Quinsy, medically known as a peritonsillar abscess, is a bacterial infection resulting in a localized collection of pus near one of the tonsils. It is considered the most common deep infection of the head and neck in adults. The abscess forms in the tissue space surrounding the tonsil, causing significant swelling and discomfort. Quinsy is a serious medical issue that requires prompt attention to prevent potential complications.
A peritonsillar abscess generally develops as a complication of untreated or inadequately treated acute tonsillitis, typically caused by bacteria like Streptococcus pyogenes (Group A strep). The infection begins within the tonsil and spreads beyond the tonsillar capsule into the surrounding loose connective tissue. This space is known as the peritonsillar space.
How Quinsy Develops
The infection often extends from the tonsillar crypts, small pockets on the tonsil’s surface, into the deeper tissue. As the infection progresses, it causes peritonsillitis (severe inflammation) before forming an abscess, which is a pocket of pus. This collection of fluid puts pressure on adjacent structures in the throat.
The abscess is often polymicrobial, containing a combination of aerobic bacteria (such as Staphylococcus species) and anaerobic bacteria. While less frequent, Quinsy can occur without a prior history of tonsillitis. Factors like smoking and chronic gum disease may increase the likelihood of developing this infection.
Distinct Symptoms of a Peritonsillar Abscess
The onset of a peritonsillar abscess is marked by a rapid escalation of symptoms. Patients experience severe throat pain that is worse on one side (unilateral pain), often radiating to the ear on the same side as the abscess.
A characteristic symptom is trismus, the involuntary spasm of the jaw muscles that limits the ability to open the mouth. This occurs because the abscess is near the inflamed pterygoid muscles responsible for jaw movement. The swelling and pain also cause significant difficulty and pain during swallowing (dysphagia or odynophagia).
The abscess mass pushes the soft palate and the uvula away from the affected side. This distortion results in the classic “hot potato voice,” a muffled or guttural speech quality. Patients may also experience fever, chills, and difficulty managing saliva, which can lead to drooling.
Diagnosis and Treatment
Diagnosis is frequently achieved through a clinical examination, where a healthcare provider visually inspects the throat for the unilateral bulge and uvular deviation. To confirm the presence of pus and rule out other deep neck infections, needle aspiration is often performed. This procedure involves inserting a needle into the swollen area to withdraw fluid, serving both a diagnostic and initial therapeutic purpose.
If the diagnosis remains uncertain or the patient has limited mouth opening, imaging like a CT scan or ultrasound may be used to visualize the extent of the abscess. Treatment involves both surgical drainage and high-dose antibiotics. If needle aspiration is insufficient, a doctor may perform an incision and drainage procedure to completely empty the pus collection.
Broad-spectrum antibiotics are started immediately to target the mixed bacterial population, including Group A Streptococcus and oral anaerobes. Commonly prescribed options include agents like clindamycin or amoxicillin-clavulanate. Prompt treatment is necessary because untreated Quinsy can lead to severe complications, such as airway obstruction or the spread of infection into the neck or chest. For patients with recurrent peritonsillar abscesses, a tonsillectomy may be recommended.