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Quinsy

Overview
 

Quinsy is a rare condition that sometimes occurs as a complication of acute tonsillitis. It can develop when an infection spreads from a swollen tonsil to the surrounding area.

An abscess develops between the back of one of the tonsils and the wall of the throat. The medical name for quinsy is a peritonsillar abscess.

How common is quinsy?

Quinsy is a condition that occurs infrequently. This is because most people who get tonsillitis receive effective treatment early enough to prevent quinsy from developing.

However, quinsy may be suspected if you have severe tonsillitis or a sore throat that gets worse very quickly. If you have either of these, see your GP as soon as possible.

See Useful links for more information about sore throat and tonsillitis.

Who is affected by quinsy?

Tonsillitis affects children more than adults. Quinsy usually occurs in teenagers and young adults, but can affect younger children.

Causes
 

Streptococcus pyogenes (strep A) is the bacteria most commonly found in samples that are taken from patients with quinsy.

It is not is clear why the infection that leads to quinsy occurs, but the most commonly accepted theory is that an abscess forms following a bout of severe, untreated tonsillitis, or tonsillitis that is not fully treated.

Another theory involves the Weber glands. The Weber glands produce saliva and are located just above the tonsils. They clear debris, such as dead tissue, from the tonsils and surrounding area.

However, if the Weber glands malfunction and cannot clear the build-up of debris from the area around the tonsils, the ducts (tubes) that drain the glands may become swollen, which causes an abscess to form.

Diagnosis
 

You should visit your GP if you have a bad sore throat or severe tonsillitis. They will ask you about your symptoms and examine your throat and tonsils.

If quinsy is suspected, you will be referred immediately to an ear, nose and throat (ENT) specialist who will make a further investigation.

Although quinsy is a rare condition, it is important to diagnose and treat it quickly in order to prevent the infection from spreading.

Treatment

Quinsy is usually treated using a combination of medication and surgery.

Medication

If you are diagnosed with quinsy, you may be prescribed a course of antibiotics to help stop the infection spreading. The antibiotics will usually be given intravenously (directly into a vein) because this method is more effective than taking them orally.

Antibiotics that are often used to treat quinsy include:

  • penicillin,
  • cephalosporins,
  • amoxicillin and clavulanic acid, and
  • clindamycin.

Some studies have shown that as well as using antibiotics, a single dose of intravenous steroids may help to reduce the symptoms of quinsy and speed up the rate of recovery.

If you have quinsy, you may be prescribed an analgesic (painkiller) to ease any pain that you are experiencing. You may be given fluids if you are dehydrated.

Surgery

In most cases of quinsy, antibiotics alone are not an effective treatment and a surgical procedure is also required.

Needle aspiration

A needle aspiration may be used to drain the build-up of fluid from your abscess. The procedure involves using a long, fine needle to draw out the pus. If you have a needle aspiration, you will usually be sedated (given medication to help you relax).

Following the procedure, the fluid that is removed from the abscess will be sent to a laboratory to be tested in order to identify the bacteria that caused the infection.

Incision and drainage

In some cases, an incision (cut) may be made in the affected area to drain the fluid from the abscess.

If incision and drainage is used, you will have a sedative, and you may also have a local anaesthetic (where the affected area is numbed), or general anaesthetic (where you are asleep).

Tonsillectomy

A tonsillectomy is an operation to remove your tonsils. It may be recommended in severe cases of quinsy, or where quinsy keeps returning.

In around 10-15% of cases of quinsy, the abscess reoccurs and, in approximately 90% of recurring cases, it returns within a year. Occasionally, the abscess returns following a tonsillectomy.

Symptoms
 

The symptoms of quinsy are similar to tonsillitis, and they include:

  • a worsening sore throat (usually on one side),
  • a high temperature (fever) of 38ºC (100.4ºF) or above,
  • difficulty opening the mouth (trismus),
  • pain when swallowing,
  • changes to the voice,
  • bad breath,
  • drooling saliva,
  • earache on the affected side,
  • headache and feeling generally unwell, and
  • inflammation (swelling) around the face and neck.