Peritonsillar abscess
Classification and external resources
ICD-10	J36.
ICD-9	475
DiseasesDB	11141
eMedicine	emerg/417
MeSH	D000039

Peritonsillar abscess, also called quinsy or abbreviated as PTA, is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil (peritonsillar space).

Contents 1 Causes 2 Symptoms and signs 3 Treatment 4 Complications associated with peritonsillar abscess 5 Notable peritonsillar abscess sufferers 6 References 7 External links

[edit] Causes

PTA usually arises as a complication of an untreated or partially treated episode of acute tonsillitis. The infection, in these cases, spreads to the peritonsillar area (peritonsillitis). This region comprises loose connective tissue and is hence susceptible to formation of abscess. PTA can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly involved species include streptococci, staphylococci and hemophilus.

[edit] Symptoms and signs

Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even age spread — from children to adults. Symptoms start appearing 2–8 days before the formation of abscess. Progressively worsening unilateral sore throat and pain during swallowing usually are the earliest symptoms. As the abscess develops, persistent pain in the peritonsillar area, fever, malaise, headache and a distortion of vowels informally known as "hot potato voice" may appear. Neck pain associated with tender, swollen lymph nodes, referred ear pain and halitosis are also common. Whilst these signs may be present in tonsillitis itself, a PTA should be specifically considered if there is limited ability to open the mouth (trismus).

Physical signs include redness and edema in the tonsillar area of the affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced towards the unaffected side. Odynophagia (pain during swallowing), and ipsilateral earache also can occur.

[edit] Treatment

Treatment is, as for all abscesses, through surgical incision and drainage of the pus, thereby relieving the pain of the pressed tissues. The drainage may be performed as an outpatient procedure, using a guarded No. 11 blade in an awake and co-operative patient. More commonly, a needle aspiration using a 9 or 10 gauge needle after a lidocaine and epinephrine gargle is used. Antibiotics are also given to treat the infection. Internationally, the infection is frequently penicillin resistant and for this reason it is now common to treat with clindamycin^[1]. Treatment can also be given while a patient is under anesthesia, but this is usually reserved for children or increasingly agitated or anxious patients.

[edit] Complications associated with peritonsillar abscess

• Parapharyngeal abscess
• Extension of abscess in other deep neck spaces leading to airway compromise
• Septicaemia
• Possible Necrosis of surrounding deep tissues
• In rare cases, Mediastinitis

[edit] Notable peritonsillar abscess sufferers

This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2009)

• Shirkuh died after a severe bout of quinsy
• George Washington is believed to have died of complications arising from quinsy.^[2]
• Pope Adrian IV, died of quinsy
• Michel de Montaigne's quinsy brought about the paralysis of his tongue.
• Georges Bizet
• James Gregory of the band The Ordinary Boys was almost killed by quinsy because it was left untreated
• Brian Sweeney
• George Nock
• Laurence Llewelyn-Bowen described suffering from quinsy as a young man on the BBC programme A Grumpy Guide to Teenagers
• Hector Berlioz
• Thomas Shepard died of quinsy at the age of 44.
• Nur ad-Din died of quinsy at the age of 59.
• Utada Hikaru

[edit] References

[edit] External links

• Practical ENT For Primary Care Physicians web site
• (Detailed description with video clipping)
• Otolaryngology Houston (Pictures of Peritonsillar Abscess)

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