Peritonsillar abscess: Difference between revisions

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* Tender submandibular and anterior cervical lymph nodes.
* Tender submandibular and anterior cervical lymph nodes.
* Tonsillar hypertrophy with likely peritonsillar edema.
* Tonsillar hypertrophy with likely peritonsillar edema.
* Stridor
* [[Stridor]]
* Trismus
* [[Trismus]]





Revision as of 17:05, 30 April 2015

Peritonsillar abscess
ICD-10 J36
ICD-9 475
DiseasesDB 11141
eMedicine emerg/417 


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Kiran Singh, M.D. [2]

Overview

Peritonsillar abscess, also called PTA or Quinsy, is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil (peritonsillar space).

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

Symptoms

  • Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even age spread — from children to adults.
  • Symptoms start appearing 2-8 days before the formation of abscess. Common symptoms are:

Physical Examination

Signs

  • Contralateral deflection of the uvula
  • Facial swelling
  • Tender submandibular and anterior cervical lymph nodes.
  • Tonsillar hypertrophy with likely peritonsillar edema.
  • Stridor
  • Trismus


Treatment

Treatment is, as for all abscesses, through surgical incision and drainage of the pus, thereby relieving the pain of the stretched tissues. The drainage can often be achieved in the Outpatient Department using a guarded No. 11 blade in an awake and co-operative patient. Sometimes, a needle aspiration can suffice. Antibiotics are also given to treat the infection.

Peritonsillar abscesses are widely considered one of the most painful complications, primarily the surgical draining of the abscess itself. The patient is operated on awake, surgically slicing open the tonsil and draining the abscess.

Complications

  • Parapharyngeal abscess
  • Extension of abscess in other deep neck spaces leading to airway compromise
  • Septicaemia

Notable Quinsy sufferers

  • George Washington is believed to have died of complications arising from Quinsy.[1]
  • Michel de Montaigne's quinsy brought about the paralysis of his tongue.
  • Georges Bizet
  • James Gregory of the band The Ordinary Boys was almost killed by quinsy because it was left untreated
  • Brian Sweeney
  • Alan Burrows

References

  1. Mount Vernon Plantation (2006). "Part 4. President and Back Home". Meet George Washington. Mount Vernon Ladies Association. Unknown parameter |accessyear= ignored (|access-date= suggested) (help)

External links

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