Peritonsilar Abscess a ENT disorder for B.Sc. Nursing students

ENT Disorder

1. Quinsy / peritonsillar abscess

2. Definition It is a collection of pus in the peritonsillar space which lies between the capsule of tonsil and the superior constrictor muscle Or It is a localized accumulation of pus in the peritonsillar tissues that forms as a result of suppurative tonsillitis

3. Causes It occurs as a complication of an untreated or partially treated tonsillitis Organisms Streptococcus - GAS Staphylococcus Heamophilus

4. Pathophysiology Tonsillitis or pharyngitis Tonsilar crypt get infected and sealed off Intra tonsillar abscess It burst into peritonsillar space through tonsillar capsule Peritonsillitis Peritonsilar abscess

5. Peritonsillar abscess (if not treated) Laryngeal edema Parapharyngeal Abscess Spread through blood – septicemia – infection to heart ( endocarditis ), kidney (nephritis), brain (brain abscess), lungs (lung abscess and pneumonia), airway obstruction, cellulitis of the jaw, neck or chest, pleural effusion

6. Signs and symptoms More common in children Symptoms start two to eight days before the formation of abscess Unilateral sore throat and pain during swallowing ( odynophagia ) Fever, malaise, headache Distortion of voice – hot potato voice Neck pain associated with tenderness, swollen lymph nodes Referred ear pain, halitosis Drooling of saliva

7. Trismus – limited ability to open the mouth Redness and edema in the tonsils Uvula may be displaced towards the unaffected side

8. Diagnosis History collection Physical examination Aspiration of the abscess using a needle - culture CT scan Ultrasonography

9. Management – surgical management Needle aspiration – low cost, and good patient tolerance The mucous membrane over the swelling is first sprayed with a topical anesthetic and then injected with a local anesthetic Single or repeated needle aspirations are performed to decompress the abscess

10. Position – sitting position to make it easier to expectorate the pus and blood that accumulate in the pharynx Patient experiences almost immediate relief If 3 ml or more of purulent material is aspirated then patient will likely need to be seen the next day for further aspiration

11. Surgical incision and drainage of the pus – this will relieve pain. Tonsillectomy – for patients who are not relieved from needle aspiration or incision and drainage. The risk for bleeding after surgery is more than normal removal of tonsils in tonsillectomy

12. Medical management Antibiotics – to treat infection Clindamycin , metronidazole in combination with penicillin G