The peritonsillar abscess is a fairly common sequel to chronic tonsillitis and,

more frequently, to acute tonsillitis. The infection penetrates from the depth of a
tonsil crypt into the connective tissue bed of the tonsil causing an inflammatory
process which leads to the formation of an abscess.
Symptoms. The commonest complaint in quinsy is a spontaneously growing
pain. The patient who has just recovered from tonsillitis again feels pain on
swallowing, mostly unilateral and has a rising fever.
Half of the soft palate becomes
markedly red and increasingly swollen, gradually hiding the tonsil and pushing the
edematous uvula to the opposite side (coloured Table III, Fig. 2). The pain is more
severe than in lacunar or (a) anterosuperior peritonsillar abscess, (b) posterior
peritonsillar abscess Line indicates site of incision follicular tonsillitis, and is felt
even when the patient is motionless.

It becomes a sharp shooting pain, frequently radiates to the ear and increases
on swallowing, coughing, or any movement. The mouth is opened with pain and
difficulty and the patient inclines his head towards the sore side. The regional
lymphatic glands on the affected side are often swollen and tender. The almost
complete immobility of the soft palate makes the voice muffled and the
swallowing of food difficult or even impossible.
The abscess forms in the connective tissue bed of the tonsil, commonly
above and before or behind the tonsil. It may also develop in connective tissue at
the lower pole of the tonsil and anteriorly to it.
In the event of an anterosuperior abscess the most marked redness is in the
soft palate and the anterior faucial pillar. An abscess behind the tonsil is identified
by an oval-shaped and extremely tender swelling and redness in the posterior
pillar, with the soft palate and the anterior pillar showing no marked changes. The
abscess comes to a head in five to seven days. Its progress is accompanied by a
characteristic throbbing pain and increased infiltration with softening in a
particular place. Frequently the abscess ruptures through the anterior pillar or
drains above through the tonsil. The opening of the abscess between the anterior
pillar and the edge of the tonsillar capsula is often inadequate for its full
evacuation and should therefore be enlarged to assist recovery.
Diagnosis. Identification of quinsy involves no special difficulties.
Peritonsillar abscess is commonly preceded by tonsillitis where unilateral redness
in the fauces gradually expands, while swelling and increasing pain with a high-
grade fever serve as another pointer to the genuine cause of the condition.
Treatment. This depends on the stage of inflammation. In the beginning, at
the stage of infiltration, it may be possible to abort the process by adequate
sulfonamide therapy in a total dose of 3 to 6 g per 24 hours. In progressive abscess
formation the use of sulfonamides or penicillin in inadequate doses sometimes
retards the process and prevents the ripening of the abscess, whereupon no
regression of inflammation in the peritonsillar connective tissue is seen for two and
even three weeks. Intramuscular injections of penicillin in comparatively large,
50,000-100,000 unit doses given six to eight times per 24 hours bring about a
decided turn for the better already within the first score of hours and full recovery
later. Synthomycin may be substituted for penicillin in 0.5 g doses given in
capsules four times daily during four or five days until complete disappearance of
the inflammatory infiltration. A decrease in inflammatory infiltration often leads to
the formation of a markedly encapsulated abscess, and quick recovery ensues after
this has been lanced. All binds of heat treatment are given to speed up resorption of
the infiltrate and the ripening of the abscess, particularly in cases where antibiotics
are not used. Hot compresses are applied to the neck, as well as inhalations of 2%
baking soda solution with an inhaler once every two or three hours, warm gargles
of diluted boric acid, potassium permanganate, baking soda, etc.
The patient should be given a diet of warm liquid or gruel. Severe pain may
be relieved by aspirin (with caffeine) given in 0.5 g doses several times a day.
Luminal in an 0.1 g dose, or morphine or bromine drugs are given at bedtime.
The ripe abscess may often be opened with a blunt probe or bent forceps via
the supratonsillar fossa upon rupturingthe tonsillar capsule. Incision of an anterior
peritonsillar abscess is made in the anterior faucial pillar, 1 to 2 cm outwards from
its edge, and over the most protruding and softened portion. Where the softened
area cannot be detected, it is recommended that the incision be carried out along
the mid-line between the base of the tongue and the posterior molar to a depth of 1
or 2 cm.

Opening of Anterosuperior Peritonsillar Abscess Through Supratonsillar Fossa
Among the complications of quinsy is hemorrhage due to pus corroding the
walls of the pharyngeal vessels, deep cervical phlegmons, edema of the larynx,
and sepsis.
Prophylaxis. Oral hygiene is extremely important as well as the treatment of
chronic tonsillitis, dental caries and suppurations in the paranasal sinuses. Frequent
recurrence of peritonsillar abscesses necessitates tonsillectomy, i.e. complete
excision of the tonsils three or four weeks after recovery from quinsy.
Where indicated, however, the presence of a peritonsillar abscess is no
obstacle to removal of the faucial tonsils which, in particular, is a prophylactic
against recurrent abscess formation.


Peritonsillar Abscess Treatment and Care at Home
There is no home treatment for peritonsillar abscess. Call your doctor for an immediate
appointment to check your symptoms.
Medical Treatment for a Peritonsillar Abscess
If you have a peritonsillar abscess, the doctor's primary concern will be your breathing and
airway. If your life is in danger because your throat is blocked, the first step may be to insert a
needle in the pus pocket and drain away enough fluid so you can breathe comfortably.
If your life is not in immediate danger, the doctor will make every effort to keep the procedure as
painless as possible. You will receive a local anesthetic (like at the dentist) injected into the skin
over the abscess and, if necessary, pain medicine and sedation through an IV inserted in your
arm. The doctor will use suction to help you avoid swallowing pus and blood.
The doctor has several options for treating you:
o Needle aspiration involves slowly putting a needle into the abscess and
withdrawing the pus into a syringe.
o Incision and drainage involves using a scalpel to make a small cut in the abscess
so pus can drain.
o Acute tonsillectomy (having a surgeon remove your tonsils) may be needed if, for
some reason, you cannot tolerate a drainage procedure, or if you have a history of
frequent tonsillitis.
You will receive an antibiotic. The first dose may be given through an IV. Penicillin is
the best drug for this type of infection, but if you are allergic, tell the doctor so another
antibiotic can be used (other choices may be erythromycin or clindamycin).
If you are healthy and the abscess drains well, you can go home. If you are very ill,
cannot swallow, or have complicating medical problems (such as diabetes), you may be
admitted to the hospital. Young children, who often need general anesthesia for drainage,
frequently require a hospital stay for observation.
Follow-Up for a Peritonsillar Abscess
Arrange follow-up with your doctor or an ear-nose-throat specialist (otolaryngologist) after
treatment for a peritonsillar abscess. Also:
If the abscess starts to return, you may need a different antibiotic or further drainage.
If you develop excessive bleeding or have trouble breathing or swallowing, seek medical
attention immediately.

Prevention of a Peritonsillar Abscess
There is no reliable method for preventing a peritonsillar abscess other than limiting risks: Do
not smoke, maintain good dental hygiene, and promptly treat oral infections.
If you develop a peritonsillar abscess, you may possibly prevent peritonsillar cellulitis by
taking an antibiotic. However, you should be closely monitored for abscess formation and
may even be hospitalized.
If you are likely to form an abscess (for example, if you have tonsillitis frequently), talk
with your doctor about whether you should have your tonsils removed.
As with any prescription, you must finish the full course of the antibiotic even if you feel
better after a few days.
Outlook for a Peritonsillar Abscess
People with an uncomplicated, well-treated peritonsillar abscess usually recover fully. If you
don't have chronic tonsillitis (in which your tonsils regularly become inflamed), the chance of the
abscess returning is only 10%, and removing your tonsils is usually not necessary.
Most complications occur in people with diabetes, in people whose immune systems are
weakened (such as those with AIDS, transplant recipients on immune-suppressing drugs, or
cancer patients), or in those who don't recognize the seriousness of the illness and do not seek
medical attention.
Major complications of a peritonsillar abscess include:

o Airway blockage
o Bleeding from erosion of the abscess into a major blood vessel
o Dehydration from difficulty swallowing
o Infection in the tissues beneath the breastbone
o Pneumonia
o Meningitis
o Sepsis (bacteria in the bloodstream)