PERITONSILLAR ABSCESS

(Quinsy)

An abscess between the tonsil capsule and the lateral wall of the pharynx

Cause

  • Follows (often mild) tonsillitis attack

Clinical features

  • Severe throat pain
  • Fever, headache, malaise, rigors may occur
  • Inability to open the mouth; salivation and dribbling
  • Bad mouth odour
  • Thickened muffled (unclear) speech
  • Ear pain
  • Enlarged cervical lymph nodes
  • Tonsil and soft palate reddish and oedematous
  • Swelling pushing the uvula to opposite side
    • May be pointing (bulging collection of pus)

Differential diagnosis

  • Tumour
  • Tonsillitis
  • Abscess in the pharynx

Investigations

  • Carry out C&S on pus if present or after drainage

MANAGEMENT

Early stages: Disease of adolescents and adults

  • Conservative management
  • Bed rest
  • Adult: Benzylpenicillin 2 MU IV or IM every 6 hours for 48 hours then switch to amoxicillin 500
    mg every 8 hours to complete a total of 7 days

If not better in 48 hours

  • Ceftriaxone 1 g IV once daily for 7 days
    Child: 50 mg/kg IV
  • Plus metronidazole 500 mg IV every 8 hours
    Child: 10 mg/kg IV every 8 hours

If unable to take oral fluids

  • Set up an IV drip e.g. Normal saline

When swelling is marked

  • Surgery (which should be done by a trained person)
    • Suction facility will be needed
    • Carry out incision and drainage at the most pointing area with the protected tip of no.11
      surgical blade
  • 6 weeks later: Refer for tonsillectomy as this condition might recur

Prevention

  • Prompt and adequate treatment of tonsillitis