ED Two Minute Update
Quinsy, also known as a peritonsillar abscess (PTA), is a potentially serious complication of tonsillitis. The abscess (a collection of pus) forms between one of the tonsils and the wall of the throat. This can happen when a bacterial infection spreads from an infected tonsil to the surrounding area. Quinsy can occur at any age, but most commonly affects teenagers and young adults. It's possible to get it more than once.
Symptoms start appearing two to eight days before the formation of an abscess. A progressively severe sore throat on one side and pain during swallowing usually are the earliest symptoms. As the abscess develops, persistent pain in the peritonsillar area, fever, a general sense of feeling unwell, 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 foul breath 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. Physical signs of a peritonsillar abscess include redness and swelling in the tonsillar area of the affected side. The uvula may be displaced towards the unaffected side. Treatment • Intravenous fluids may be required to correct dehydration. • Analgesia should be prescribed (Paracetamol and NSAID) • Intravenous antibiotics - Penicillin, cephalosporins and clindamycin are all appropriate antibiotics. Metronidazole plus penicillin may be helpful in selected cases • Studies have also shown that the use of single-dose intravenous steroids as well as antibiotics may be beneficial] They may help to reduce symptoms and to speed recovery In many cases, antibiotics alone are not effective, and it may be necessary to drain the pus from the abscess. This can be done by: • needle aspiration – a long, fine needle is used to draw out the pus • incision and drainage – a small cut (incision) is made over the affected area to drain the pus body of text
• Bloods – FBC, U+E, CRP. • Monospot
• Pain relief
• Encourage oral fluids as patient is able to tolerate
• Use of mouth wash for discharge.
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