Peritonsillar abscess (quinsy)

This is an abscess that can follow tonsillitis. It forms normally round one tonsil, and the swelling pushes the tonsil downwards into the mouth. The patient may find it so difficult and painful to swallow that he may refuse to eat. He may have earache on the affected side. The swelling on the tonsil will be extremely tender, and a finger pressing gently inwards just below and behind the angle of the jaw will cause pain. There is usually fever, sometimes quite high (up to 40 °C). The throat will be red and a swelling will be seen above the tonsil on the affected side.

General treatment

The patient should be put to bed and his temperature, pulse, and respiration taken and recorded every 4 hours. Give a liquid diet or minced food in a sauce, as solids are usually painful to swallow. Ice-cold drinks are much appreciated as they dull the pain and thus allow some fluid and nourishment to be taken.

Specific treatment

Give the patient one intramuscular injection of 600 000 units of procaine benzylpenicillin unless the patient is allergic to penicillin, and immediately start the standard antibiotic treatment.

If the patient cannot swallow whole tablets he may be able to take them ground up in water or in a teaspoonful of honey. If swallowing is impossible and the patient is not allergic to penicillin, give procaine benzylpenicillin, 600 000 units intramuscularly, every day for 5 days.

Give 2 acetylsalicylic acid or paracetamol tablets every 6 hours to relieve the pain.

Subsequent management

A peritonsillar abscess may settle down with treatment, or it may burst. The patient should be told that the abscess will be very painful before it bursts, and that when the abscess does break there will be severe pain, followed by a discharge of pus, which should be spat out. The patient should be given a mouthwash of water to gargle with after the abscess breaks. Soon after the abscess has broken, the patient will feel much better and he can be allowed up when his temperature has remained normal for 24 hours.

I. Read and translate the text

II. Tell what is the general treatment for sore throat