Peritonsillar abscess

Peritonsillar abscess (PTA), also known as quinsy, is an accumulation of

PTA is typically due to infection by a number of types of bacteria.^[1] Often it follows streptococcal pharyngitis.^[1] They do not typically occur in those who have had a tonsillectomy.^[1] Diagnosis is usually based on the symptoms.^[1] Medical imaging may be done to rule out complications.^[1]

Treatment is by removing the pus,

Physical signs of a peritonsillar abscess include redness and swelling in the tonsillar area of the affected side and swelling of the jugulodigastric lymph nodes. The uvula may be displaced towards the unaffected side.^[3]

Unlike

While most people recover uneventfully, there is a wide range of possible complications.[4] These may include:^[1]

• Retropharyngeal abscess
• Extension of abscess in other deep neck spaces leading to airway compromise (see Ludwig's angina)
• Airway obstruction
• Aspiration pneumonitis
• Lung abscess (following rupture)
• Sepsis
• Life-threatening
  hemorrhage (following erosion or septic necrosis into the carotid sheath
  of the neck)
• strep throat
  )

Difficulty swallowing can lead to decreased oral intake and dehydration.

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 an abscess. PTA can also occur de novo. Both aerobic and anaerobic bacteria can be causative. Commonly involved aerobic pathogens include Streptococcus, Staphylococcus and Haemophilus. The most common anaerobic species include Fusobacterium necrophorum, Peptostreptococcus, Prevotella species, and Bacteroides.^{[5][6][7][8][9][10]}

Diagnosis

Diagnosis is usually based on the symptoms.

Treatment can also be given while a patient is under anesthesia, but this is usually reserved for children or anxious patients. Tonsillectomy can be indicated if a patient has recurring peritonsillar abscesses or a history of tonsillitis. For patients with their first peritonsillar abscess most ENT-surgeons prefer to "wait and observe" before recommending tonsillectomy.^[14]

Epidemiology

It is a commonly encountered

The number of new cases per year of peritonsillar abscess in the United States has been estimated approximately at 30 cases per 100,000 people.^[15] In a study in Northern Ireland, the number of new cases was 10 cases per 100,000 people per year.^[16] In Denmark, the number of new cases is higher and reaches 41 cases per 100,000 people per year.^[17] Younger children who develop a peritonsillar abscess are often immunocompromised and in them, the infection can cause airway obstruction.^[18]

Etymology

The condition is often referred to as "quincy", "quinsy",^[19] or "quinsey", anglicised versions of the French word esquinancie which was originally rendered as squinsey and subsequently quinsy.^[20]

Notable cases

• Sultan Tekish of Kwarezm^[21]
• Osceola^[22]
• Michel de Montaigne^[23]
• Pope Adrian IV
• 1920 VFL Grand Final
  , but in fact, was in his hometown of Bendigo recovering from quinsy.
• George Washington was believed to have died of complications arising from quinsy, but is now thought to have died from epiglottitis.^[24]
• James Gregory of the band The Ordinary Boys almost died from quinsy because it was left untreated for so long before emergency treatment was started.^[25]
• Eiichiro Oda, author of the best-selling One Piece manga, was hospitalized due to complications.^[26]
• Ian Maclaren died of complications from quinsy while on a lecture tour of the United States.^[27]

The ancient Roman goddess