Quinsy

What is quinsy?

Quinsy is a build-up of pus surrounding the tonsil, often pushing it out of shape. It's also known as a peritonsillar abscess, and it usually happens when a bout of tonsillitis hasn't fully cleared up.

What are the symptoms of quinsy?

Quinsy tends to come on quickly and get worse over a short space of time. You might notice:

• a severe sore throat that worsens quickly, usually more on one side
• pain when swallowing, and sometimes difficulty swallowing that causes drooling
• difficulty opening your mouth, sometimes to only a centimetre or so
• swelling inside your mouth and throat
• a change to your voice, often described as a muffled or ‘hot potato’ voice
• bad breath
• earache on the affected side
• swollen, tender glands in your neck
• a headache and feeling generally unwell
• a high temperature, although this sometimes settles before the abscess fully forms
• in more severe cases, difficulty breathing.

What are the causes of quinsy and who is at risk?

Quinsy develops when bacteria travel from an infected tonsil into the tissue around it, where they create a pocket of pus.

Group A streptococcus, the bacteria behind many throat infections, is the most common culprit, though other bacteria, including some that thrive without oxygen, can be involved too.

Anyone can get quinsy, but it's most common in teenagers and young adults. Smoking appears to raise your risk, and you can develop quinsy more than once, even after treatment. It rarely affects people who have already had their tonsils removed.

How is quinsy diagnosed?

To diagnose quinsy, your GP will talk through your symptoms with you and look at the back of your throat and your tonsils. If they suspect quinsy, they'll refer you straight to a hospital ear, nose and throat (ENT) team without delay, since catching it early helps stop the infection spreading further.

A blood test may be used to check for glandular fever, which can look similar to quinsy in its early stages. In some cases, doctors will also arrange a scan, such as a CT, MRI or ultrasound, to see whether the infection has spread beyond the area around the tonsil.

How is quinsy treated?

Most people with quinsy are treated in hospital. Your length of stay depends on the severity of the infection and your response to treatment, but typically this would be a few days.

Non-surgical treatment for quinsy

You'll be given antibiotics to clear the infection, usually through a drip into a vein at first, before switching to tablets once you're able to swallow more easily, which you’ll need to take for 10 to 14 days in total.

Typically a penicillin-based antibiotic, as well as, metronidazole are used to cover for a range of possible causative bacteria, which would be adjusted for those with penicillin allergies.

You'll also be offered painkillers such as paracetamol or ibuprofen, and sometimes a short course of corticosteroids to help bring down the swelling in your throat. If it's caught early, before pus has fully formed, the swelling often improves within 24 to 48 hours on antibiotics alone.

Surgical treatment for quinsy

Antibiotics alone don't always clear the infection, so the pus may need to be drained using one of the following:

• Needle aspiration: A fine-needle draws the pus out – you're usually awake, with a local anaesthetic or a sedative to help you relax
• Incision and drainage: A small cut lets the trapped pus escape, carried out under sedation, local anaesthetic or a general anaesthetic depending on your situation
• Tonsillectomy: An operation to remove your tonsils – this is rarely done while you still have quinsy, but may be recommended around six weeks after you've recovered if you keep getting it.

If a large collection of pus has formed, the opening made during drainage may need to be widened so it can drain fully. Once the pus is released, pain usually eases quickly and recovery tends to be straightforward.

When should I see a doctor?

See your GP as soon as possible if you or your child develop symptoms of quinsy, especially a sore throat that's rapidly getting worse on one side, or difficulty opening your mouth.

Getting a quick diagnosis matters, because quinsy that isn't treated promptly can lead to serious problems, including swelling severe enough to affect your breathing.If breathing or swallowing becomes very difficult, this needs urgent medical attention straight away.