• Peritonsillar abscess (quinsy) is a complication of acute tonsillitis, when pus is trapped between the tonsillar capsule and the lateral pharyngeal wall. It may occur without previous tonsillitis. May also be a complication of infectious mononucleosis (glandular fever). Less common in children than in teenagers and young adults. Causes include infection with one or more of:
• Streptococcus pyogenes
• Staphylococcus aureus
• Haemophilus influenza

Symptoms include severe throat pain, fever, drooling, foul breath, difficulty swallowing and/or opening the mouth (trismus), earache on the affected side and neck stiffness.

Examination may be difficult as 65-70% of patients can experience trismus.

Referral: if quinsy is suspected, refer to a GP or admit as management generally requires IV fluids and antibiotics, and needle aspiration or surgery to drain the abscess. Tonsillectomy may be carried out immediately or at a later date.

See Tonsillitis