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120                  THE PHARYNX AND NASOPHARYNX


Peritonsillar Abscess (Quinsy). This consists of suppuration outside the
tonsillar capsule, and is situated in the region of the upper pole and involves
the soft palate. Infection begins in the intratonsillar fossa which lies between
the upper pole and body of the tonsil, and from here it extends around the
tonsil. A quinsy is usually unilateral and most frequently affects adult males.
It may occur at any age, and is much more common in children than is thought.
Many extremely fibrous and adherent tonsils are removed from quite young
children who have never been suspected of having had a quinsy.

SYMPTOMS. A peritonsillar abscess follows,a tonsillitis which appears to
settle and then recurs severely on one side. The patient looks ill and his
temperature rises to about 40 C with a shivering attack or a rigor. There is
acute pain in the throat radiating to the ear, and this makes swallowing so
impossible that saliva dribbles from the mouth. The swelling in the throat
imparts a thick, muffled tone to the voice.

Fig. 49. Evacuation of peritonsillar abscess.

CLINICAL FEATURES. Examination may be difficult because the patient can
only open his jaws to a slight extent, but with good illumination the affected
side of the palate is seen to be congested and bulging (Plate VI, 5); the uvula is
oedematous and pushed towards the opposite side; the affected tonsil is
usually hidden by the swelling but may have some mucopus on its surface.
The glands are enlarged and tender. If not relieved either by antibiotics or by
surgery the abscess may burst or leak slowly in about a week.

TREATMENT. Systemic penicillin should be given in large doses whenever the
diagnosis is made. Frank pus forms on about the fifth day, so that if the
patient is not seen until then, or if penicillin fails to relieve the condition, the
abscess must be opened. A long pair of sinus forceps is plunged into the most
prominent part of the swelling and the abscess drained by opening the blades
of the forceps (Fig. 49). The throat may first be sprayed with 10 per cent
cocaine hydrochloride solution hi the adult. This reduces the trismus which
makes the operation easier, but it does not relieve the pain of incision, and the
patient should be so warned. The immediate relief compensates for the agony.
In children a short anaesthetic is given, a mouth gag inserted and opened and