known as Quinsy or PTA. Peritonsillar abscess remains the most common deep infection of the head and neck. Many world famous person is believed to died from quinsy. Quinsy is more common in Adults than children. This region comprises loose connective tissue and is thats whyit is susceptible to formation of abscess.

Peritonsillar Abscess is also referred to as “quincy”, “quinsy” or “quinsey”. These are Anglicised versions of the French word esquinancie which was originally rendered as Squinsey and subsequently Quinsy.[Wikipedia]

Peritonsillar space: It is a potential space between the tonsillar capsule medially and superior constrictor muscle laterally.

Peritonsillar Abscess: Collection of Pus in the peritonsillar space between tonsillar capsule and superior constrictor muscle of Pharynx.

Causes of Quinsy:

1. As a complication of an untreated or partially treated episode of acute tonsillitis.
2. Fish bone or Foreign body impaction in tonsil.
3. Can also occur de novo. Both aerobic and anaerobic bacteria can cause this. Commonly involved species include streptococci, staphylococci and hemophylus.

Aetiology of Peritonsillar Abscess:

Symptoms:

Symptoms start appearing two to eight days before the formation of an abscess.

1. Severe unilateral pain in the throat
2. Pyrexia above 103 degree F
3. Unilateral Earache
4. Odynophagia and difficulty to shallow saliva.
5. Trismus is common
6. Change in voice — muffled voice, “hot potato” voice.
7. Intense salivation and dribbling,Thickened speech, Foetor oris, Halitosis
8. Pain in the neck
9. Malaise, Headache, Rigor may occur

Signs:

1. The affected tonsillar area is marked congestion, bulging and oedema of the tonsillar, peritonsillar and palatal region on the affected side. Tonsil may be hidden by the swelling.
2. The uvula is oedematous and pushed to opposite side. The soft palate is also oedematous and may be heaped up with pus.
3. Jugulodigastric lymphnode on the affected side is enlarged and tender.

Complications of Peritonsillar Abscess:

1. Parapharyngeal abscess
2. Oedema of the larynx
3. Retropharyngeal abscess
4. Septicaemia
5. Pneumonia
6. Airway obstruction; Extension of abscess in other deep neck spaces leading to airway compromise.
7. Cellulitis of the jaw, neck, or chest.

Investigations:

• Throat swab for C/S
• Blood for T.C. D.C.

Treatment of Peritonsillar Abscess:

• Patient usually needs to get admitted in Hospital.
• Early Stage/Cellulitic Stage: Needle aspiration with proper analgesia and antibiotics.
• When Abscess Formation: Incision and drainage under L.A in Upright position. The incision is given over the maximum bulging area usually it is the surpratonsillar area OR midway between the base of the uvula and upper third molar teeth. Sinus forceps is used to open the abscess cavity and suction is used.
• Antibiotics Coamoxyclav 600/1200 Mg Three times daily (TID) is used. 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 done in children or anxious patients.
• Anti septic mouth wash is given. Metronidazole is also used.
• Tonsillectomy is advised 4-6 weaks if indicated.

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Category: ENT