---
title: "Peritonsillar Abscess (Quinsy)"
description: "Detailed notes of anatomy of Peritonsillar Space, pathogenesis, clinical features, diagnosis, management, and complications of Peritonsillar Abscess (Quinsy) - for medical students and ENT residents."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/peritonsillar-abscess-quinsy"
categories: ["Neck"]
video: "https://www.youtube.com/watch?v=O5BamBD7NNA"
image: "https://media.theentresident.com/og-images/peritonsillar-abscess-quinsy.png"
---

# Peritonsillar Abscess (Quinsy)

Detailed notes of anatomy of Peritonsillar Space, pathogenesis, clinical features, diagnosis, management, and complications of Peritonsillar Abscess (Quinsy) - for medical students and ENT residents. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=O5BamBD7NNA

## Peritonsillar Space and Peritonsillar Abscess (Quinsy)

### 📌 Boundaries of Peritonsillar Space

The **peritonsillar space** is a *potential space* between:
- **Medially**: Fibrous capsule of the palatine tonsil
- **Laterally**: Superior constrictor muscle
- **Anteriorly**: Anterior pillar (palatoglossal fold)
- **Posteriorly**: Posterior pillar (palatopharyngeal fold)

### 📌 Contents of Peritonsillar Space

- Loose areolar tissue
- Communicates with **parapharyngeal** and **retropharyngeal spaces**  

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### 💡 What is Peritonsillar Abscess (Quinsy)?
It is the **collection of pus in the peritonsillar space**, typically occurring between the **tonsillar capsule** and the **superior constrictor muscle**.

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### 🔬 Etiology and Pathogenesis of Peritonsillar Abscess

- **Most commonly** follows acute tonsillitis
- May also occur **de novo**, without prior sore throat

- Frequently involves the **crypta magna**, leading to:
  1. **Intratonsillar abscess**
  2. Burst through capsule → **Peritonsillitis**
  3. Progression to **abscess**

### Common Organisms
- **Streptococcus pyogenes**
- **Staphylococcus aureus**
- **Anaerobes**
- Typically a **mixed growth**

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### 👨‍⚕️ Clinical Presentation of Peritonsillar Abscess

**Demographics**

- **Adults > Children**
- **Unilateral > Bilateral** cases (rare)

**General Symptoms** (due to septicemia)

- Fever, chills, rigor
- Malaise, body ache
- Headache, nausea
- Constipation

**Local Symptoms**

- Severe **unilateral throat pain**
- **Odynophagia** (cannot swallow saliva)
- **Hot potato voice** (muffled, thick speech)
- **Foul breath**
- **Referred ear pain** (via glossopharyngeal nerve)
- **Trismus** (due to pterygoid muscle spasm)

**🔍 Clinical Examination**

- Congested, swollen **soft palate and pillars**
- Tonsil may appear **normal or buried** in oedema
- **Uvula deviated** to opposite side
- Bulging above the **upper pole of tonsil**
- **Mucopus** over tonsillar region
- **Jugulodigastric lymphadenopathy**
- **Torticollis** (neck tilted to affected side)

---

### 🛠️ Management of Peritonsillar Abscess

**Conservative Treatment (for Peritonsillitis)**

- Hospitalization

- **IV fluids** for dehydration

- **Broad-spectrum antibiotics** (aerobic + anaerobic)

- **Analgesics** (e.g., Paracetamol)
  - Avoid **aspirin** (risk of bleeding)

- **Oral hygiene**: Hydrogen peroxide/saline mouthwash

- **Incision and Drainage** (for Abscess)

>What are the indications for **Incision and Drainage** in Peritonsillar Abscess?

>Where is the site of incision for **I&D** in Peritonsillar Abscess?

- **Tonsillectomy**

>What is **Interval Tonsillectomy**? When is it done?

>What is **Hot Tonsillectomy**? What is it's Indication?

---

### ⚠️ Complications of Peritonsillar Abscess

- Parapharyngeal abscess
- Laryngeal edema
- Septicemia → Endocarditis, nephritis, brain abscess
- Pulmonary complications: Pneumonitis, lung abscess
- Jugular vein thrombosis
- Hemorrhage from carotid artery or jugular vein
- Airway obstruction
- Mediastinitis

---

### 🧩 Differential Diagnosis of Peritonsillar Abscess

1. Infectious
    - Parapharyngeal abscess
    - Upper third molar abscess
    - Infectious mononucleosis

2. Inflammatory
    - Kawasaki disease

3. Vascular
    - Internal carotid artery pseudoaneurysm

4. Benign
    - Benign lymphoepithelial cyst

5. Malignant
    - Tonsillar carcinoma
    - Tonsillar lymphoma
    - Rhabdomyoma
    - Minor salivary gland tumors

---

## About This Note

This free ENT note on Peritonsillar Abscess (Quinsy) was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/peritonsillar-abscess-quinsy

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Neck: https://www.theentresident.com/ent-notes-lectures/category/neck.md

## About The ENT Resident

The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students.

Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself.

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The ENT Resident provides educational material for medical learning and revision. It does not provide patient-specific medical advice, diagnosis, or emergency care, and it is not a substitute for evaluation by a qualified healthcare professional.

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