Peritonsillar abscess

Peritonsillar abscess

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Peritonsillar abscess also called a quinsy or abbreviated as PTA is a recognised complication of tonsillitis
Tonsillitis
Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While no treatment has been found to shorten the duration of viral tonsillitis, bacterial causes are treatable with antibiotics...

 and consists of a collection of pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...

 beside the tonsil
Tonsil
Palatine tonsils, occasionally called the faucial tonsils, are the tonsils that can be seen on the left and right sides at the back of the throat....

 (peritonsillar space).

Symptoms and signs


Unlike tonsillitis
Tonsillitis
Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While no treatment has been found to shorten the duration of viral tonsillitis, bacterial causes are treatable with antibiotics...

, which is more common in the pediatric age group, PTA has a more even age spread — from children to adults.
Symptoms start appearing two to eight days before the formation of an abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

. 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 node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...

s, referred ear pain and halitosis are also common. While these signs may be present in tonsillitis itself, a PTA should be specifically considered if there is limited ability to open the mouth (trismus
Trismus
-Common causes:*Pericoronitis is the most common cause of trismus.*Inflammation of muscles of mastication. It is a frequent sequel to surgical removal of mandibular third molars . The condition is usually resolved on its own in 10–14 days, during which time eating and oral hygiene are compromised...

).

Physical signs include redness and edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...

 in the tonsillar area of the affected side and swelling of the jugulodigastric lymph node
Jugulodigastric lymph node
The jugulodigastric lymph node is a large node found in the proximity of where the posterior belly of the digastric muscle crosses the internal jugular vein....

s. The uvula
Uvula
The palatine uvula, usually referred to as simply the uvula , is the conic projection from the posterior edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers .-Function in language:The uvula plays a role in the...

 may be displaced towards the unaffected side. Odynophagia
Odynophagia
Odynophagia is painful swallowing, in the mouth or esophagus. It can occur with or without dysphagia, or difficult swallowing....

 (pain during swallowing), and ipsilateral earache also can occur.

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
De novo
In general usage, de novo is a Latin expression meaning "from the beginning," "afresh," "anew," "beginning again." It is used in:* De novo transcriptome assembly, the method of creating a transcriptome without a reference genome...

.
Both aerobic and anaerobic bacteria can be causative. Commonly involved species include streptococci, staphylococci and hemophilus.

Treatment


Treatment is, as for all abscesses, through surgical incision and drainage of the pus, thereby relieving the pain of the pressed tissues. Antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...

s are also given to treat the infection. Internationally, the infection is frequently penicillin resistant, so it is now common to treat with clindamycin
Clindamycin
Clindamycin rINN is a lincosamide antibiotic. It is usually used to treat infections with anaerobic bacteria but can also be used to treat some protozoal diseases, such as malaria...

. Treatment can also be given while a patient is under anesthesia, but this is usually reserved for children or anxious patients.

Complications

  • Retropharyngeal abscess
    Retropharyngeal abscess
    Most commonly seen in infants and young children, retropharyngeal abscess is an abscess located in the tissues in the back of the throat behind the posterior pharyngeal wall . Because RPA's typically occur in deep tissue, they are difficult to diagnose by physical examination alone...

  • Extension of abscess in other deep neck spaces leading to airway compromise. See Ludwig's angina
    Ludwig's angina
    Ludwig's angina, otherwise known as angina ludovici, is a serious, potentially life-threatening cellulitis, or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections. It is named after the German physician, Wilhelm Friedrich von Ludwig...

  • Septicaemia
  • Possible necrosis
    Necrosis
    Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...

     of surrounding deep tissues
  • In rare cases, mediastinitis
    Mediastinitis
    Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic.Acute mediastinitis is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition...


Naming


The condition Peritonsillar Abscess is also referred to as "quincy." quinsy or quinsey or quincy is really the Anglofied version of the French word esquinancie which was originally converted to Squinsey and later on Quinsy.

Notable cases

  • Sultan Tekish of Kwarezm
  • George Washington
    George Washington
    George Washington was the dominant military and political leader of the new United States of America from 1775 to 1799. He led the American victory over Great Britain in the American Revolutionary War as commander-in-chief of the Continental Army from 1775 to 1783, and presided over the writing of...

     is believed to have died of complications arising from quinsy.
  • James Gregory of the band The Ordinary Boys
    The Ordinary Boys
    The Ordinary Boys are an English indie rock band from Worthing, in West Sussex, England. Originally named Next in Line, they were influenced by mod revival and Britpop music, as well as the bands Madness, The Specials, The Kinks and The Smiths...

     almost died from quinsy because it was left untreated for so long before emergency treatment was started.
  • Osceola
    Osceola
    Osceola, also known as Billy Powell , became an influential leader with the Seminole in Florida. He was of Creek, Scots-Irish and English parentage, and had migrated to Florida with his mother after the defeat of the Creek in 1814.Osceola led a small band of warriors in the Seminole resistance...

  • Michel de Montaigne
    Michel de Montaigne
    Lord Michel Eyquem de Montaigne , February 28, 1533 – September 13, 1592, was one of the most influential writers of the French Renaissance, known for popularising the essay as a literary genre and is popularly thought of as the father of Modern Skepticism...


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