Quinsy is another name for a peritonsillar abscess, a collection of pus in the back of the throat between the tonsils. The loose connective tissue in this area is highly susceptible to abscesses when an infection develops. Quinsy is the most common infection of this area that brings people to the emergency room, affecting about one in 10,000.
Quincy usually occurs after tonsillitis, but mononucleosis can also cause it. It rarely develops without a history of a sore throat or a throat infection, though chronic dental problems and smoking might also bring it on. Strep is the most common bacteria that causes quinsy, but not the only one.
Prevalence and Risk Factors
Quinsy is most common in teenagers. It can occur at any age, but it is rare in children under 5. It affects males and females at about the same rate, and does not appear to affect any ethnicity more than another. One study shows that the biggest risk factor to developing quinsy is smoking, possibly because smoking alters the natural flora in the back of the throat.
Symptoms begin gradually with the onset of a one-sided sore throat, difficulty swallowing, fever, and swollen lymph nodes in the neck on the affected side. Some people with quinsy have so-called hot potato voice, where the affected person talks as if they have hot food in their mouth. Other possible symptoms include drooling, bad breath, and redness.
Doctors diagnose quinsy through physical exam, looking for swelling on one side of the throat, an enlarged tonsil, or a bulge on the soft palate. Lab work may show elevated white blood cells, and tests of the pus from the abscess identify the cause of the infection. Young patients may benefit from a CT scan to check for complications.
Unless the abscess is very small, draining it is a key part of treatment. The doctor may do needle aspiration, using a needle to puncture the abscess and a syringe to withdraw the pus. In some cases, doctors use ultrasound during a needle aspiration to better view the abscess. The doctor may need to make an incision to drain the abscess instead of using a needle and syringe in some cases. These procedures are generally performed in the hospital so any complications with breathing can be quickly and safely corrected.
Tonsillectomy was a routine treatment for quinsy in the past. In some cases, doctors still consider immediate tonsillectomy, but as removing the tonsils still leaves patients with a 40 percent chance of getting quinsy again, this treatment is usually reserved for patients with a history of frequent bouts of tonsillitis. Tonsillectomy is also commonly considered in children as they are more prone to recurrent episodes of tonsillitis.
Inpatient vs Outpatient
Most people with quinsy are outpatients, but this is not always the case. Hospital admission is necessary for those experiencing dehydration who cannot take in enough liquids by mouth or if the airway is swollen and they have breathing difficulties. The average hospital stay for a patient with quinsy is two to four days.Those managed as outpatients are observed for several hours after the abscess is drained to ensure they can tolerate liquids by mouth. They normally have a follow-up appointment within two or three days.
Risk of Complication
Complications are rare, but they can happen to anyone. Some populations are more likely to develop them. Males older than 40 have the highest risk, even after treatment with draining and antibiotics. Some bacteria are more likely to cause complications, too, particularly strep.
Complications generally occur from the infection spreading. Acute epiglottitis — swelling of the flap that prevents food from entering the airway when swallowing — is one possible life-threatening complication. Studies show epiglottitis usually responds well to broad-spectrum antibiotics.Other complications include upper airway construction due to the size of the abscess or the amount of swelling in the throat.
Most patients who get prompt treatment of quinsy with drainage and antibiotics recover within a week. Recurrent abscesses occur in as many as 5 percent of patients. Those with the highest risk for reoccurrence are young patients who have had at least five episodes of tonsillitis.After treatment, quinsy completely resolves, with complications affecting less than 1 percent of all cases.