Tonsillitis/Quinsy

Dr Omar and Dr Lowe are back to discuss everything you need to know about tonsillitis and the much feared quinsy.

 

Lecture by

Video Duration: 13 minutes

  • Tonsillitis/Quinsy
    Created by Helen Bartlett
    General
    Epidemiology

    "Tonsillar inflammation in response to infection"

    Quinsy - peritonsillar abscess

    Pathology

    Local inflammatory pathways resulting in oropharyngeal swelling, oedema, erythema and pain.

    Top three causes

    Viral

    • Adenovirus
    • Rotavirus
    • EBV

    Bacterial

    • Group A B-Haemolytic streptococcus
    Clinical Features
    Symptoms
    • Dysphagia
    • Dysphonia
    • Dyspnoea
    • Recent URTI
    • Trismus
    Signs

    Vital signs

    • Hypoxia
    • Tachypnoea
    • Signs of sepsis
      • Tachycardia
      • Pyrexia
      • Hypotension

    General examination

    • Signs of respiratory distress
    • Stridor

    Oropharynx

    • Swelling
      • Bi/unilateral
    • Exudates
    • Uvula deviation
    • Signs of quinsy
      • Unilateral
      • Uvula deviation
      • Peritonsillar
      • Trismus

    Lympadenopathy -> may be Glandular fever

    • Hepatospenomegaly?

    Trismus

    Investigations
    Cultures

    None

    Bloods

    Severe infection

    • UEs
    • FBC
    • CRP
    • Monospot test
    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    None

    Medical

    Tonsillitis without quinsy

    • Oral antibiotics

    Severe infection

    • IV Abx
      • Benzylpenicillin and metronidazole
    • Analgesia
      • Paracetamol
      • Oral difflam
    • Consider IV dexamethasone
    Surgical

    Quinsy

    • Aspiration
      • Point - intersection of a line from the molar upwards, and the line from the base of the uvula
      • Spray local anaesthetic
      • Use tongue depressor, 10mL syringe and large bore canula using only the needle

    Tonsillitis

    • Tonsillectomy - for recurrent episodes of tonsillitis