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Peritonsillar abscess

A peritonsillar abscess (PTA), also known as quinsy, is a localized collection of pus that forms in the peritonsillar space between the tonsillar capsule and the pharyngeal constrictor muscle as a complication of acute tonsillitis.^[1] It represents the most common deep infection of the head and neck region.^[2] This condition primarily arises from bacterial infection, most often involving group A beta-hemolytic Streptococcus (Streptococcus pyogenes), though it is frequently polymicrobial, incorporating oral flora such as anaerobes like Fusobacterium and Prevotella species.^[3]^[4] Risk factors include prior episodes of tonsillitis, smoking, and possibly seasonal variations, with higher incidence reported in spring and winter in some regions.^[5] In the United States, the annual incidence is approximately 30 cases per 100,000 individuals, translating to about 45,000 new cases yearly, predominantly affecting adolescents and young adults aged 15 to 30 years, with males showing a slight predominance in certain studies.^[1]^[6] Clinically, patients present with severe, unilateral throat pain, fever, odynophagia (painful swallowing), trismus (limited mouth opening), and a characteristic muffled "hot potato" voice due to peritonsillar swelling.^[2] Additional features may include drooling, ipsilateral otalgia, cervical lymphadenopathy, and uvular deviation toward the unaffected side on examination, reflecting the asymmetric inflammation.^[3] If untreated, complications such as airway obstruction, sepsis, or spread to deeper neck spaces can occur, though these are rare with prompt intervention.^[7] Diagnosis is chiefly clinical, based on history and physical findings, with imaging such as computed tomography (CT) reserved for atypical presentations or suspected complications to confirm the abscess and rule out alternative pathologies like parapharyngeal abscess.^[1] Treatment typically involves empiric intravenous antibiotics targeting streptococci and anaerobes (e.g., penicillin plus metronidazole), combined with drainage via needle aspiration, incision and drainage, or, in recurrent cases, immediate tonsillectomy.^[7]^[4] Supportive care includes analgesia, hydration, and monitoring for airway compromise, with most patients recovering fully within days to weeks.^[3]

Definition and pathophysiology

Definition

A peritonsillar abscess (PTA) is defined as a localized collection of pus within the peritonsillar space, situated between the tonsillar capsule and the superior constrictor muscle of the pharynx.^[7] Also known historically as quinsy, this condition represents a suppurative complication typically arising from untreated or inadequately managed acute tonsillitis.^[8] The peritonsillar space is a potential anatomical compartment bounded medially by the palatine tonsil, laterally by the superior pharyngeal constrictor muscle, and posteriorly by the palatopharyngeus muscle.^[9] Abscess formation most commonly occurs at the superior pole of the tonsil, accounting for 41% to 70% of cases, with less frequent involvement at the inferior pole or mid-tonsillar region.^[10] PTA must be differentiated from peritonsillar cellulitis, which involves inflammatory edema in the same space but lacks a discrete pus collection and is considered a precursor stage.^[11]

Pathophysiology

A peritonsillar abscess typically arises as a complication of acute bacterial tonsillitis, where the initial infection within the palatine tonsils leads to suppuration and pus accumulation in the peritonsillar space—a potential space between the tonsillar capsule and the superior constrictor muscle of the pharynx.^[7] The process begins with bacterial invasion of the tonsillar parenchyma or crypts, progressing to localized infection when the pathogens breach the tonsillar barrier and enter the adjacent peritonsillar tissue.^[1] Several mechanisms explain the spread of infection to the peritonsillar space. Direct extension from the tonsillar crypts is a primary pathway, allowing bacteria to invade the loose connective tissue laterally and superiorly. Additionally, involvement of the Weber glands—minor salivary glands located in the supratonsillar fossa—may serve as a nidus, where ductal obstruction leads to bacterial overgrowth and abscess formation.^[7]^[1] The inflammatory response in peritonsillar abscess involves intense local edema, hyperemia, and tissue necrosis driven by the host immune reaction to bacterial toxins and enzymes. Mixed aerobic and anaerobic flora, often originating from the oral cavity, synergistically promote abscess maturation by producing proteolytic enzymes that liquefy tissue and facilitate pus formation. A fibrous capsule eventually forms around the necrotic debris and pus, walling off the infection but potentially delaying resolution due to reduced vascularity and poor antibiotic penetration in the avascular core.^[7]^[1]^[12] The condition evolves through stages, starting as peritonsillar cellulitis—a diffuse, non-localized phlegmonous infection characterized by widespread inflammation without discrete pus collection. If untreated, this progresses to a mature abscess, marked by a fluctuant, encapsulated pus pocket, often influenced by factors such as impaired host immunity or persistent bacterial virulence that hinders clearance.^[1]^[12]

Clinical presentation

Signs and symptoms

Patients with peritonsillar abscess typically present with severe unilateral sore throat, often described as the most intense pain in the affected area.^[13] This is accompanied by odynophagia, making swallowing extremely painful, and dysphagia, which contributes to reduced oral intake.^[2] Fever is a common systemic symptom, frequently exceeding 38.5°C, along with malaise, fatigue, and headaches.^[13] Voice changes are characteristic, including a muffled or "hot potato" voice due to peritonsillar swelling affecting resonance.^[7] On physical examination, trismus is a hallmark sign, resulting from irritation of the internal pterygoid muscle and limiting mouth opening to less than 2 cm in many cases.^[4] Tonsillar asymmetry is evident, with enlargement and bulging of the affected tonsil and soft palate toward the contralateral side, often accompanied by uvular deviation away from the abscess.^[14] Unilateral exudate may be visible on the tonsil, and the soft palate appears erythematous and swollen.^[7] Cervical lymphadenopathy, particularly tender anterior cervical nodes, is frequently observed ipsilateral to the abscess.^[7] Associated features include drooling due to painful swallowing, halitosis from anaerobic infection, and referred otalgia to the ipsilateral ear.^[13] The condition often progresses from initial symptoms of acute tonsillitis that fail to resolve, with worsening unilateral symptoms over 2-5 days.^[7] Bilateral peritonsillar abscess is rare, occurring in less than 5% of cases, and presents with symmetric swelling, bilateral trismus, and muffled voice without uvular deviation.^[15]

Complications

Untreated or inadequately managed peritonsillar abscess can lead to serious local complications, primarily due to progressive swelling and potential rupture of the abscess. Airway obstruction is a rare but life-threatening outcome, resulting from extensive edema that compromises breathing, particularly when severe trismus limits mouth opening and exacerbates the risk. Rupture of the abscess into adjacent deep neck spaces may cause rapid spread of infection, potentially leading to Ludwig's angina, a bilateral cellulitis of the submandibular space that causes floor-of-mouth elevation and further airway compromise.^[12]^[16]^[17] Systemic complications arise from dissemination of the infection beyond the peritonsillar region. Bacteremia and sepsis occur in a significant proportion of cases, with approximately half of patients meeting sepsis diagnostic criteria, often linked to factors like smoking or delayed antibiotic therapy. Extension into the parapharyngeal space can produce neck stiffness and further propagate infection, while deeper spread may result in descending mediastinitis, a severe necrotizing infection of the mediastinum reported in multiple cases.^[18]^[19]^[20] Recurrent peritonsillar abscesses represent a common sequela, with an overall recurrence rate of approximately 10 to 15 percent in the absence of tonsillectomy, potentially evolving into chronic tonsillitis with repeated episodes of inflammation.^[21] Rare complications include internal jugular vein thrombosis, a variant of Lemierre's syndrome involving septic thrombophlebitis, and intracranial extension such as brain abscess, both of which carry high morbidity. Immunocompromised patients face increased risk of severe morbidity from these infections due to impaired host defenses, often requiring more aggressive intervention.^[20]^[22]^[23]

Etiology and risk factors

Causes

Peritonsillar abscess (PTA) is primarily caused by bacterial infections originating from the oral flora, often progressing from an initial episode of acute tonsillitis. The condition typically arises when bacteria invade the peritonsillar space, leading to localized pus accumulation.^[24] The predominant pathogen is Group A Streptococcus (Streptococcus pyogenes), which is identified in 20-30% of cases and is considered the most common aerobic isolate. Other frequent streptococcal species include Group C and G streptococci, as well as viridans group streptococci such as Streptococcus anginosus (formerly milleri group). Anaerobic bacteria play a significant role, with Fusobacterium necrophorum (prevalent in adolescents and young adults) and Prevotella species commonly isolated.^[25]^[6]^[26] Most PTAs exhibit a polymicrobial nature, involving mixed aerobic and anaerobic infections derived from the normal tonsillar and oral microbiota. This combination facilitates abscess formation through synergistic bacterial interactions, where aerobes like streptococci may create conditions favorable for anaerobe proliferation in the tonsillar crypts.^[6]^[4] PTA most commonly develops as a suppurative complication of bacterial pharyngitis or tonsillitis, allowing infection to spread from the tonsillar parenchyma to the peritonsillar space.^[12]^[27] Less common causes include superinfections following viral upper respiratory infections, such as those associated with infectious mononucleosis, and rare non-infectious mimics like foreign bodies in the tonsillar area or neoplastic processes presenting similarly. However, these are exceptional, with bacterial etiology confirmed in the vast majority of instances.^[4]^[7]

Risk factors

Peritonsillar abscess (PTA) predominantly affects adolescents and young adults, with the highest incidence occurring between the ages of 15 and 30 years.^[28] This age group experiences peak rates, potentially due to increased exposure to infectious agents in social settings and anatomical factors related to tonsillar development. The condition is slightly more common in males, particularly after adolescence, although the overall male-to-female ratio approximates 1:1, with females tending to present at younger ages.^[29]^[28] A history of recurrent tonsillitis (such as five or more prior episodes) significantly predisposes individuals to PTA, as repeated episodes of tonsillar infection can lead to local tissue damage and bacterial superinfection. Additionally, a prior PTA episode markedly increases the likelihood of recurrence, with rates reported between 10% and 15%.^[30]^[21] Behavioral and environmental factors play a key role in susceptibility. Smoking is a well-established risk factor, as it impairs mucosal defenses and promotes bacterial colonization in the oropharynx, with studies indicating a dose-dependent association. Poor oral hygiene, including significant periodontal disease, further heightens risk by facilitating polymicrobial infections. Seasonal viral infections, such as those caused by Epstein-Barr virus (EBV) or influenza, can act as triggers by inducing local immunosuppression and paving the way for secondary bacterial invasion.^[25]^[12]^[25] Comorbidities and anatomical variations also contribute to PTA development. Immunosuppressive conditions, including HIV and diabetes mellitus, compromise host defenses, leading to higher susceptibility and more severe presentations; for instance, type 2 diabetes independently elevates PTA risk. Anatomical abnormalities, such as enlarged tonsils or deep tonsillar crypts, may obstruct drainage and promote abscess formation. Furthermore, individuals in low socioeconomic settings are at greater risk due to barriers to timely medical care, resulting in progression from uncomplicated tonsillitis to abscess.^[12]^[31]^[32]

Diagnosis

Clinical assessment

The clinical assessment of peritonsillar abscess begins with a detailed history taking to identify key features suggestive of the condition. Patients typically report a severe sore throat lasting several days, often preceded by tonsillitis, accompanied by fever, dysphagia, and the recent onset of trismus that limits mouth opening.^[13] Systemic symptoms such as malaise and dehydration may also be elicited, helping to gauge severity and duration.^[7] Physical examination focuses on intraoral inspection and palpation to detect characteristic abnormalities. Asymmetry in the oropharynx is common, with unilateral tonsillar enlargement, peritonsillar edema, and medial displacement of the soft palate or uvula toward the contralateral side; bimanual palpation along the superior tonsillar pole may reveal fluctuance indicating pus collection.^[12] Trismus is assessed by measuring interincisor distance, where opening less than 2 cm is highly suggestive due to irritation of the internal pterygoid muscle.^[33] A muffled "hot potato" voice and drooling may be noted during the exam.^[7] The presumptive diagnosis relies on the constellation of these clinical signs, which collectively offer high diagnostic accuracy. For instance, the presence of uvula deviation, hot potato voice, and pharyngeal edema demonstrates a sensitivity of approximately 90% for peritonsillar abscess in recent prospective studies.^[34] Trismus combined with peritonsillar swelling further supports suspicion.^[13] Differential diagnosis during assessment includes distinguishing peritonsillar abscess from epiglottitis or retropharyngeal abscess, which may present with similar trismus but lack unilateral tonsillar asymmetry and show more diffuse airway involvement on exam.^[12] Careful evaluation of voice quality and neck mobility aids in ruling out these alternatives.^[7]

Diagnostic tests

Diagnosis of peritonsillar abscess (PTA) often involves ancillary investigations to confirm the presence of a fluid collection and identify potential complications, particularly when clinical assessment is equivocal.^[7] Imaging modalities play a key role in visualization, with intraoral ultrasound serving as a first-line, non-invasive option due to its portability and lack of radiation exposure. Ultrasound demonstrates high sensitivity, approximately 89-95%, for detecting fluid collections indicative of PTA, allowing for differentiation from peritonsillar cellulitis by identifying hypoechoic areas adjacent to the tonsil.^[35]^[36] Its specificity ranges from 78-100%, making it effective for ruling out abscesses in emergency settings and guiding needle aspiration to avoid vascular structures like the carotid artery.^[37] Computed tomography (CT) with contrast enhancement is reserved for cases with suspected complications, such as deep neck extension or airway involvement, revealing a rim-enhancing fluid collection adjacent to the enlarged tonsil with 100% sensitivity and 75% specificity.^[20]^[38] Laboratory tests provide supportive evidence of infection but are not diagnostic on their own. A complete blood count (CBC) typically shows leukocytosis with a left shift, reflecting neutrophilia in response to bacterial infection.^[39] Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels indicate systemic inflammation, often correlating with disease severity and hospitalization duration.^[5] Throat swabs for culture or rapid antigen detection testing for group A Streptococcus have low yield in confirming PTA etiology, as surface cultures do not reliably sample the abscess cavity, with positivity rates as low as 8% in impending cases.^[40]^[41] Needle aspiration of the suspected abscess serves as the gold standard for microbiologic confirmation, providing pus for Gram stain, culture, and sensitivity testing to guide antibiotic therapy.^[7] This invasive procedure not only confirms the diagnosis by yielding purulent material but also offers therapeutic drainage, though it carries risks such as vascular injury if not ultrasound-guided.^[39] Emerging research in 2025 has explored serological markers to aid differentiation between PTA and peritonsillar cellulitis without invasive procedures. Elevated serum levels of high-mobility group box 1 (HMGB1) and reduced kallistatin show promise as biomarkers, with receiver operating characteristic analysis indicating potential diagnostic utility in research settings, though they are not yet part of routine clinical practice.^[42]

Treatment

Medical management

Medical management of peritonsillar abscess primarily involves empiric antibiotic therapy targeted at the polymicrobial etiology, including group A Streptococcus and oral anaerobes, alongside supportive measures to alleviate symptoms and maintain hydration. Initial treatment typically consists of intravenous penicillin G (2-4 million units every 4-6 hours) or clindamycin (600-900 mg every 8 hours) for hospitalized patients, as these agents provide broad coverage against the predominant pathogens.^[12]^[7] This regimen demonstrates high efficacy, with penicillin-based therapy achieving resolution rates of 95-99% when combined with drainage in most cases, though antibiotics alone can be effective in select scenarios.^[4] Therapy duration is generally 10-14 days, transitioning to oral amoxicillin-clavulanate (875 mg twice daily) once the patient tolerates oral intake and clinical improvement occurs.^[43] For patients with penicillin allergy, clindamycin remains the preferred alternative due to its anaerobic coverage.^[12] Supportive care focuses on symptom relief and prevention of complications from odynophagia and dehydration. Analgesics such as ibuprofen (400-600 mg every 6-8 hours) or acetaminophen (500-1000 mg every 4-6 hours) are used to control pain and fever, often supplemented with nonsteroidal anti-inflammatory drugs for their anti-inflammatory effects. Corticosteroids, such as dexamethasone (8-10 mg IV) or methylprednisolone (2-3 mg/kg IV), may be administered to reduce swelling and improve symptoms.^[21]^[44] Hydration is maintained through intravenous fluids if oral intake is impaired, and antiemetics like ondansetron (4-8 mg as needed) may be administered to manage nausea associated with severe swallowing pain.^[12] These measures help stabilize patients while antibiotics take effect, typically within 24-48 hours. In cases of small abscesses, particularly those less than 2 cm in diameter with minimal symptoms, conservative management with antibiotics alone is a viable option, avoiding immediate drainage. Recent pediatric studies support this approach, reporting success rates of approximately 94% in avoiding surgical intervention within two weeks, with primary failure rates around 6% and no reported complications in selected children under 13 years.^[45] This strategy is most appropriate for younger patients or those without airway compromise, emphasizing close follow-up to monitor resolution. Monitoring is essential, especially in severe cases warranting hospitalization for intravenous therapy, fluid support, and airway observation to detect potential obstruction from swelling.^[12] Regimens should be adjusted for local resistance patterns; if methicillin-resistant Staphylococcus aureus (MRSA) is suspected based on risk factors or culture results, vancomycin (15-20 mg/kg every 8-12 hours) is added for coverage.^[12]^[46] Drainage may serve as an adjunct in non-responders, but medical optimization remains the cornerstone.^[43]

Surgical interventions

Surgical interventions for peritonsillar abscess (PTA) primarily focus on draining the pus collection to alleviate symptoms and prevent complications, with techniques ranging from minimally invasive procedures to more definitive surgical options. Needle aspiration serves as the first-line drainage method, often feasible in an outpatient setting under local anesthesia. This procedure involves using an 18- to 20-gauge needle to puncture the most fluctuant area of the abscess, typically at the superior pole of the tonsil, allowing for both diagnosis via pus confirmation and therapeutic evacuation of contents. Studies indicate recurrence rates of 10-15% following needle aspiration, though it remains cost-effective and less invasive than alternatives.^[47]^[43]^[48] Incision and drainage (I&D) offers a more thorough approach for larger or multiloculated abscesses, performed under local anesthesia by making a small incision over the fluctuant area followed by blunt dissection and evacuation. This method is considered more definitive than needle aspiration, with lower reported recurrence rates in comparative studies, and can be completed in an office or emergency setting. I&D may require repeat procedures in up to 10% of cases but provides superior pus yield and visualization of the cavity.^[9]^[47]^[49] For patients with recurrent PTA or failure of initial drainage, advanced surgical options include quinsy tonsillectomy, which entails immediate bilateral tonsillectomy during the acute infection phase. This procedure is particularly indicated for recurrent cases and has demonstrated high efficacy with low complication rates in experienced hands, addressing the underlying tonsillar pathology directly. Alternatively, interval tonsillectomy is performed electively 6-8 weeks after abscess resolution, allowing inflammation to subside and reducing perioperative risks while preventing future episodes in those with a history of recurrent tonsillitis.^[50]^[49]^[51] In pediatric patients, where cooperation may be challenging, conscious sedation is increasingly utilized during drainage procedures to enhance tolerability. Recent 2024 prospective studies report that conscious sedation facilitates effective PTA drainage with greater pus volume evacuated (mean 4.9 mL versus 3.2 mL with local anesthesia alone) and excellent safety profiles, including no major airway events. For smaller abscesses in children, less invasive alternatives such as ultrasound-guided aspiration under sedation may be preferred to minimize trauma. Post-procedure care involves administering culture-directed antibiotics based on aspirate analysis to target pathogens like Streptococcus pyogenes, alongside close follow-up to monitor for resolution of trismus, dysphagia, and fever. Potential complications include bleeding, occurring in approximately 1-2% of drainage cases, though rates rise to 11-13% following tonsillectomy; most are managed conservatively or with hemostasis.^[43]^[52]^[53]

Epidemiology and prognosis

Epidemiology

Peritonsillar abscess (PTA) has an annual incidence of approximately 30 cases per 100,000 persons in developed countries, primarily affecting individuals aged 5 to 49 years.^[54] In the United States, this translates to an estimated 45,000 new cases each year.^[1] The condition is most prevalent among adolescents and young adults, with rates reaching up to 40 cases per 100,000 person-years in those aged 15 to 19, compared to 30 to 40 cases per 100,000 in adults overall.^[55] Males show a slight predominance.^[1] In pediatric populations, incidence remains stable at 20 to 30 cases per 100,000 annually, though it is rarer in children under 5 years.^[56] Historical trends indicate a relatively stable incidence in developed countries around 30 per 100,000.^[1] However, post-COVID-19 data from 2024 and 2025 reveal shifts, including a temporary decrease during nonpharmaceutical interventions (14.9 cases per 100,000) followed by a rebound to 26.9 cases per 100,000 after restrictions lifted, potentially due to delayed care and accumulated infections.^[57] Incidence exhibits seasonal peaks in winter and spring, correlating with higher rates of respiratory infections.^[58] Geographic variations show higher PTA rates in rural and low-resource settings, where access to timely antibiotic treatment for tonsillitis is limited.^[59] Studies indicate that over 50% of non-streptococcal pathogens in PTA cultures show penicillin resistance, complicating management.^[12]

Prognosis

With appropriate treatment, peritonsillar abscess (PTA) typically resolves rapidly, with 90-95% of cases showing significant symptom improvement within 24-48 hours.^[21] Hospitalization duration typically ranges from 2 to 4 days, though it can extend to 5-7 days in complicated cases.^[12] The risk of recurrence following a single episode is estimated at 5-15%, but rises to 20-30% in patients with prior recurrent tonsillitis or multiple abscess episodes.^[60]^[61] Recent 2025 data indicate that conservative antibiotic management in pediatric cases achieves success in approximately 87% of patients, thereby reducing the immediate need for surgical intervention.^[62] Prognosis is influenced by several factors, including timely diagnosis; delays can increase the risk of complications such as airway obstruction.^[7] Outcomes are generally more favorable in immunocompetent individuals without underlying comorbidities.^[7] Long-term sequelae are rare, with tonsillectomy reducing the risk of future PTA by 80-90% in high-risk patients.^[63] Overall mortality is less than 0.1% with modern care, though it can rise significantly if treatment is delayed leading to severe complications.^[7]^[24]

History and etymology

Historical background

The peritonsillar abscess, historically known as quinsy, was first recognized in ancient medical texts as a severe suppurative infection of the throat. Hippocrates, around 400 BCE, described quinsy as a painful swelling of the tonsils accompanied by fever and difficulty swallowing, recommending incision and drainage as a therapeutic approach when suppuration occurred.^[64] In the Roman era, Aulus Cornelius Celsus, in the first century CE, further detailed the condition in his work De Medicina, advocating for surgical incision to relieve the abscess and prevent complications such as airway obstruction, marking an early milestone in its surgical management.^[65] By the 18th century, anatomical understanding advanced, with Italian physician Giovanni Battista Morgagni contributing to the pathological description of deep neck infections, including those akin to peritonsillar abscesses, through his systematic postmortem studies in De Sedibus et Causis Morborum per Anatomem Indagatis.^[66] In the 19th century, management relied primarily on incision and drainage, with less invasive needle aspiration techniques developed in the mid-20th century and gaining widespread adoption in the 1980s for outpatient treatment.^[7]^[67] The 20th century brought transformative changes with the advent of antibiotics in the 1940s, particularly penicillin, which dramatically reduced the incidence and mortality of streptococcal infections, including peritonsillar abscesses, by targeting group A Streptococcus pyogenes, the primary pathogen.^[68] Pre-antibiotic era mortality rates for complicated peritonsillar and deep neck infections could reach 25%, dropping to less than 1% post-World War II due to penicillin and improved care, leading to a significant decline in severe suppurative complications.^[69]^[70] From the 1980s onward, a shift toward conservative management emerged, emphasizing outpatient needle aspiration combined with oral antibiotics over immediate surgical intervention, supported by studies demonstrating high success rates and reduced hospitalization needs. In the mid-20th century, initial studies explored outpatient approaches; by the 1980s, Herzon's work demonstrated high success with needle aspiration and antibiotics, further promoting this shift.^[67]^[71] In the modern era, imaging-guided techniques have gained prominence, with recent studies from 2024 and 2025 highlighting the use of ultrasound for diagnosis and, in select cases, guided drainage to aid precise localization and aspiration while minimizing risks like vascular injury in emergency settings.^[72]^[73] These advancements reflect ongoing refinements in imaging and procedural safety, building on the foundational surgical principles established centuries earlier.

Etymology

The term "peritonsillar abscess" combines the Greek prefix peri-, meaning "around" or "about," with tonsillar, pertaining to the tonsils, and abscess, denoting a localized collection of pus. The word tonsil derives from Latin tonsillae (plural), a diminutive form possibly related to tōlēs, referring to a swollen gland or goiter, evoking the almond-like shape of these lymphoid structures in the throat.^[74] Abscess originates from Latin abscessus, the past participle of abscēdere ("to go away" or "separate"), which in ancient medical theory described the "departure" of harmful humors as pus.^[75] Historically, the condition has been known by the synonym quinsy, a term prevalent in English medical and lay usage until the early 20th century. Quinsy stems from Middle English quinesye, borrowed from Old French quinencie and Medieval Latin quinancia, tracing back to Ancient Greek kynanchē—a compound of kyn- (from kyōn, "dog") and anchein ("to strangle" or "choke")—capturing the sensation of throat constriction akin to a dog's collar.^[76]^[77] The precise nomenclature "peritonsillar abscess" gained standardization in 19th-century medical texts, with the adjective peritonsillar entering English usage in the 1870s to accurately denote the suppurative collection in the space surrounding the tonsillar capsule.^[78] Earlier or alternative designations, such as "paratonsillar abscess," appeared occasionally but were deemed anatomically imprecise, as the infection develops in the peritonsillar space rather than simply adjacent to the tonsil. In other languages, equivalent terms mirror this anatomical focus; for instance, the French "abcès périamygdalien" employs péri- (around) and amygdalien (from Latin amygdala, "almond," highlighting the tonsil's shape).^[79]

Notable cases

Historical cases

Pope Adrian IV (c. 1100–1159), the only English pope, reportedly died from quinsy, a peritonsillar abscess, though some accounts suggest he choked on a fly in his wine.^[80] French Renaissance philosopher Michel de Montaigne (1533–1592) died at age 59 from quinsy, which caused throat inflammation and deprived him of speech in his final days.^[81]

Modern cases

In 2017, English singer and actor Lee Ryan of the band Blue was hospitalized for quinsy as a complication of tonsillitis, requiring treatment and rest.^[82] Reality television personality Bianca Gascoigne was hospitalized for quinsy in 2016 and again in 2018 in Dubai, describing severe throat pain and swelling.^[83] Actress Crissy Rock was rushed to hospital in 2019 for a throat abscess diagnosed as quinsy, undergoing drainage due to intense pain.^[84]

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Associations between Peritonsillar Abscess and Deep Neck ... - MDPI
Apr 9, 2024 · In the socioeconomic environment, low socioeconomic status is supposed to increase susceptibility to DNI [28]. This high vulnerability to ...<|control11|><|separator|>
[32]
Peritonsillar Abscess and Cellulitis - Ear, Nose, and Throat Disorders
The most serious consequences include airway obstruction, septic shock, rupture of the abscess into the airway resulting in aspiration pneumonia or asphyxia, ...Missing: bacteremia | Show results with:bacteremia
[33]
Diagnosis of Peritonsillar Abscess—A Prospective Study Comparing ...
Jan 20, 2025 · Uvula deviation was defined as the shift of the uvula from the midline. Hot potato voice (or muffled voice) was defined by the lack of resonance ...
[34]
Test characteristics of ultrasound for the diagnosis of peritonsillar ...
Ultrasound demonstrates high sensitivity for ruling out PTA, but it only has moderate specificity for ruling in the diagnosis.
[35]
The Use of Point of Care Ultrasound in Diagnosis of Peritonsillar ...
POCUS has increasingly been used as an adjunct for diagnosis of PTA, with a sensitivity ranging from 89-95% and specificity of 78-100%.
[36]
Bedside Ultrasound for the Diagnosis of Peritonsillar Abscess - JETem
Oct 11, 2017 · Although diagnosis of PTA using intraoral ultrasound has a sensitivity and specificity of between 89%-95% and 79%-100% respectively, it is ...
[37]
POCUS for Peritonsillar Abscess - Tampa Emergency Medicine
Dec 6, 2022 · A step-by-step breakdown of how to efficiently use Ultrasound to find a possible PTA, including locating the all important carotid artery.
[38]
Peritonsillar Abscess Workup - Medscape Reference
Sep 3, 2024 · Needle aspiration of the abscess site (see the image below) may be performed just before the drainage procedure is attempted. It allows ...
[39]
Throat Culture in Impending Peritonsillar Abscess - PubMed
Throat cultures done immediately before the development of a peritonsillar abscess were positive for beta-hemolytic streptococci in only one of 12 cases.
[40]
The epidemiology of peritonsillar abscess disease in Northern Ireland
Culture yield was greatest from needle aspirates; throat swabs and blood cultures were typically unhelpful. Beta haemolytic streptococci were the most ...
[41]
HMGB1 and Kallistatin: Novel Serological Markers for Differentiating ...
Conclusions: Serum HMGB1 and kallistatin may be effective adjunctive biomarkers for differentiating PTA from PTC. Keywords: HMGB1 protein; ...
[42]
Peritonsillar Abscess Treatment & Management
Sep 3, 2024 · Others have shown that immediate or delayed tonsillectomy may not be necessary because of the high rate of success and the low recurrence rate ...
[43]
Outcomes of conservative antibiotic therapy in pediatric peritonsillar ...
Sep 18, 2025 · Our findings suggest that conservative management of pediatric PTA with antibiotics is a safe and effective approach in selected cases. While ...
[44]
Peritonsillar/Retropharyngeal Abscess
ID consultation is recommended for head and neck infections occurring in immunocompromised patients, and for those with atypical features, chronic course, or ...Missing: complications | Show results with:complications
[45]
Needle aspiration versus incision and drainage for the treatment of ...
Recurrence in the needle aspiration group ranged from 4.9% to 80.0%. In the incision and drainage group recurrence ranged from 0% to 20%. The studies that ...
[46]
A Randomized Trial for Outpatient Management of Peritonsillar ...
These data indicate that outpatient permucosal needle drainage of peritonsillar abscess is an acceptable, inexpensive treatment comparing favorably with ...
[47]
The Surgical Treatment of Peritonsillar Abscess: A Retrospective ...
Jun 10, 2021 · For PTA, principally three surgical options are described: needle aspiration (NA), incision and drainage (ID), and abscess tonsillectomy (ATE, ...
[48]
Immediate tonsillectomy for peritonsillar abscess - ScienceDirect.com
In this paper, we review these 103 cases and conclude that immediate tonsillectomy is the most safe and effective treatment for PTA.
[49]
[PDF] Early Interval Tonsillectomy as Compared to Delayed Interval ...
The surgical treatment involves needle aspiration, incision drainage and tonsillectomy.The procedure of tonsillectomy done in PTA patient on emergency basis ...
[50]
Conscious sedation for the management of peritonsillar abscess in ...
Jul 14, 2024 · Conclusions: Conscious sedation facilitates PTA drainage with excellent safety and improved efficacy compared to local anesthesia in children.
[51]
The peritonsillar abscess and its management – is incision and ...
Nov 28, 2023 · This study aims to examine the long-term management of peritonsillar abscess and compare needle aspiration, incision with drainage, and tonsillectomy.Abstract · Introduction · Results · DiscussionMissing: pathophysiology | Show results with:pathophysiology<|control11|><|separator|>
[52]
Peritonsillar Abscess - DynaMed
Sep 13, 2024 · Untreated or inadequately treated infections are a risk factor for peritonsillar abscess, including oropharyngeal infections such as ...Missing: percentage | Show results with:percentage
[53]
At what age are peritonsillar abscesses most commonly diagnosed?
Sep 30, 2025 · Adolescents and young adults: Highest incidence (40 cases per 100,000 person-years) 2. Adults aged 20-40: Most common demographic, with mean ...
[54]
Recognizing a Peritonsillar Abscess in Pediatric Patients | CE Article
Peritonsillar abscesses are the most common deep space infection of the head and the neck with the incidence in pediatrics being approximately 14-20 cases per ...
[55]
Peritonsillar Abscess and Antibiotic Prescribing for Respiratory ...
4. Reduction of antibiotic prescribing raises a concern that fewer antibi- ... Incidence of Peritonsillar Abscess. There were 9,870,559 registered patients ...<|separator|>
[56]
Full article: Post-Pandemic shifts in peritonsillar abscess: incidence ...
The number of cases positive for Streptococcuspyogenes and Fusobacterium necrophorum increased post-NPI (n = 102 and n = 89, respectively) compared to during ...<|control11|><|separator|>
[57]
Seasonal variation and demographic characteristics of acute ...
Oct 15, 2024 · Objective: Peritonsillar abscess (PTA) is a common soft tissue infection of the head and neck. It remains unclear to what extent inflammatory ...Missing: prevalence | Show results with:prevalence
[58]
Peritonsillar abscess: Incidence, current management practices, and ...
rural difference in med- ical or surgical treatment for PTAs or in the number of. PTAs treated. The 1425 surveyed otolaryngologists, none of whom were retired, ...
[59]
Association between clinical outcome and microbiological findings ...
May 14, 2025 · Peritonsillar abscesses can be caused by numerous pathogens, including Streptococcus pyogenes/Group A streptococci (GAS) as well as Group C/G ...
[60]
Initial Factors Influencing Duration of Hospital Stay in Adult Patients ...
Jun 18, 2016 · The mean duration of hospitalization was 6.2±6.0 days. With univariate linear regression, a prolonged hospital stay was associated with several ...Missing: short- | Show results with:short-
[61]
An evidence-based review of peritonsillar abscess - PubMed
Peritonsillar abscess is a common condition with increasing incidence. We demonstrate the potential for evidence-based modifications in clinical management.
[62]
The Impact of Prior Tonsillitis and Treatment Modality on the ... - NIH
Oct 7, 2014 · The recurrence rate of PTA is poorly defined in the literature, ranging from 5% to 22%, with variability in age, sex, duration of follow-up, and ...
[63]
Outcomes of conservative antibiotic therapy in pediatric peritonsillar ...
Sep 18, 2025 · Conclusions: Our findings suggest that conservative management of pediatric PTA with antibiotics is a safe and effective approach in selected ...
[64]
Peritonsillar abscess: recurrence rate and the indication ... - PubMed
The patients were divided into those with a history of recurrent tonsillitis prior to developing PTA (72 patients, 25%), and those without (218 patients, 75%).
[65]
Inferior pole peritonsillar abscess - ScienceDirect.com
One of the first references to the practice of incision and drainage of a peritonsillar abscess was by Hippocrates. The method of performing such drainage ...
[66]
The Historical Evolution of Oto-Laryngology - Sage Journals
on "Diseases of the Nose and Throat "! Celsus has much to say in regard to cynanche (quinsy), as indeed had all the ancient authors, and he describes the ...
[67]
Giovanni Battista Morgagni and his contribution to pediatric surgery
He was also the first to describe pediatric pathological conditions like epispadia, meconium peritonitis, Crohn's disease, and coarctation of the aorta. Finally ...Missing: peritonsillar abscess
[68]
The Discovery of Penicillin—New Insights After More Than 75 Years ...
After just over 75 years of clinical use, it is clear that penicillin's initial impact was immediate and profound.
[69]
Respiratory Infections in the U.S. Military: Recent Experience and ...
Group A streptococcus respiratory infections have had a long history of impact on the U.S. military dating back to WWII, where such infections associated with ...
[70]
[PDF] SAS Journal of Medicine (SASJM) Perıtonsıllar Abscess
Needle aspiration and drainage became popular in the United States in the 1980s [15]. In a large number of studies, peritonsillar abscess treatment, needle.
[71]
CT-guided transcutaneous drainage of peritonsillar abscess after ...
Nov 25, 2023 · This case exhibits an uncommon approach to PTA aspiration via an external CT-guided percutaneous approach with rapid subsequent clinical improvement.
[72]
Tonsil - Etymology, Origin & Meaning
Originating c. 1600 from Latin "tonsillae," diminutive of "toles" meaning "goiter," tonsil refers to lymphatic tissue in the throat, linked to immune ...
[73]
Abscess - Etymology, Origin & Meaning
Abscess, from Latin abscessus (1610s), means a pus collection in the body; origin traces to abscedere, "to withdraw," reflecting humors leaving via pus.
[74]
QUINSY Definition & Meaning - Merriam-Webster
Middle English quinesie, from Anglo-French esquinauncy, quinancie, from Late Latin cynanche, from Greek kynanchē, from kyn-, kyōn dog + anchein to strangle ...
[75]
quinsy - Wiktionary, the free dictionary
From Middle English quinesye, from Old French quinencie, from Medieval Latin quinancia, from Ancient Greek κυνάγχη (kunánkhē, “canine quinsy”), from κύων (kúōn, ...
[76]
peritonsillar, adj. meanings, etymology and more | Oxford English ...
Where does the adjective peritonsillar come from? ... The earliest known use of the adjective peritonsillar is in the 1870s. OED's earliest evidence for ...
[77]
peritonsillar abscess - Translation into French - examples English
Peritonsillar abscess and cellulitis are acute pharyngeal infections most common among adolescents and young adults. L'abcès périamygdalien et la cellulite sont ...