Quinsy
Quinsy, also known as peritonsillar abscess, is a rare medical condition that typically arises in young adults following severe tonsillitis. It is characterized by the formation of an abscess in the peritonsillar space, often due to a bacterial infection, primarily from streptococci. Common symptoms include a tender throat, fever, chills, painful swallowing, and in some cases, difficulty opening the mouth, known as trismus. Patients may also experience facial swelling, drooling, hoarseness, and bad breath.
Preventive measures often involve the use of antibiotics during episodes of tonsillitis to avoid the spread of infection. When quinsy occurs, it is diagnosed through a physical examination and possibly imaging if necessary. Treatment typically includes draining the abscess either through incision or needle aspiration, with tonsillectomy considered only if other treatments fail. While most patients recover, there is a risk of complications such as pneumonia and meningitis, necessitating prompt medical attention for severe symptoms. Historically, the term "quinsy" has roots in ancient Greek references to throat abscesses and has been part of medical literature since the 14th century.
Quinsy
ALSO KNOWN AS: Peritonsillar abscess
ANATOMY OR SYSTEM AFFECTED: Glands, lungs, mouth, throat
DEFINITION: An abscess usually forming in the peritonsillar space behind the tonsils
CAUSES: Spread of bacterial infection (usually streptococci) after extreme tonsillitis
SYMPTOMS: Pus-filled tissues in throat, swollen tonsils, sometimes infection of palate and lungs, fever, chills, tender throat glands, painful swallowing, facial swelling, drooling, hoarseness, bad breath, earache, headache, fatigue; complications may include pneumonia, meningitis, heart inflammation, fluid surrounding lungs
DURATION: Acute, sometimes recurrent
TREATMENTS: Prevention through antibiotics, abscess drainage, tonsillectomy if needed
Causes and Symptoms
Quinsy, also called peritonsillar abscess, is a rare disorder. Medical professionals most often diagnose the condition in young adults. Primarily after extreme tonsillitis, bacterial infections (usually streptococci) spread from one or both to adjacent tissues, which become pus-filled. In addition to the throat, the infection may cover the palate and extend to the lungs, potentially blocking the airway.
Patients develop a fever and tender throat glands. Some people experience chills. Because swollen tonsils shift and push the uvula aside, patients often are unable to open their mouths normally, a condition known as trismus, and swallowing is painful. Patients sometimes lean their heads in the direction of the abscess. Other symptoms include swelling of facial tissues, drooling, fatigue, earache, and headache. Some patients become hoarse and have foul breath.
Quinsy is often prevented because patients with are administered antibiotics and are monitored to stop infections from spreading. A person who has had tonsillitis and who develops symptoms of quinsy should consult health care professionals. Sore throats that do not heal with antibiotics or that become worse alert physicians to the possibility of quinsy.
Medical professionals evaluate patients for quinsy by examining the tonsils for swelling and abnormal reddening of the mouth, throat, and chest tissues. In some cases of quinsy, the tonsils may appear normal. Samples of aspirated are examined for bacteria. Ultrasound or computer imaging is used if patients cannot open their mouths.
Treatment and Therapy
Physicians are divided on the preferred treatment for quinsy. Surgical procedures involve draining pus from abscesses through incisions or needle aspiration. Studies have shown that incision drainage is effective at stopping quinsy and that needle is more likely to result in additional abscessing. Tonsillectomy specifically for quinsy is usually advised only if no other treatments are effective. Approximately 10 to 15 percent of patients undergoing treatment experience recurring quinsy.
Emergency surgery is necessary if quinsy affects breathing. Other possible complications include pneumonia, meningitis, heart (pericarditis), and fluid surrounding the (pleural effusion). Rarely, quinsy patients develop endocarditis, a bacterial infection of the heart. Quinsy patients should seek medical care if they have chest pains, coughing, or breathing complications.
Perspective and Prospects
The word “quinsy” is based on references made by the ancient Greeks to abscessed throats. As early as the fourteenth century, medical literature included details about the peritonsillar space. The term quinsy was appropriated after that time to describe sore throats and tonsils. Modern physicians disproved claims that President George Washington died from quinsy, as contemporary sources had claimed. Since the 1980s, researchers have been evaluating the most effective treatments for quinsy. The Haemophilus influenzae type b vaccine, first administered in 1987, has minimized quinsy occurrence.
Bibliography
Ben-Joseph, Elana Pearl. "What Is a Peritonsillar Abscess?" TeensHealth. Nemours Foundation, Mar. 2023, kidshealth.org/en/teens/peritonsillar-abscess.html. Web. Accessed 8 Aug. 2023.
Bluestone, Charles D., et al., eds. Pediatric Otolaryngology. 4th ed. 2 vols. Philadelphia: W. B. Saunders, 2003.
Gleeson, Michael, et al, ed. Scott-Brown’s Otolaryngology: Head and Neck Surgery. 7th ed. Boston: Butterworth-Heinemann, 2008.
Litin, Scott C., ed. Mayo Clinic Family Health Book. 4th ed. New York: HarperResource, 2009.
Neff, Deanna M., and Michael Woods. "Peritonsillar Abscess." Health Library, Mar. 15, 2013.
Orobello, Nicklas C., et al. "Predicting Failure of Detection of Peritonsillar Abscess with Ultrasound in Pediatric Populations." American Journal of Otolaryngology, vol. 45, no. 1, 2024. DOI: 10.1016/j.amjoto.2023.104021. Accessed 8 Apr. 2024.
Schwartz, Seth, et al. "Peritonsillar Abscess." MedlinePlus, 29 Nov. 2022, medlineplus.gov/ency/article/000986.htm. Web. Accessed 8 Aug. 2023.
Woodson, Gayle E. Ear, Nose, and Throat Disorders in Primary Care. Philadelphia: W. B. Saunders, 2001.