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| {{Infobox_Disease | | __NOTOC__ |
| | Name = Peritonsillar abscess
| | {{Peritonsillar abscess}} |
| | Image =
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| | Caption =
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| | DiseasesDB = 11141
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| | ICD10 = {{ICD10|J|36||j|30}}
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| | ICD9 = {{ICD9|475}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj = emerg
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| | eMedicineTopic = 417
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| | MeshID =
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| }}
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| __Notoc__
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| {{SI}} | | {{CMG}}; {{AE}} {{PTD}} |
| {{CMG}}; {{KS}} | |
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| ==Overview==
| | {{SK}} PTA, Tonsillar abscess, Intratonsillar abscess, Quinsy |
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| '''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).
| | ==[[Peritonsillar abscess overview|Overview]]== |
| ==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''.
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| Both aerobic and anaerobic bacteria can be causative. Commonly involved species include [[streptococci]], [[staphylococci]] and [[haemophilus]].
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| ==Symptoms== | | ==[[Peritonsillar abscess historical perspective|Historical Perspective]]== |
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| Unlike tonsillitis, which is more common in the pediatric age group, PTA has a more even age spread — from children to adults.
| | ==[[Peritonsillar abscess classification]]== |
| Symptoms start appearing 2-8 days before the formation of [[abscess]]. Progressively worsening unilateral sore throat and pain during swallowing usually are the earliest symptoms. As the abscess develops,
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| persistent pain in the peritonsillar area, fever, malaise, headache and change in voice (hot potato voice) may appear. Neck pain associated with tender, swollen [[lymph node]]s, referred ear pain and breath odour are also common. Whilst these signs may be present in tonsillitis itself, a PTA should be specifically considered if there is limited ability to open the mouth ([[Trismus]]).
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| ==Physical Examination== | | ==[[Peritonsillar abscess pathophysiology|Pathophysiology]]== |
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| ===Signs=== | | ==[[Peritonsillar abscess causes|Causes]]== |
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| * Contralateral deflection of the uvula
| | ==[[Peritonsillar abscess differential diagnosis|Differentiating Peritonsillar abscess from other Diseases]]== |
| * Facial swelling
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| * Tender submandibular and anterior cervical lymph nodes.
| | ==[[Peritonsillar abscess epidemiology and demographics|Epidemiology and Demographics]]== |
| * Tonsillar hypertrophy with likely peritonsillar edema.
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| * Stridor
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| * Trismus
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| | ==[[Peritonsillar abscess screening|Screening]]== |
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| <div align="left">
| | ==[[Peritonsillar abscess risk factors|Risk Factors]]== |
| <gallery heights="175" widths="175">
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| Image:Peritonsillar-abscess-001.jpg|Peritonsillar abscess <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Peritonsillar-abscess-002.jpg|Peritonsillar abscess <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Peritonsillar-abscess-003.jpg|Peritonsillar abscess <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Peritonsillar-abscess-004.jpg|Peritonsillar abscess <small>Image courtesy of RadsWiki and copylefted</small>
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| </gallery>
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| </div>
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| ==Treatment== | | ==[[Peritonsillar abscess natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| 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. [[Antibiotic]]s are also given to treat the infection.
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| 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. | | ==Diagnosis== |
| | [[Peritonsillar abscess history and symptoms|History and Symptoms]] | [[Peritonsillar abscess physical examination|Physical Examination]] | [[Peritonsillar abscess laboratory findings|Laboratory Findings]] | [[Peritonsillar abscess x rays|X Rays]] | [[Peritonsillar abscess other imaging findings|Other Imaging Findings]] | [[Peritonsillar abscess other diagnostic studies|Other Diagnostic Studies]] |
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| ==Complications== | | ==Treatment== |
| *Parapharyngeal abscess
| | [[Peritonsillar abscess medical therapy|Medical Therapy]] | [[Peritonsillar abscess primary prevention|Primary Prevention]] | [[Peritonsillar abscess secondary prevention|Secondary Prevention]] |
| *Extension of abscess in other deep neck spaces leading to airway compromise
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| *Septicaemia
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| ==Notable Quinsy sufferers==
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| *George Washington is believed to have died of complications arising from Quinsy.<ref name"MountVernon">{{cite web | author =Mount Vernon Plantation | authorlink =Mount Vernon Plantation | year=2006 | url =http://www.mountvernon.org/learn/meet_george/index.cfm/pid/208/ | title =Part 4. President and Back Home | format = | work = Meet George Washington | publisher = Mount Vernon Ladies Association | accessyear =2006 }}</ref>
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| *Michel de Montaigne's quinsy brought about the paralysis of his tongue.
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| *Georges Bizet
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| *James Gregory of the band The Ordinary Boys was almost killed by quinsy because it was left untreated
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| *Brian Sweeney
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| *Alan Burrows
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| ==References== | | ==Case Studies== |
| <references/>
| | [[Peritonsillar abscess case study one|Case #1]] |
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| ==External links==
| | {{Respiratory pathology}} |
| *[http://icarus.med.utoronto.ca/carr/manual/pta.html Practical ENT For Primary Care Physicians web site]
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| *[http://www.drtbalu.com/quinsy.html (Detailed description with video clipping)]
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| {{Respiratory pathology}}
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| | {{WH}} |
| | {{WS}} |
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| [[nl:Peritonsillair abces]] | | [[Category:Otolaryngology]] |
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