Related Subjects:
|Assessing Hearing Loss
|Benign Paroxysmal Positional Vertigo (BPPV)
|Cholesteatoma
|Epistaxis (Nosebleeds)
|Acute Mastoiditis
|Nasal polyps
|Peritonsillar Abscess (Quinsy)
|Acute Sinusitis
|Sudden Sensorineural Hearing loss (SNHL)
|Causes of Vertigo
📖 About
- 🤒 A peritonsillar abscess (quinsy) is a complication of acute tonsillitis where pus accumulates in the peritonsillar space.
- ⚠️ If untreated, it can cause deep neck space infection and airway obstruction.
- 👩⚕️ Common in adolescents & young adults, but can occur at any age.
🧬 Aetiology
- The palatine tonsils are part of Waldeyer’s ring (lymphoid tissue of the oropharynx).
- The abscess forms in the peritonsillar space (between palatine tonsil & pharyngeal mucosa).
- Often follows untreated or inadequately treated tonsillitis.
🦠 Microbiology
- Common organisms:
- 🧫 Group A Streptococcus (S. pyogenes)
- 🧫 Staphylococcus aureus (incl. MRSA)
- 🧫 Haemophilus influenzae
- 🧫 Fusobacterium spp. (Lemierre’s syndrome)
- 🧫 Peptostreptococcus
- 🧫 Pigmented Prevotella
🩺 Clinical Presentation
- 🔥 Severe unilateral throat pain (often radiating to ear).
- 🚫 Odynophagia (painful swallowing), drooling due to inability to swallow saliva.
- 🌡️ Fever, 🤐 trismus (difficulty opening mouth), and “hot potato” muffled voice.
- 👅 Oropharyngeal asymmetry: swelling, erythema, uvula pushed to opposite side.
- 🦠 Tender cervical lymphadenopathy.
- 💧 Dehydration from poor oral intake.
🔎 Investigations
- 🧪 Bloods: FBC (↑WBC), CRP (raised), U&E (hydration status).
- 🖼️ CT neck: confirms abscess, rules out deep neck spread if diagnosis unclear.
- 💉 Needle aspiration: diagnostic & therapeutic → send pus for culture.
⚠️ Complications
- 😮 Airway obstruction from swelling.
- 🌬️ Aspiration pneumonitis/lung abscess if rupture occurs.
- 💉 Carotid sheath erosion → life-threatening haemorrhage.
- ⬇️ Spread to deep neck tissues → posterior mediastinitis.
- 🦠 Post-streptococcal disease (GN, rheumatic fever).
💊 Management
- Key steps: Drainage + IV antibiotics + Supportive care
- 🩸 Needle aspiration (16–18g needle) → relieve pain & culture pus.
- 🔪 Incision & drainage: ENT if aspiration fails or recurrent.
- 🧵 Tonsillectomy: recurrent abscess or chronic tonsillitis.
- 💉 Example IV therapy (10 days):
- 💊 Benzylpenicillin 1.8 g q6h + Metronidazole 500 mg q8h
- 💊 Clindamycin 450 mg q6h if penicillin allergy
- 🤕 Supportive: analgesia, antipyretics, IV fluids if needed.
🩸 Complications of Drainage
- 🌬️ Aspiration of blood
- 💉 Haemorrhage (carotid injury risk)
- 🤕 Pain/discomfort
- 🌀 Incomplete drainage → recurrence
🚫 Contraindications to Drainage
- 🙅 Poor patient cooperation (children, severe trismus).
- 🩸 Coagulopathy / anticoagulation.
- ❓ Uncertain diagnosis → get imaging before attempting drainage.
🛠️ Equipment for Drainage
- 💉 IV analgesia & sedation meds
- 💉 Local anaesthetic (1% lidocaine + adrenaline)
- 💨 Topical anaesthetic spray (lidocaine 4%)
- 👅 Tongue depressor & headlamp
- 🧲 Suction catheter (Frazier or Yankauer)
- 💉 Syringe + 18–20g needle for aspiration
- 🔪 Scalpel No. 11 or 15 for I&D
💉 The Role of Steroids
- 📉 Dexamethasone may reduce swelling & speed recovery.
- 🛑 Not routine yet, but considered in severe swelling/airway risk.
📚 References
