AKT · ENT/Throat & airway

Quinsy (peritonsillar abscess)

Pus collection between the tonsil capsule and pharyngeal muscle

Overview

A collection of pus beside the tonsil (between the tonsillar capsule and the superior constrictor), usually a complication of tonsillitis. Severe UNILATERAL throat pain with TRISMUS, a "hot-potato" voice and the uvula deviated away from the swelling. It needs drainage plus antibiotics.

Recognise

Severe unilateral sore throat, odynophagia, drooling, and TRISMUS (difficulty opening the mouth)
Muffled "hot-potato" voice; the swollen peritonsillar area pushes the UVULA to the opposite side
Systemic upset, fever, ipsilateral ear pain (referred)

Red flags

Airway compromise, inability to swallow saliva/drooling, spread to a parapharyngeal/retropharyngeal abscess → urgent ENT/airway

Differentials & how to tell them apart

Severe tonsillitisbilateral, no trismus or uvular deviation — quinsy is unilateral with trismus and uvular displacement

Infectious mononucleosisgross bilateral tonsillar enlargement, systemic features

Retropharyngeal/parapharyngeal abscessdeeper neck swelling, more airway risk — imaging

Epiglottitisstridor, drooling, tripod posture — supraglottic, do not examine the throat

Quinsy — peritonsillar swelling, uvular deviation
James Heilman, MD / CC BY-SA 3.0 — Wikimedia Commons

Investigations

Clinical diagnosis. Urgent ENT review for needle aspiration/incision. Bloods if systemically unwell; imaging only if deep-neck spread suspected.

Management

Urgent ENT for aspiration/drainage + IV antibiotics

1Refer urgently to ENT for needle aspiration or incision and drainage; IV antibiotics (penicillin-based, covering anaerobes); analgesia, IV fluids, and consider a single dose of steroid.Gate: Quinsy needs DRAINAGE, not antibiotics alone — unilateral trismus + uvular deviation + hot-potato voice distinguishes it from bilateral tonsillitis and means the pus must be aspirated/incised
2Interval tonsillectomy may be considered (especially for recurrent quinsy); watch for deep-neck/airway spread.

Needle aspiration or incision & drainage — the key treatment — drain the pus (ENT)

IV antibiotics — e.g. benzylpenicillin/co-amoxiclav (cover Strep/anaerobes)

Analgesia + IV fluids + single-dose steroid — supportive; steroid can reduce symptoms

Key points

Unilateral + trismus + uvular deviation + hot-potato voice = quinsy → drain it. It is the abscess complication of tonsillitis; antibiotics alone are not enough.

Monitor & prognosis

Symptom/airway response; recurrence; deep-neck spread.

Good after drainage + antibiotics.

Source: NICE CKS; ENT UK