Peritonsillar abscess

Quinsy is a complication of tonsillitis. 

It is a collection of pus that develops between the back of one of your tonsils and the wall of your throat. This is known as an abscess. An abscess can develop when an infection spreads from a swollen tonsil to the surrounding area.

The medical name for quinsy is peritonsillar abscess.

When to see your GP

Quinsy may be suspected if you have tonsillitis or a sore throat that gets worse very quickly. See your GP as soon as possible if this happens.

If the abscess grows large enough, it can block your airways and cause breathing difficulties. Therefore, it is important that treatment is started as soon as possible.

See Quinsy - symptoms for more information.

Treating quinsy

Antibiotics will be recommended to clear the infection and painkillers will be used to deal with any pain. Pus from the abscess may need to be drained. This may involve having a minor surgical procedure that is carried out under anaesthetic in hospital. See Quinsy - treatment for more information.

How common is quinsy?

Quinsy is not common. This is because most people with tonsillitis have effective treatment early enough to prevent quinsy from developing. For every 100,000 people with a sore throat, 96 may develop quinsy.

Quinsy most commonly occurs in teenagers and young adults.

The symptoms of quinsy, also called peritonsillar abscess, are similar to those of tonsillitis.  . They include:

• a worsening sore throat usually on one side
• a high temperature of 38C (100.4F) or above
• difficulty opening your mouth 
• pain when swallowing
• difficulty swallowing
• changes to your voice or difficulty speaking 
• bad breath 
• drooling saliva due to the difficulty swallowing 
• earache on the affected side
• headache and feeling generally unwell
• swelling around your face and neck
• tiredness
• dehydration,when the normal water content of your body is reduced

Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Tonsils

Two small glands found at the back of your throat, behind the tongue.

Quinsy, also known as peritonsillar abscess, is caused by an infection. Several bacteria can cause quinsy, but the most common types are haemophilus influenzae and streptococcus bacteria, particularly streptococcus pyogenes.

It is not clear why the infection that leads to quinsy occurs, but the most commonly accepted theory is that a collection of pus, called an abscess, forms after a bout of severe, untreated tonsillitis, or tonsillitis that is not fully treated.

Weber glands

Another theory about the causes of quinsy involves the Weber glands. The Weber glands produce secretions and are located just above the tonsils. They clear debris, such as dead tissue, from the tonsils and surrounding area.

If the Weber glands malfunction and cannot clear the build-up of debris from the area around the tonsils, the tubes that drain the glands may become swollen. This can cause an infection to develop, which gets worse and causes an abscess to form.

Risk factors

Factors that may increase your risk of developing quinsy after having a sore throat include: 

• having diabetes
• having an immune system (the body's natural defence system) that is less able to fight infections, for example if you have HIV                   

Immune system

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Tonsils

Two small glands found at the back of your throat, behind the tongue.

See your GP if you have:

• a bad  sore throat
• severe tonsillitis. (infection of the tonsils)

Your GP will ask you about your symptoms and examine your throat and tonsils. Your tonsils are the two small glands found at the back of your throat, behind your tongue.

If quinsy (peritonsillar abscess) is suspected, you will be referred immediately to an ear, nose and throat specialist who will carry out further investigations. You may be admitted to hospital immediately if you have severe quinsy.

It is important that quinsy is diagnosed and treated quickly to prevent the infection from spreading.

Quinsy, also called peritonsillar abscess, is usually treated with a combination of medication and surgery.

Medication

Antibiotics

If you are diagnosed with quinsy, you will be prescribed a course of antibiotics to treat the infection. The antibiotics will usually be given directly into a vein (intravenously). This method is more effective than taking antibiotics tablets.

Antibiotics often used to treat quinsy include:

• phenoxymethylpenicillin, also called penicillin V - a type of penicillin
• clarithromycin, if you are allergic to penicillin 
• amoxicillin
• clindamycin 
• erythromycin 

Several different antibiotics are available. The choice will depend on the type of bacteria causing your infection and what medicines suit you best. For example, some types of medication may not be suitable if you have another medical condition, such as liver or kidney problems.

Some types of antibiotics may interact with some types of contraception, such as the combined contraceptive pill. If this affects you, the healthcare professionals treating you will advise you about which additional contraception is suitable to use during this time.

Corticosteroids

Corticosteroids are medicines that contain steroids, a type of hormone. They help reduce swelling and may be used to treat quinsy. If you have a severe sore throat or severe difficulty swallowing, corticosteroids may be considered.

Studies have found that corticosteroids are a safe and effective method of treating quinsy.

Painkillers

If you have quinsy, you may be prescribed painkillers to help ease any pain you have. The most commonly prescribed painkillers are paracetamol and ibuprofen.

Surgery

In most cases of quinsy, antibiotics alone are not an effective treatment, and a surgical procedure is also required. Procedures that may be used include:

• needle aspiration
• incision and drainage
• tonsillectomy

These are briefly described below.

Needle aspiration

Needle aspiration may be used to drain the build-up of fluid from the abscess. The procedure involves using a long, fine needle to draw out the pus. If you have needle aspiration, you will usually be given medication called a sedative to help you relax, or a local anaesthetic may be used to numb the area so that you do not feel any pain.

After the procedure, the fluid that is removed from the abscess will be sent to a laboratory to identify the bacteria that caused the infection.

Incision and drainage

In some cases, a cut will be made in the affected area to drain the fluid from the abscess. This is called incision and drainage.

Incision and drainage is performed either under sedation to relax you, local anaesthetic to numb the area, or general anaesthetic to put you to sleep.

Tonsillectomy

A tonsillectomy is an operation to remove your tonsils. These are the two small glands found at the back of your throat, behind your tongue. A tonsillectomy may be recommended in severe cases of quinsy or if you have recurring bouts of sore throats.

In around 15 out of 100 cases of quinsy, the abscess comes back. Some people may choose to have a tonsillectomy to prevent quinsy returning.

See the Health A-Z topic about Tonsillitis - treatment for more information about tonsillectomies.

Hospital treatment

Depending on how severe your infection is, you may need to spend two to four days being treated for quinsy in hospital.

During this time, medicines and fluids will be given to you through a drip in your arm.

After leaving hospital, you may need to rest at home for up to a week. You will probably be given antibiotics and painkillers to carry on taking at home. 

Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Tonsils

Two small glands found at the back of your throat, behind the tongue.

 

Tonsillitis

Quinsy, also known as peritonsillar abscess, can happen after you have had  tonsillitis.  The best way to prevent tonsillitis is to avoid close contact with people who have the viral or bacterial infections that cause the condition.

For example, do not share a toothbrush with someone who has tonsillitis and avoid using the same eating and drinking utensils. Maintain a high level of hygiene by washing your hands regularly with soap and hot water.

Smoking

Smoking could possibly increase your risk of quinsy. See the Health A-Z topic about Quitting smoking for information and advice about giving up smoking.

Tonsils

Two small glands found at the back of your throat, behind the tongue.