Treating quinsy - HSE.ie 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. Useful Links 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 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. Useful Links Causes of quinsy 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 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. Useful Links 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. Useful Links 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 a re 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 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. Quinsy - NHS Choices Quinsy Quinsy Introduction Quinsy, also known as a peritonsillar abscess, is a rare and potentially serious complication of tonsillitis . The abscess (a collection of pus) forms between one of your tonsils and the wall of your throat. This can happen when a bacterial infection spreads from an infected tonsil to the surrounding area.

Quinsy can occur at any age, but most commonly affects teenagers and young adults. It's possible to get it more than once. Signs and symptoms Symptoms of quinsy can include: a severe and quickly worsening sore throat , usually on one side swelling inside the mouth and throat difficulty opening your mouth difficulty swallowing, which may cause you to drool changes to your voice or difficulty speaking earache on the affected side headache and feeling generally unwell difficulty breathing Some people with quinsy may also have a high temperature (fever), although this sometimes passes before the abscess develops. When to see your GP You should see your GP if you or your child have symptoms of quinsy. Your GP will ask you about your symptoms and examine your throat and tonsils. These are the two small glands found at the back of your throat, behind your tongue. If quinsy is suspected, you will be referred immediately to a hospital ear, nose and throat (ENT) specialist for further tests and treatment. It's important that quinsy is diagnosed and treated quickly to prevent the infection from spreading and to avoid serious problems caused by severe swelling, such as breathing difficulties. Treating quinsy People with quinsy usually need to be treated in hospital.

Depending on how severe the infection is, you may need to stay in hospital for a few days and rest at home for a week or two afterwards. Medication You will be given antibiotics to clear the infection. These will usually be given directly into a vein (intravenously) at first, but you may switch to a short course of tablets or capsules once you are well enough leave hospital. Painkillers, such as paracetamol and ibuprofen , will be given to help ease any pain. You can continue to take these while you recover at home if necessary. Occasionally, corticosteroid medication may also be used to help reduce the swelling in your throat. Surgery and procedures In many cases, antibiotics alone are not effective, and it may be necessary to drain the pus from the abscess.

This can be done by: needle aspiration – a long, fine needle is used to draw out the pus incision and drainage – a small cut (incision) is made over the affected area to drain the pus a tonsillectomy – an operation to remove your tonsils (this is rarely necessary while you have quinsy, but is often recommended at least six weeks after you’ve recovered) You will often remain awake during a needle aspiration or incision and drainage procedure, but you will be given either a sedative to help you relax and/or a local anaesthetic to numb the area being treated. Tonsillectomies and some incision and drainage procedures are carried out under general anaesthetic . This means you will be asleep and won't feel any pain while these procedures are carried out. Preventing quinsy One of the best ways to prevent quinsy is to reduce your risk of developing tonsillitis. You can help do this by avoiding close contact with people who have viral or bacterial infections that cause tonsillitis , regularly washing your hands with soap and warm water, and not sharing glasses or utensils with people who are ill.

Smoking may increase your risk of quinsy, so stopping smoking may reduce your chances of getting it. Using antibiotics to treat viral tonsillitis doesn't significantly reduce the risk of quinsy and isn't routinely recommended. Page last reviewed: 08/12/2014 Quinsy - Sore Throat Guide Changes to the tone or pitch of the voice Swelling around the neck and face Headache Feeling unwell or under the weather The worst aspect of quinsy is the painful sore throat. This causes a great deal of swelling around the infected area which makes it difficult to swallow and in some cases, to breathe normally. Diagnosing quinsy If you have tonsillitis or a painful sore throat which is also affecting your breathing then visit your GP. He/she will examine your throat including your tonsils and will confirm or reject a diagnosis of quinsy. If quinsy has been diagnosed then you will be referred to an ear, nose and throat (ENT) specialist who will carry out tests as part of a further investigation. It is important to attend to this as soon as possible to stop the infection from spreading, for example into the lungs.

Dangers of quinsy This is a serious condition which needs to be treated as soon as possible. If left untreated it will worsen over time to the extent that it could become life threatening. The worst case scenario is that the infected abscess on the tonsil bursts which causes pus to be inhaled. If this reaches the lungs then it can cause a condition called ‘aspiration’. Aspiration occurs when substances or foreign bodies enter the trachea and the lungs. If this happens then small sections of lung tissue may be damaged or it can result in a serious disease such as chemical pneumonitis. There is also the risk of bacterial infections such as lung abscess or acute respiratory failure. Treatment for quinsy This usually involves medication and surgery. Medication includes a course of antibiotics –usually intravenously - to prevent the infection from spreading. Examples of antibiotics used to treat quinsy include amoxicillin and penicillin. You may also be given a dose of steroids –also intravenously as this has been shown to help speed up the recovery process. Painkillers are also useful to deal with any discomfort such as a sore throat. Most cases of quinsy cannot be cured by medication alone which means that surgery is needed.

This means draining away the pus filled fluid from the abscess. Known as ‘needle aspiration’ it involves the use of fine needle which helps to draw out the pus. The surgeon then removes pus from the infected area using this needle. This pus is then sent to a laboratory for analysis. Another option is where you are given a local or general anaesthetic before an incision and drainage procedure. The surgeon will make a small incision in the abscess to drain off the infected fluid. This fluid will also undergo laboratory analysis. Tonsillectomy If you have a severe form of quinsy or experience this on more than one occasion then a tonsillectomy will be performed. This is surgical removal of the tonsils. Find out more in our throat surgery section. This usually deals with the majority of quinsy cases but there are a few situations where quinsy reoccurs even after a tonsillectomy. The reason for this is that it develops between the tonsil and the back of the throat as well as on the actual tonsil itself. So if you have had quinsy before and it occurred near to your tonsils then there is a risk of it happening again. Your surgeon or GP will discuss this with you.

Quinsy | definition of quinsy by Medical dictionary Quinsy | definition of quinsy by Medical dictionary Related to quinsy: tonsillitis , Ludwig's angina abscess [ab´ses] a localized collection of pus in a cavity formed by the disintegration of tissue. Abscesses are usually caused by specific microorganisms that invade the tissues, often by way of small wounds or breaks in the skin. An abscess is a natural defense mechanism in which the body attempts to localize an infection and wall off the microorganisms so that they cannot spread throughout the body. As the microorganisms destroy the tissue, an increased supply of blood is rushed to the area. The cells, bacteria, and dead tissue accumulate to form a clump of cream-colored liquid, which is the pus. The accumulating pus and the adjacent swollen, inflamed tissues press against the nerves, causing pain. The concentration of blood in the area causes redness. The abscess sometimes “comes to a head” by itself and breaks through the skin or other tissues, allowing the pus to drain. Local applications of heat may be used to facilitate localization and drainage. Abscess, cross section.

alveolar abscess a localized suppurative inflammation of tissues about the apex of the root of a tooth. amebic abscess an abscess cavity of the liver resulting from liquefaction necrosis due to entrance of Entamoeba histolytica into the portal circulation in amebiasis; amebic abscesses may also affect the lungs, brain, and spleen. Bartholin abscess acute infection of a Bartholin gland with symptoms including pain, swelling, cellulitis of the vulva, and dyspareunia. Treatment is incision and drainage of the abscess. Cultures should be obtained to rule out infections by Neisseria gonorrhoeae or Chlamydia. Bezold's abscess one deep in the neck resulting from a complication of acute mastoiditis. Peritonsillar Abscess in Emergency Medicine: Practice Essentials, Background, Pathophysiology Peritonsillar Abscess in Emergency Medicine Updated: May 25, 2016 Author: Jorge Flores, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD more...

Share Overview Practice Essentials Peritonsillar abscesses (PTAs) are common infections of the head and neck region, accounting for approximately 30% of soft tissue head and neck abscesses. With an incidence of about 1 in 10,000, PTA (see the image below) is the most common deep space infection of the head and neck that presents to the emergency department. Right peritonsillar abscess. The soft palate, which is erythematous and edematous, is displaced anteriorly. The patient has a "hot potato–sounding" voice.

Symptoms of PTA usually begin 3-5 days before evaluation and may include the following: Fever Throat pain (more severe on the affected side; occasionally referred to the ipsilateral ear) Dysphagia Physical findings may include the following: Mild-to-moderate distress Drooling, salivation, or trouble handling oral secretions Trismus “Hot potato” or muffled voice Rancid or fetid breath Cervical lymphadenitis in the anterior chain Asymmetric tonsillar hypertrophy Inferior and medial displacement of the tonsil Contralateral deviation of the uvula Erythema of the tonsil See Presentation for more detail. Diagnosis No definitive studies are required to diagnose PTA.

The following laboratory tests may be considered: Basic studies, such as complete blood count, electrolytes, and C-reactive protein (if the patient has significant comorbidities) Monospot test/heterophile antibody test (to rule out infectious mononucleosis if the etiology is unclear) Culture of fluid from needle aspiration (to guide antibiotic selection or changes) Blood cultures (if the clinical presentation is severe) The following imaging studies may be considered: Lateral soft tissue neck radiography (to help rule out other causes) Intraoral ultrasonography Computed tomography (CT) of the head and neck with intravenous (IV) contrast (if incision and drainage fails, if the patient cannot open his or her mouth, or if the patient is young and uncooperative) See Workup for more detail. Management Initial management of PTA may include the following: Transport with supplemental oxygen.

Attention to the ABCs (airway, breathing, and circulation) If the patient’s airway is compromised, immediate endotracheal intubation or, if this cannot be accomplished, cricothyroidotomy or tracheostomy; alternatively, awake fiberoptic bronchoscopy Fluid resuscitation as necessary If acute surgical management of PTA is indicated, the following 3 options are available: Needle aspiration Quinsy tonsillectomy (eg, simultaneous tonsillectomy with open abscess drainage) Additional pharmacologic therapy may include the following: Empiric antibiotics See Treatment and Medication for more detail. Next: Background Peritonsillar abscesses (PTAs) are common infections of the head and neck region; they comprise approximately 30% of soft tissue head and neck abscesses. [ 1 ] With an incidence of about 1 in 10,000, it is the most common deep space infection of the head and neck that presents to the emergency department. [ 2 ] Physicians must be aware of the typical clinical presentation and diagnostic strategies in order to quickly diagnose and appropriately treat these patients, thus preventing complications and further propagation of the infectious process.

A peritonsillar abscess is shown in the image below. Right peritonsillar abscess. The soft palate, which is erythematous and edematous, is displaced anteriorly. The patient has a "hot potato–sounding" voice. Next: Pathophysiology The two palatine tonsils are on the lateral walls of the oropharynx, within the depression between the anterior and posterior tonsillar pillars. Each pillar is composed primarily of the glossopalatine and the pharyngopalatine muscles. During embryonic development, the tonsils arise from the second pharyngeal pouch as buds of endodermal cells. [ 3 ] The tonsils then grow irregularly and reach their ultimate size and shape at approximately age 6-7 years. Each tonsil is surrounded by a capsule, a specialized portion of the intrapharyngeal aponeurosis that covers the medial portion of the tonsils and provides a path for blood vessels and nerves. [ 3 ] It is within this potential space, between the tonsil and capsule, that peritonsillar abscesses form.

[ 4 ] Note that the peritonsillar space is anatomically contiguous with several deeper spaces, and infections can potentially involve the parapharyngeal and retropharyngeal spaces. [ 5 ] Peritonsillar abscesses usually progress from tonsillitis to cellulitis and ultimately to abscess formation. Weber glands are thought to also play a key role in the etiology of the infection. These mucous salivary glands are located superior to the tonsil in the soft palate and clear the tonsillar area of debris. If these glands become inflamed, local cellulitis develops. As the infection progresses, inflammation worsens and results in tissue necrosis and pus formation, most commonly just above the superior pole of the tonsil where the glands are located. [ 4 ] Klug et al, citing evidence for peritonsillar abscess as a complication of acute tonsillitis and as a consequence of Weber gland infection, hypothesized that peritonsillar abscesses develop when bacteria infect the tonsillar mucosa and then, using the salivary duct system, spread to the peritonsillar space.

[ 6 ] Previous Frequency United States In the United States, the incidence of peritonsillar abscess has been estimated at 30 cases per 100,000 persons per year, accounting for approximately 45,000 cases annually.It has also been estimated to result in at least $150 million a year in health care expenditures. [ 7 ] Most infections occur during November to December and April to May, which coincide with the highest incidence rates of streptococcal pharyngitis and exudative tonsillitis. [ 4 ] International A higher rate is reported internationally due to recurrence and antibiotic resistance. Previous Next: Mortality/Morbidity Mortality of peritonsillar abscess is unknown. Morbidity of peritonsillar abscess is due mostly to pain, cost of treatment, lost time from work and school, and complications. Using data from the National (Nationwide) Inpatient Sample, a study by Qureshi et al found evidence that retropharyngeal abscess is occurring at an increasing rate among adult inpatients with peritonsillar abscess.

According to the investigators, between 2003 and 2010 the annual rate at which retropharyngeal abscess occurred concurrently with peritonsillar abscess rose from 0.5% to 1.4% among inpatients aged 18 years or older. The study also indicated that patient age affects concurrence of the two conditions, with the likelihood that retropharyngeal abscess will complicate peritonsillar abscess increasing in patients aged 40 years or older. [ 8 ] Race No racial predilection of peritonsillar abscess is noted. Sex The male-to-female ratio of peritonsillar abscess is equal. Age Peritonsillar abscess can occur in anyone aged 10-60 years according to one source, although peritonsillar abscess is most commonly seen in those aged 20-40 years. [ 9 ] The younger children who get peritonsillar abscess are often immunocompromised. Previous References Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg.

2003 Mar. 128(3):332-43. [Medline] . Herzon FS, Martin AD. Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep. 2006 May. 8(3):196-202. [Medline] . Steyer TE. Peritonsillar abscess: diagnosis and treatment. Am Fam Physician. 2002 Jan 1. 65(1):93-6. [Medline] . Galioto NJ. Peritonsillar abscess. Am Fam Physician. 2008 Jan 15. 77(2):199-202. [Medline] . Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. 2008 Jun. 41(3):459-83, vii. [Medline] . Klug TE, Rusan M, Fuursted K, Ovesen T.

Peritonsillar Abscess: Complication of Acute Tonsillitis or Weber's Glands Infection?. Otolaryngol Head Neck Surg. 2016 Mar 29. [Medline] . Johnson RF, Stewart MG. The contemporary approach to diagnosis and management of peritonsillar abscess. Curr Opin Otolaryngol Head Neck Surg. 2005 Jun. 13(3):157-60. [Medline] . Qureshi HA, Ference EH, Tan BK, et al. National Trends in Retropharyngeal Abscess among Adult Inpatients with Peritonsillar Abscess. Otolaryngol Head Neck Surg. 2015 Jan 20. [Medline] . Herzon FS. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope. 1995 Aug. 105(8 Pt 3 Suppl 74):1-17. [Medline] .

Sakae FA, Imamura R, Sennes LU, Araujo Filho BC, Tsuji DH. [Microbiology of peritonsillar abscesses]. Rev Bras Otorrinolaringol (Engl Ed). 2006 Mar-Apr. 72(2):247-51. [Medline] . Klug TE, Henriksen JJ, Fuursted K, Ovesen T. Significant pathogens in peritonsillar abscesses. Eur J Clin Microbiol Infect Dis. 2011 May. 30(5):619-27. [Medline] . Powell EL, Powell J, Samuel JR, Wilson JA. A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother. 2013 Sep. 68(9):1941-50. [Medline] . Powell J, Wilson JA. An evidence-based review of peritonsillar abscess. Clin Otolaryngol. 2012 Apr. 37(2):136-45.

[Medline] . Lyon M, Blaivas M. Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. Acad Emerg Med. 2005 Jan. 12(1):85-8. [Medline] . Costantino TG, Satz WA, Dehnkamp W, Goett H. Randomized trial comparing intraoral ultrasound to landmark-based needle aspiration in patients with suspected peritonsillar abscess. Acad Emerg Med. 2012 Jun. 19(6):626-31. [Medline] . Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg. 2003 Mar. 128(3):332-43. [Medline] . Rahn R, Hutten-Czapski P. Quinsy (peritonsillar abscess). Can J Rural Med. 2009 Winter. 14(1):25-6. [Medline] . Bovo R, Barillari MR, Martini A.

Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?. Eur Arch Otorhinolaryngol. 2015 Jan 11. [Medline] . Chau JK, Seikaly HR, Harris JR, Villa-Roel C, Brick C, Rowe BH. Corticosteroids in peritonsillar abscess treatment: a blinded placebo-controlled clinical trial. Laryngoscope. 2014 Jan. 124 (1):97-103. [Medline] . Lee YJ, Jeong YM, Lee HS, Hwang SH. The Efficacy of Corticosteroids in the Treatment of Peritonsillar Abscess: A Meta-Analysis. Clin Exp Otorhinolaryngol. 2016 Jun. 9 (2):89-97. [Medline] . [Full Text] . Losanoff JE, Missavage AE. Neglected peritonsillar abscess resulting in necrotizing soft tissue infection of the neck and chest wall. Int J Clin Pract.

2005 Dec. 59(12):1476-8. [Medline] . Ahmed K, et al. Radiology in focus: The role of ultrasound in the management of peritonsillar abscess. J Laryngol Otol. 1994. 108:610-612. Aldakhail AA, Khan MI. A retrospective study of peritonsillar abscess in Riyadh Medical Complex [corrected]. Saudi Med J. 2006 Aug. 27(8):1217-21. [Medline] . Araujo Filho BC, Sakae FA, Sennes LU, Imamura R, de Menezes MR. Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses. Rev Bras Otorrinolaringol (Engl Ed). 2006 May-Jun. 72(3):377-81. [Medline] . Blokmanis A. Ultrasound in the diagnosis and management of peritonsillar abscesses. J Otolaryngol.

1994 Aug. 23(4):260-2. [Medline] . Chen MM, Roman SA, Sosa JA, Judson BL. Safety of Adult Tonsillectomy: A Population-Level Analysis of 5968 Patients. JAMA Otolaryngol Head Neck Surg. 2014 Jan 30. [Medline] . Garcia Callejo FJ, Nunez Gomez F, Sala Franco J, Marco Algarra J. [Management of peritonsillar infections]. An Pediatr (Barc). 2006 Jul. 65(1):37-43. [Medline] . Hanna BC, McMullan R, Hall SJ. Corticosteroids and peritonsillar abscess formation in infectious mononucleosis. J Laryngol Otol. 2004 Jun. 118(6):459-61. [Medline] . Kieff DA, Bhattacharyya N, Siegel NS, Salman SD. Selection of antibiotics after incision and drainage of peritonsillar abscesses. Otolaryngol Head Neck Surg.

1999 Jan. 120(1):57-61. [Medline] . Lamkin RH, Portt J. An outpatient medical treatment protocol for peritonsillar abscess. Ear Nose Throat J. 2006 Oct. 85(10):658, 660. [Medline] . Lyon M, Blaivas M. Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. Acad Emerg Med. 2005 Jan. 12(1):85-8. [Medline] . Martin Campagne E, del Castillo Martin F, Martinez Lopez MM, Borque de Andres C, de Jose Gomez MI, Garcia de Miguel MJ. [Peritonsillar and retropharyngeal abscesses: study of 13 years]. An Pediatr (Barc). 2006 Jul. 65(1):32-6. [Medline] . Melville NA. Adult tonsillectomy shown to be safe, with few complications. Medscape Medical News. 2014 Feb 4. [Full Text] .

Ozbek C, Aygenc E, Tuna EU, Selcuk A, Ozdem C. Use of steroids in the treatment of peritonsillar abscess. J Laryngol Otol. 2004 Jun. 118(6):439-42. [Medline] . Passy V. Pathogenesis of peritonsillar abscess. Laryngoscope. 1994 Feb. 104(2):185-90. [Medline] . Roberts J. Emergency department considerations in the diagnosis and treatment of peritonsillar abscess. Emerg Med News. 1996. 2:4-7. Sakaguchi M, Sato S, Asawa S, Taguchi K. Computed tomographic findings in peritonsillar abscess and cellulitis. J Laryngol Otol. 1995 May. 109(5):449-51. [Medline] . Strong EB, Woodward PJ, Johnson LP. Intraoral ultrasound evaluation of peritonsillar abscess. Laryngoscope. 1995 Aug.

105(8 Pt 1):779-82. [Medline] . Media Gallery Right peritonsillar abscess. The soft palate, which is erythematous and edematous, is displaced anteriorly. The patient has a "hot potato–sounding" voice. Pus is aspirated through a wide-bore needle from the right peritonsillar abscess. An additional incision will be made to drain any other pus pockets. of 2 Abscess - body, causes, What Causes Abscesses?, External abscesses Abscess Abscess Photo by: Lev Dolgatsjov An abscess is an accumulation of pus that can result from an infec tion in any part of the body. An abscess is often surrounded by red, swollen tissue. KEYWORDS for searching the Internet and other reference sources Infection Inflammation An abscess is an accumulation or collection of pus * that can result from an infection in any part of the body. An abscess is often surrounded by red, swollen tissue.

The pus is made up of a mixture of fluid and several kinds of cells: There are microorganisms that are causing the infection, there are immune-system cells that are fighting the infection, and there are millions of body cells that have died in the struggle. Although pus is not pleasant to look at, its presence means that the body is defending itself against disease-causing microbes * . Some abscesses, like boils, are very common. They form just under the skin and usually go away on their own. Some abscesses can form in the gum near a tooth, and those often require treatment by a dentist. Still other abscesses form deep within the body, especially in the abdominal organs or the chest. These are rarer but can be very serious. They must be treated by a doctor and often require surgery. What Causes Abscesses? Abscesses may be caused by many different bacteria, fungi, or protozoans, which are kinds of disease-causing microbes. Abscesses result from infections that are or become localized or confined to one part of the body, as opposed to infections that spread throughout the body. External abscesses Boils and carbuncles are common among teenagers, but virtually everyone gets them at some time.

They are called external abscesses because they form on the surface of the body. They are quite similar to each other. The main difference is that carbuncles have a number of core areas where the pus forms, while boils have a single core at their center. Thus carbuncles may resemble a cluster of interconnected boils. * pus is a thick, creamy fluid, usually yellow or greenish in color, that forms at the site of an infection. * microbes and microorganisms are small organisms that can cause disease and that can usually be seen only under a microscope, They include bacteria, viruses, protozoa, and fungi. * follicles are tiny pits in the skin from which hair grows. External abscesses commonly occur on the back of the neck or on the face. They also frequently form on moist parts of the body, such as the armpit or groin. Abscesses in hair follicles * may result in a condition called folliculitis (fo-lik-u-LY-tis). An abscess at the base of an eyelash, which is a special type of follicle, is called a sty.

Dental abscesses A dental abscess or gumboil is an accumulation of pus in the gums or jaw tissues surrounding a tooth. It is usually formed as a result of infection by bacteria. A common contributing cause is dental decay, which is why regular dental checkups are important. Dental abscesses may also result from injuries such as a fracture in the tooth. If the cause is a dental cavity, the infection begins when the bacteria enter the pulp * portion inside the tooth. At this point, the condition is known as pulpitis (pul-PY-tis). An abscess on the gum is formed as the infection spreads from the pulp of the tooth. Internal abscesses Abscesses may form in any organ or cavity of the body. There are many different kinds, and they may be caused by any of a variety of microorganisms. All abscesses occurring in the internal organs require medical attention. In the abdomen, abscesses may result from infections of the gall bladder, liver, kidney, intestine, or pelvic organs in women. They may also be a complication of abdominal surgery.

An abscess that forms due to obstruction of the appendix is called appendicitis (a-pen-di-SY-tis), which usually causes severe pain in the lower right part of the abdomen. Doctors usually recommend surgery (appendectomy) to remove the appendix immediately. Otherwise the appendix may burst, causing the infection to spread through the abdominal cavity. In the lungs, abscesses may be a complication of pneumonia. In the throat, peritonsillar (per-i-TON-si-lar) abscess may result from the spread of tonsillitis, infection of the tonsils * . Peritonsillar abscess occurs frequently in young adults. Abscesses may also occur in the brain and in other organs of the body. * pulp is the sensitive area deep inside the central part of the tooth, where the nerves and blood vessels are located. * tonsils are paired clusters of lymph tissues in the throat. They help protect the body from bacteria or viruses that enter through a person's nose or mouth. What Happens When People Get Abscesses?

External abscesses and dental abscesses most often are caused by staphylococci, which are bacteria in the staphylococcus (STAF-i-lo-KOK-us) An external abscess is an accumulation of pus that results from bacterial infection. Abscesses that form under the skin may go away on their own. Some require drainage (removal of the pus). group. The bacteria enter the body through the mouth, or through pores in the skin, or through minor cuts and abrasions, such as places where clothing chafes the body. An example of chafing is when a shirt or coat collar rubs the back of the neck. Often, the exact source of the infection is not known. The bacteria that usually cause boils are very common, and having boils does not mean a person is dirty or will spread infection to others. Once the bacteria are under the skin, they are attacked by leukocytes * , which are white blood cells sent by the body's immune system to combat the bacteria. Pus forms as the white blood cells, bacteria, and destroyed cells accumulate, and the body creates a fibrous wall or lining to keep the infection sealed off from surrounding tissues.

People who have conditions that may lower the body's immune response, such as diabetes, are more likely to get boils and carbuncles. A person first notices a boil when it becomes a red, sore lump. As the pus builds up inside, the boil begins to swell. It also becomes more painful due to the increasing pressure on the nerve endings in the surrounding areas of the skin and to the inflammatory substances created by the body's response to the infection. Boils on the nose or ear are usually more painful than others. The pressure on the nerves is greater because the skin is tighter in these areas and cannot stretch as much. Usually, a yellowish head, or point, forms on the boil as the pus forces its way toward the surface. Sometimes, however, the boil may subside and disappear on its own, if the immune system is able to overcome the infection early enough. If the boil does form a head, pressure may cause it to rupture, spilling the pus to the outside. Carbuncle infections, which have several closely adjoining points, usually are more severe than boils. They may be accompanied by headache, loss of appetite, chills, and fever.

These signs and symptoms are easy to recognize, but if swelling is accompanied by fever, significant pain, or any unusual symptoms, then a visit to the doctor is advisable. How Are Abscesses Treated? External abscesses Many simple abscesses are treated at home with warm moist compresses that help bring the infection to the skin surface so it can drain. While boils are draining, they are usually covered with dry, sterile dressings until they are completely healed. Healing may take several days or sometimes weeks. Boils that are large, painful, or widespread should be treated by a doctor. This is particularly important if swelling is accompanied by fever, significant pain, or unusual symptoms, or if an abscess is firm with no tenderness. A doctor may prescribe an antibiotic to help fight the infection, or the doctor may lance the boil, which involves making a puncture or an incision with a sterile needle or a surgical knife to let the pus out. Lancing by a doctor only takes a couple of seconds and often results in remarkable pain relief and faster healing. * leukocytes (LOO-ko-sites) are white blood cells sent by the body's immune system to fight infection.

"Furuncles" Almost everyone gets a boil at some time in their life. Doctors call boils "furuncles" (FYOO-ryn-kulz). In the Bible (Job 2:7), the prophet Job was afflicted with boils from head to toe to test his faith in God. Dental abscesses In a tooth where a dental abscess starts, the first symptom is often a painful twinge when eating hot or cold foods. As the infection spreads from the tooth to the gum, the pain becomes throbbing and continuous. A person with a dental abscess will have trouble chewing because pressing the teeth together can be extremely painful. If the abscess or gumboil bursts, the pain may be somewhat relieved. Sometimes people with dental abscesses also have a fever. Dentists can diagnose dental abscesses by noting their patients' symptoms and by x-ray examination. Redness and swelling also may be directly observed in the gum around the tooth. The dentist might need to perform a root canal * procedure in order to save the tooth. If this treatment cannot stop the infection, the tooth may have to be removed. The dentist also may prescribe antibiotics and warm mouthwashes.

Internal abscesses All abscesses occurring in the internal organs require medical attention. If possible, the source of the infection must be found and treated. Usually, treatment includes surgical drainage of the abscess and antibiotics. * root canal is a procedure in which a dentist cleans out the pulp of an infected tooth, removes the nerve, and then fills the cavity with a protective substance. See also Peritonsillar Abscess - American Family Physician Peritonsillar Abscess NICHOLAS J. GALIOTO, MD, Broadlawns Medical Center, Des Moines, Iowa Am Fam Physician. 2008 Jan 15;77(2):199-202. Patient information: See related handout on peritonsillar abscess , written by the author of this article. This article exemplifies the AAFP 2008 Annual Clinical Focus on infectious disease: prevention, diagnosis, and management. References Peritonsillar abscess remains the most common deep infection of the head and neck.

The condition occurs primarily in young adults, most often during November to December and April to May, coinciding with the highest incidence of streptococcal pharyngitis and exudative tonsillitis. A peritonsillar abscess is a polymicrobial infection, but Group A streptococcus is the predominate organism. Symptoms generally include fever, malaise, sore throat, dysphagia, and otalgia. Physical findings may include trismus and a muffled voice (also called “hot potato voice”). Drainage of the abscess, antibiotics, and supportive therapy for maintaining hydration and pain control are the foundation of treatment. Antibiotics effective against Group A streptococcus and oral anaerobes should be first-line therapy. Steroids may be helpful in reducing symptoms and speeding recovery. To avoid potential serious complications, prompt recognition and initiation of therapy is important. Family physicians with appropriate training and experience can diagnose and treat most patients with peritonsillar abscess. Peritonsillar abscess is the most common deep infection of the head and neck in young adults, despite the widespread use of antibiotics for treating tonsillitis and pharyngitis.

This infection can occur in all age groups, but the highest incidence is in adults 20 to 40 years of age. 1 , 2 Peritonsillar abscess most commonly occurs during November to December and April to May, which coincides with the highest incidence rates of streptococcal pharyngitis and exudative tonsillitis. 3 , 4 Peritonsillar abscesses are almost always first encountered by the family physician, and those with appropriate training and experience can diagnose and treat most patients. Prompt recognition and initiation of therapy is important to avoid potential serious complications. SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Treatment for peritonsillar abscess should include drainage and antibiotic therapy. C Initial empiric antibiotic therapy for peritonsillar abscess should include antimicrobials effective against Group A streptococcus and oral anaerobes. C Steroids may be useful in reducing symptoms and in speeding recovery in patients with peritonsillar abscess. B A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.

For information about the SORT evidence rating system, see page 131 or . SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Treatment for peritonsillar abscess should include drainage and antibiotic therapy. C Initial empiric antibiotic therapy for peritonsillar abscess should include antimicrobials effective against Group A streptococcus and oral anaerobes. C Steroids may be useful in reducing symptoms and in speeding recovery in patients with peritonsillar abscess. B A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 131 or . Anatomy References The two palatine tonsils lie on the lateral walls of the oropharynx in the depression between the anterior tonsillar pillar (palatoglossal arch) and the posterior tonsillar pillar (palatopharyngeal arch). The tonsils form during the last months of gestation and grow irregularly, reaching their largest size at approximately six or seven years of age.

The tonsils begin to gradually involute at puberty, and by older age little tonsillar tissue remains. 5 When healthy, the tonsils do not project beyond the tonsillar pillars medially. 2 Each tonsil has a number of crypts on its surface and is surrounded by a capsule that provides a pathway for blood vessels and nerves. Peritonsillar abscesses form in the area between the palatine tonsil and its capsule. 1 Etiology References Peritonsillar abscess has traditionally been regarded as the end point of a continuum that begins as acute exudative tonsillitis, progresses to cellulitis, and eventually forms an abscess. A recent review implicates Weber's glands as playing a key role in the formation of peritonsillar abscesses. 6 , 7 This group of 20 to 25 mucous salivary glands are located in the space just superior to the tonsil in the soft palate and are connected to the surface of the tonsil by a duct. 7 The glands clear the tonsillar area of debris and assist with the digestion of food particles trapped in the tonsillar crypts. If Weber's glands become inflamed, local cellulitis can develop.

As the infection progresses, the duct to the surface of the tonsil becomes progressively more obstructed from surrounding inflammation. The resulting tissue necrosis and pus formation produce the classic signs and symptoms of peritonsillar abscess. 8 These abscesses generally form in the area of the soft palate, just above the superior pole of the tonsil, in the location of Weber's glands. 7 The occurrence of peritonsillar abscesses in patients who have undergone tonsillectomy further supports the theory that Weber's glands have a role in the pathogenesis. Other clinical variables include significant periodontal disease and smoking. 6 Clinical Manifestations References Patients with peritonsillar abscess appear ill and present with fever, malaise, sore throat, dysphagia, or otalgia. The throat pain is markedly more severe on the affected side and is often referred to the ear on the same side. Physical examination usually reveals trismus, with the patient having difficulty opening his or her mouth because of pain from inflammation and spasm of masticator muscles. 9 Swallowing is also highly painful, resulting in pooling of saliva or drooling. 9 Patients often speak in a muffled voice (also called “hot potato voice”).

Markedly tender cervical lymphadenitis may be palpated on the affected side. Inspection of the oropharynx reveals tense swelling and erythema of the anterior tonsillar pillar and the soft palate overlying the infected tonsil. The tonsil is generally displaced inferiorly and medially with contralateral deviation of the uvula ( Figure 1 ). The most common symptoms and physical findings are summarized in Table 1 . Potential complications of peritonsillar abscess are outlined in Table 2 . Death can occur from airway obstruction, aspiration, or hemorrhage from erosion or septic necrosis into the carotid sheath. Patient with right peritonsillar abscess. Figure 1.

Common Symptoms and Physical Findings in Patients with Peritonsillar Abscess Symptoms Severe sore throat (worse on one side) Dysphagia Erythematous, swollen soft palate with uvula deviation to contralateral side and enlarged tonsil Trismus Muffled voice (“hot potato voice”) Rancid or fetor breath Common Symptoms and Physical Findings in Patients with Peritonsillar Abscess Symptoms Severe sore throat (worse on one side) Dysphagia Erythematous, swollen soft palate with uvula deviation to contralateral side and enlarged tonsil Trismus Muffled voice (“hot potato voice”) Rancid or fetor breath Aspiration pneumonitis or lung abscess secondary to peritonsillar abscess rupture Death secondary to hemorrhage from erosion or septic necrosis into carotid sheath Extension of the infection into the tissues of the deep neck or posterior mediastinum Poststreptococcal sequelae (e.g., glomerulonephritis, rheumatic fever) when infection is caused by Group A streptococcus Table 2 Aspiration pneumonitis or lung abscess secondary to peritonsillar abscess rupture Death secondary

 to hemorrhage from erosion or septic necrosis into carotid sheath Extension of the infection into the tissues of the deep neck or posterior mediastinum Poststreptococcal sequelae (e.g., glomerulonephritis, rheumatic fever) when infection is caused by Group A streptococcus Diagnosis References The diagnosis of peritonsillar abscess is often made on the basis of a thorough history and physical examination.

Differential diagnosis includes infectious mononucleosis, lymphoma, peritonsillar cellulitis, and retromolar or retropharyngeal abscess. Patients often present with peritonsillar cellulitis with the potential to progress to abscess formation. In peritonsillar cellulitis, the area between the tonsil and its capsule is edematous and erythematous, but pus has not yet formed. 1 On occasions when the diagnosis of peritonsillar abscess is in question, the presence of pus on needle aspiration or radiologic testing may help confirm the diagnosis. Transcutaneous or intraoral ultrasonography also can be helpful in identifying an abscess and in distinguishing peritonsillar abscess from peritonsillar cellulitis. 1 , 6 If spread of the infection beyond the peritonsillar space or complications involving the lateral neck space are suspected, computed tomography (CT) or magnetic resonance imaging (MRI) is indicated. CT can distinguish between peritonsillar cellulitis and peritonsillar abscess, as well as demonstrate the spread of the infection to any contiguous spaces in the deep neck region ( Figure 2 ).

MRI has the advantage of improved soft-tissue definition over CT without exposure to radiation. Additionally, MRI is superior to CT in detecting complications from deep neck infections such as internal jugular vein thrombosis or erosion of the abscess into the carotid sheath. Disadvantages of MRI include longer scanning times, higher cost, lack of availability, and the potential for claustrophobia. 10 Computed tomography of a right peritonsillar abscess. Figure 2. Computed tomography of a right peritonsillar abscess. Treatment References Drainage of the abscess, antibiotics, and supportive therapy to maintain hydration and pain control are the foundation of treatment for peritonsillar abscess. Because peritonsillar cellulitis represents a transitional stage in the development of peritonsillar abscess, its treatment is similar to that of a peritonsillar abscess, excluding the need for surgical drainage. The main procedures for the drainage of peritonsillar abscess are needle aspiration, incision and drainage, and immediate tonsillectomy.

Drainage using any of these methods combined with antibiotic therapy will result in resolution of the peritonsillar abscess in more than 90 percent of cases. 6 The acute surgical management of peritonsillar abscess has evolved over time from routine immediate tonsillectomy to increased use of incision and drainage or needle aspiration. 11 Immediate abscess tonsillectomy has not been proven to be any more effective than needle aspiration or incision and drainage, and it is considered to be less cost-effective. 12 Several studies comparing needle aspiration with incision and drainage have found no significant statistical differences in outcomes. 11 , 12 Although it is not routinely performed for the treatment of peritonsillar abscess, immediate tonsillectomy should be considered for patients who have strong indications for tonsillectomy, including those who have symptoms of sleep apnea, a history of recurrent tonsillitis (four or more infections per year despite adequate medical therapy), or a recurrent or nonresolving peritonsillar abscess. 6 Initial empiric antibiotic therapy should include antimicrobials effective against Group A streptococcus and oral anaerobes.

13 The most common organisms associated with peritonsillar abscess are listed in Table 3 . 8 , 14 Although peritonsillar abscesses are polymicrobial infections, several studies have shown intravenous penicillin alone to be as clinically effective as broader-spectrum antibiotics, provided the abscess has been adequately drained. 12 , 14 In these studies, inadequate clinical response following 24 hours of antibiotic therapy played a significant role in the decision to use broad-spectrum antibiotics. Several other studies have reported that more than 50 percent of culture results demonstrated the presence of betalactamase producing anaerobes, leading many physicians to use broader-spectrum antibiotics as first-line therapy. 8 , 14 , 15 Table 4 shows suggested antimicrobial regimens. 16 Common Organisms Associated with Peritonsillar Abscess Aerobic bacteria Information from references 8 and 14 .

Table 3 Common Organisms Associated with Peritonsillar Abscess Aerobic bacteria Antimicrobial Regimens for Peritonsillar Abscess Intravenous therapy Ampicillin/sulbactam (Unasyn) 3 g every six hours Penicillin G 10 million units every six hours plus metronidazole (Flagyl) 500 mg every six hours If allergic to penicillin, clindamycin (Cleocin) 900 mg every eight hours Oral therapy Amoxicillin/clavulanic acid (Augmentin) 875 mg twice daily Penicillin VK 500 mg four times daily plus metronidazole 500 mg four times daily Clindamycin 600 mg twice daily or 300 mg four times daily Information from reference 16 .

Antimicrobial Regimens for Peritonsillar Abscess Intravenous therapy Ampicillin/sulbactam (Unasyn) 3 g every six hours Penicillin G 10 million units every six hours plus metronidazole (Flagyl) 500 mg every six hours If allergic to penicillin, clindamycin (Cleocin) 900 mg every eight hours Oral therapy Amoxicillin/clavulanic acid (Augmentin) 875 mg twice daily Penicillin VK 500 mg four times daily plus metronidazole 500 mg four times daily Clindamycin 600 mg twice daily or 300 mg four times daily Information from reference 16 . Although steroids have been used to treat edema and inflammation in other otolaryngologic diseases, their role in the treatment of peritonsillar abscess has not been extensively studied.

A recent study reported that 32 patients who received a single high dose of steroids (methylprednisolone [DepoMedrol] 2 to 3 mg per kg up to 250 mg) intravenously plus antibiotics responded much more quickly to treatment than 28 patients who received antibiotics plus placebo. 17 The use of steroids in the treatment of peritonsillar abscess appears to help speed recovery, but additional studies are needed before making a recommendation for their routine use. 6 , 17 When the family physician is inexperienced in treating peritonsillar abscess or when complications or questions arise during treatment, an otolaryngologist should be consulted. Once the diagnosis has been established, drainage or aspiration of the abscess should be performed in a setting where possible airway complications can be managed. 3 Peritonsillar aspiration is a technique well suited for the family physician who has had appropriate training. The patient should be observed for a few hours after aspiration to ensure he or she can tolerate oral antibiotics and pain medications. Outpatient follow-up should occur in 24 to 36 hours. 18 Oral antibiotics are continued for 10 days.

Most patients with a peritonsillar abscess can be treated in an outpatient setting, but a small percentage (e.g., 14 percent in one study) may require hospitalization. 12 Hospital stays usually do not exceed two days and are required for pain control and hydration. The overall risk of developing a second peritonsillar abscess is approximately 10 to 15 percent. 11 , 12 Up to 30 percent of patients with a peritonsillar abscess meet the criteria for tonsillectomy. 12 This operation may be performed immediately or delayed until the abscess has resolved. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Already a member/subscriber? Already a member or subscriber? Log in Immediate, unlimited access to all AFP content More than 130 CME credits per year Access to the AFP app Print delivery option Immediate access to this issue CME credits in this issue Immediate access to this article To see the full article, log in or purchase access. The Author show all author info NICHOLAS J.

GALIOTO, MD, is associate director of the Family Medicine Residency Program and director of the Transitional Year Residency Program for Broadlawns Medical Center in Des Moines, Iowa. He also has a clinical teaching appointment in the Department of Family Medicine at the University of Iowa Carver College of Medicine in Iowa City. Dr. Galioto received his medical degree from Creighton University in Omaha, Neb., and completed a family medicine residency at Broadlawns Medical Center.... Address correspondence to Nicholas J. Galioto, MD, Broadlawns Medical Center, 1801 Hickman Rd., Des Moines, IA 53104 (e-mail: ngalioto@broadlawns.org ). Reprints are not available from the author. Author disclosure: Nothing to disclose. REFERENCES show all references 1. Steyer TE. Peritonsillar abscess: diagnosis and treatment [Published correction appears in Am Fam Physician. 2002;66(1):30]. Am Fam Physician. 2002;65(1):93–96.... 2. Khayr W, Taepke J.

Management of peritonsillar abscess: needle aspiration versus incision and drainage versus tonsillectomy. Am J Ther. 2005;12(4):344–350. 3. Belleza WG, Kalman S. Otolaryngologic emergencies in the outpatient setting. Med Clin North Am. 2006;90(2):329–353. 4. Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH, for the Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis. 2002;35(2):113–125. 5. Berkovitz BK, ed. Pharynx. In: Standring S, ed. Grays Anatomy. The Anatomical Basis of Clinical Practice. 39th ed. New York, NY: Churchill Livingstone, 2005:623–625. 6. Herzon FS, Martin AD.

Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep. 2006;8(3):196–202. 7. Passy V. Pathogenesis of peritonsillar abscess. Laryngoscope. 1994;104(2):185–190. 8. Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg. 2004;62(12):1545–1550. 9. Nwe TT, Singh B. Management of pain in peritonsillar abscess. J Laryngol Otol. 2000;114(10):765–767. 10. Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management of deep neck space infections. Otolaryngol Head Neck Surg. 1997;116(1):16–22. 11.

Johnson RF, Stewart MG, Wright CG. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg. 2003;128(3):332–343. 12. Herzon FS, Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope. 1995;105(8 pt 3 suppl 74):1–17. 13. Brook I. The role of beta lactamase producing bacteria and bacterial interference in streptococcal tonsillitis. Int J Antimicrob Agents. 2001;17(6):439–442. 14. Kieff DA, Bhattacharyya N, Siegel NS, Salman SD. Selection of antibiotics after incision and drainage of peritonsillar abscesses. Otolaryngol Head Neck Surg. 1999;120(1):57–61. 15.

Ozbek C, Aygenc E, Unsal E, Ozdem C. Peritonsillar abscess: a comparison of outpatient IM clindamycin and inpatient IV ampicillin/sulbactam following needle aspiration. Ear Nose Throat J. 2005;84(6):366–368. 16. Fairbanks DN, ed. Pocket Guide to Antimicrobial Therapy in Otolaryngology—Head and Neck Surgery. 12th ed. Alexandria, Va.: American Academy of Otolaryngology—Head and Neck Surgery Foundation, Inc. 2005: 40, 86–90. 17. Ozbek C, Aygenc E, Tuna EU, Selcuk A, Ozdem C. Use of steroids in the treatment of peritonsillar abscess. J Laryngol Otol. 2004;118(6):439–442. 18. Roberts JR. ED considerations in the diagnosis and treatment of peritonsillar abscess. Emerg Med News.

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Question: Quinsy is the inflammation of which body organ due to abscess?
Answer: Tonsils