Peritonsillar Abscess (Quinsy): Symptoms, Urgency and Treatment

01Basics

What is quinsy?

MedlinePlus defines a peritonsillar abscess as a collection of infected material in the area around the tonsils. The NHS leaflet from University Hospitals Dorset describes it as a pus-filled pocket that forms near one of the tonsils. Quinsy is the traditional name for the same condition.

Both sources say it is usually a complication of tonsillitis, although the leaflet notes this is not always the case. According to MedlinePlus it most often affects older children, teenagers and young adults, and it has become rare since antibiotics have been used to treat tonsillitis.

02Symptoms

Pain and other symptoms

The infection starts in one or both tonsils and spreads into the surrounding tissue. Symptoms listed by the two sources include:

• severe throat pain, usually on one side
• fever and chills
• ear pain on the same side as the abscess, and headache
• difficulty opening the mouth, and pain when opening it
• difficulty swallowing, drooling or being unable to swallow saliva
• swelling of the face or neck and tender glands in the jaw and throat
• a muffled or changed voice
• neck stiffness

A sore throat on one side has many possible causes; our guide to a sore throat on one side covers the more common ones. What points toward quinsy is the combination of worsening one-sided pain with trouble opening the mouth or swallowing.

04Causes

Causes and associated factors

MedlinePlus says peritonsillar abscess is most often caused by group A beta-hemolytic streptococcus, the bacteria behind many cases of strep throat. The NHS leaflet likewise notes it is often caused by the same bacteria that cause strep throat.

Because it usually follows tonsillitis, MedlinePlus states that prompt treatment of tonsillitis, especially when bacterial, may help prevent it. The leaflet also advises avoiding alcohol and smoking during recovery and suggests considering stopping smoking.

05Differences

How it differs from tonsillitis

In tonsillitis the infection affects the tonsils themselves. In a peritonsillar abscess it has spread into the tissue around a tonsil and formed a pocket of pus. MedlinePlus explains that the infection can be treated with antibiotics if it is caught early, but once an abscess has developed it needs to be drained.

On examination, MedlinePlus notes that the throat often shows swelling on one side and on the roof of the mouth, and that the uvula may be pushed away from the swelling. The leaflet also lists a tonsil pushing the uvula to one side. These are findings a clinician looks for; you do not need to see them yourself before seeking care. Our guides on tonsillitis treatment and swollen tonsils cover the uncomplicated forms.

06Assessment

Clinical assessment

Diagnosis begins with a look at the throat. MedlinePlus lists tests that may be done: aspiration of the abscess with a needle, a CT scan, and fiberoptic endoscopy to check whether the airway is blocked. The NHS leaflet adds blood tests to check infection markers.

If you are seen urgently, it helps to tell the team when the sore throat started and how it has changed, whether you can swallow liquids and saliva, any medicines you take and any allergies, especially to antibiotics, and whether you have already been treated for tonsillitis. Gathering this should never delay going in.

07Treatment

Antibiotics and professional drainage

According to MedlinePlus, antibiotics can treat the infection if it is caught early; an established abscess needs to be drained with a needle or by cutting it open, after pain relief. In rare, very severe cases the tonsils are removed at the same time, under general anesthesia.

The NHS leaflet describes care in a same-day emergency ENT clinic: blood tests, possibly antibiotics, fluids or steroids through a drip, and drainage after a numbing spray and local anesthetic. The team aims to send people home the same day, though some need admission. Drainage is a medical procedure and must never be attempted at home.

08Recovery

Fluids, pain relief and rest

The NHS leaflet gives discharge advice:

• if antibiotics are prescribed, complete the full course
• take the pain relief you are advised to take
• eat as normal and drink plenty
• rest for around a week
• avoid alcohol and smoking

If you get worse after going home, the leaflet advises contacting the hospital team or attending the emergency department, and attending immediately if you have difficulty breathing.

09Sources

Where the sources differ

Link with tonsillitis. MedlinePlus presents peritonsillar abscess as a complication of tonsillitis. The NHS leaflet agrees it usually is, but adds that this is not always the case.

Detail of treatment. MedlinePlus summarizes treatment as antibiotics early, drainage once an abscess forms, and rare removal of the tonsils. The NHS leaflet describes one hospital pathway, with drip antibiotics, fluids or steroids, same-day discharge where possible and follow-up in some cases. Local practice varies, so the team treating you decides.

Recurrence. MedlinePlus says most cases go away with treatment but the infection may return; the leaflet does not give a recurrence figure. Neither source offers a personal prediction.

10Summary

In summary

A peritonsillar abscess, or quinsy, is a collection of pus beside a tonsil, usually after tonsillitis. Severe one-sided throat pain, fever, ear pain, difficulty opening the mouth or swallowing, drooling and a muffled voice are typical. Breathing difficulty, stridor or being unable to swallow saliva is an emergency.

Treatment is antibiotics if caught early and professional drainage once an abscess has formed. Recovery involves completing any antibiotic course, pain relief, fluids and rest. It can come back, so new symptoms should be checked again. In our ENT practice in Bilbao we can assess recurring throat problems in adults outside an emergency (consultations are in Spanish).