A. Retropharyngeal Abscess.
B. Parapharyngeal Abscess.
C. Peritonsillar Abscess.
D. Acute Tonsillitis.
Ans;C. Peritonsillar Abscess
- Quinsy consists of suppuration outside the tonsil capsule .
- There is collection of pus between the capsule of tonsil and the superior constrictor muscle, i.e. in the peritonsillar area.
- Peritonsillar abscess is a complication of tonsillitis and is most commonly caused by group A beta – hemolytic streptococcus.
CLINICAL FEATURES :
- General : They are due to septicaemia and resemble any acute infection. They include fever (up to 104°F), chills and rigors, general malaise, body aches, headache, nausea and constipation.
- Severe pain in throat. Usually unilateral.
- Odynophagia. It is so marked that the patient cannot even swallow his own saliva which dribbles from the angle of his mouth. Patient is usually dehydrated.
- Muffled and thick speech, often called “Hot potato voice”.
- Foul breath due to sepsis in the oral cavity and poor hygiene.
- Ipsilateral earache. This is referred pain via CN IX which supplies both the tonsil and the ear.
- Trismus due to spasm of pterygoid muscles which are in close proximity to the superior constrictor.
EXAMINATION FINDINGS :
- The tonsil, pillars and soft palate on the involved side are congested and swollen. Tonsil itself may not appear enlarged as it gets buried in the oedematous pillars.
- Uvula is swollen and oedematous and pushed to the opposite side.
- Bulging of the soft palate and anterior pillar above the tonsil.
- Mucopus may be seen covering the tonsillar region.
- Cervical lymphadenopathy is commonly seen. This involves jugulodigastric lymph nodes.
- Torticollis : Patient keeps the neck tilted to the side of abscess.
- IV fluids
- Antibiotics : High dose penicllin. (iv benzipenicillin) is the DOC. In patients allergic to penicillin erythromycin is the DOC.
- Incision and drainage per orally, if the abscess does not resolve depite high dose of iv antibiotics in 48 hours.
- Tonsillectomy is done 6-8 weeks following an attack of quinsy (interval tonsillectomy).