A peritonsillar abscess (also called paratonsillar abscess) is a collection of pus in the space between the tonsil and the superior pharyngeal constrictor muscle.
A peritonsillar abscess is often considered to be a complication of tonsillitis. However, it is now thought to be secondary to infection of a peritonsillar salivary gland (Weber gland) which is located between the tonsillar capsule and the muscle of the tonsillar fossa.
Patients often present with:
Severe sore throat
Odynophagia (painful swallowing) with drooling
Muffled voice ( ‘Hot Potato Voice’)
Difficulty opening mouth (trismus)
Examination often reveals:
Limited mouth opening (trismus), less than three finger width
Unilateral swollen enlarged tonsil with fluctuant swelling extending up to the soft palate (most characteristic)
Deviation of the uvula away from the affected side
Enlarged tender cervical lymph node on the associated side
The patient is usually febrile, and often ‘toxic’ looking
Patients require hospitalisation for rehydration, intravenous antibiotics, analgesia and, in most cases, surgical drainage of the abscess.
Antibiotics need to cover Streptococcus pyogenes and anaerobes
A combination of intravenous Benzylpenicillin and Metronidazole is recommended – Antibiotics
As a rule of thumb, all peritonsillar abscesses should be drained
Generally, children less than 7-10 years of age will not tolerate oropharyngeal procedures under local anaesthetic very well. Needle aspiration or incision and drainage of the abscess under general anaesthesia is usually required.
Patients who are septic and have airway obstruction may be considered for quinsy tonsillectomy.
It is worth noting that in some very young children quinsy tends to resolve with IV antibiotics, hence medical treatment and observation for 24 hours may be worthwhile.