Quinsy

Group B beta-hemolytic streptococci and Fusobacterium and the most commonly involved bacteria. Incidence of quincy is estimated at about 45,000 cases per year within the USA. Remaining tissue at upper tonsillar pole extending into loose surrounding areolar tissue, or  suppuration of tonsillar tissue are thought to be cause of the condition.

Alternative explanation for quinsy formation after tonsillectomy may be remnants of the 2nd internal pharyngeal pouch can form a congenital fistula, as the scar after the procedure may block off this tract preventing free drainage of infection occurring. Dental infection may affect etiology. Presence of foreign bodies, syphilis or tuberculosis, and injury to the area can lead to lesion which can also result in quinsy. Local immune response is weakened by tonsillectomy, and increases risk of infection.

Intraoral ultrasound diagnoses are correct in 95% cases, with the peritonsillar area on affected side displaying as swollen and reddened, soft palate inflamed, and the uvula pushed opposite swelling.

Antibiotics which cover anaerobic and aerobic bacteria are typically prescribed. Steroids are sometimes used to alleviate symptoms of swelling and pain which also help to decrease recovery time, but steroids weaken the immune responses so it is only used if required.

Aspiration of peritonsillar abscess is standard management, providing confirmation of diagnosis and relief of the condition, incision and drainage are also equally effective. Tonsillectomy is part of management as a safe procedure and helps to make recovery more rapid, reducing need for follow up and avoids a second admission. Tonsillectomy is thought as overtreatment as majority of patients are fully cured following needle aspiration in competent hands.

Chances that quincy may recur are 9-22%, high recurrence risk may be used for interval tonsillectomy following successful resolution of the abscess. Recurrence indicates presence of dental disease or interventions, congenital fistulae, or recurrent tonsillitis.