Quinsy or peritonsillar abscess is a complication of acute tonsillitis in which pus collects in the peritonsillar space. It is the most common deep infection of the head & neck, occurring primarily in young adults and affects around 12 per 100,000 people in England. Usually, it follows a tonsilitis episode when the infection spreads from swollen tonsil to the surrounding area. It happens mostly as a unilateral presentation.
Signs & symptoms of Quinsy
- sore throat usually on one side.
- a high fever of 38C (100.4F) or above.
- difficulty opening the mouth.
- pain when swallowing.
- difficulty swallowing.
- changes to the voice or difficulty speaking.
- bad breath.
- drooling saliva due to difficulty swallowing.
Causes of Quinsy
Followed by a bacterial infection to the tonsils, mostly by Haemophilus influenzae and streptococcus bacteria, particularly streptococcus pyogenes.
Pathophysiology of Quinsy
The exact pathophysiology of peritonsillar abscess is not known yet. Theories suggest that an infection develops in crypta magna, then spreads beyond the brims of the tonsillar capsule, initially causing peritonsilitis and then into a peritonsillar abscess.
Another theory is of necrosis and pus formation in the capsule which then blocks the webers glands, leading to abscess formation. These are minor salivary glands in peritonsillar space which are responsible for clearing debris from the tonsillar area. The occurrence of peritonsillar abscess in patients who have undergone tonsillectomy further support this theory.
computed tomographic scan
Treatments of Quinsy
- Incision & Drainage of abscess
Prognosis of Quinsy
Peritonsilar abscess shows a good prognosis with proper treatment. In most cases, it recovers within a few days. A few show recurrence, requiring tonsillectomy.
Complications of Quinsy
Rare complications of a peritonsillar abscess include:
- Parapharyngeal abscess
- Retropharyngeal abscess
- Laryngeal oedema leading to airway compromise
- Rarely pneumonia or lung abscess following aspiration of a ruptured abscess.
Ayurvedic Concept of Quinsy
Ayurvedic Nidana of Quinsy
Kapha vitiation foods and habits.
Ayurvedic Purvaaroopa of Quinsy
Ayurvedic Samprapti of Quinsy
Food and habits vitiating Kapha, increases Kapha and it obstructs Vata and vitiates Vata. Vitiated two doshas inturn impair third dosha- Pitta and thus all three doshas are vitiated.
Ayurvedic Lakshana of Quinsy
Abscess in the throat with severe pain & fever
The fast spread of infection and pus formation
Foul-smelling pus discharge from the abscess
Ayurvedic Divisions of Quinsy
Ayurvedic Prognosis of Quinsy
Kricchrasadhya- Difficult to treat
Ayurvedic Chikithsa of Quinsy
Lepanam with Rookshana dravya
Then treatment of wound should be done
Commonly used Ayurvedic medicines for Quinsy
Home remedies for Quinsy
Applying turmeric paste
Lose excess weight and shred off the excess fat
Apple cider vinegar intake
Avoid intake of fat in food
Take enough omega 3 fatty acids
Diet for Quinsy
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, obstruct channels and respiratory tract infections
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with minimal spices
Protect yourself from the cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid a sedentary lifestyle.
Yoga for Quinsy
Regular stretching and mild cardio exercises are advised after the infection is cured. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles of Quinsy
- PMID: 29110574
Objective This study was performed to determine whether the efficacy and safety of medical management of uncomplicated peritonsillar abscess (PTA) presenting in the emergency department is equivalent to medical plus surgical therapy. Study Design Case series with chart review. Setting Southern California Permanente Medical Group (SCPMG). Subjects and Methods Upon successful completion of a prospective study comparing medical treatment (MT) to surgical treatment (ST) of PTA in 2008, MT was adopted by 12 SCPMG centers while 7 centers continued standard surgical drainage. Clinical outcomes are now reviewed on a random sampling of 211 patients with PTA treated with MT and 96 patients treated with ST between 2008 and 2013 at the respective medical centers. Patients were treated with intravenous (IV) fluids, weight-appropriate IV ceftriaxone, clindamycin, and dexamethasone, and then discharged on clindamycin × 10 days (MT). Patients in the ST group received MT but also surgical drainage. Primary end points were complication rates and failure rates. Results MT and ST resulted in no significant difference in treatment success or complications. However, patients in the MT group obtained significantly less liquid opioid prescriptions (MT, 30.8 ± 5.65; ST, 77.75 ± 13.41; P < .0001), reported fewer sore days (MT, 4.48 ± 0.27; ST, 5.77 ± 0.49; P = .0004), and required less days off from work (MT, 3.4 ± 0.44; ST, 4.9 ± 0.82; P = .044). Conclusions Compared to ST, MT appears to be equally safe and efficacious, with less pain, opioid use, and days off work, especially if patients with PTA present without trismus. MT for PTAs reduces the possibility of surgical complications, as well as the cost and inconvenience associated with ST.
- PMID: 23794382
Objectives/hypothesis: Sore throat is a common, benign emergency department (ED) presentation; however, peritonsillar abscess (PTA) is a complication that requires aggressive management. Use of systemic corticosteroids (SCSs) in PTA is occurring without clear evidence of benefit. This study examined the efficacy and safety of SCS treatment for patients with PTA.
Study design: Randomized, double-blind, placebo-controlled trial.
Methods: A controlled trial with concealed allocation and double-blinding was conducted at two Canadian EDs. Following written informed consent, eligible patients received 48 hours of intravenous clindamycin and a single dose of the study drug (dexamethasone [DEX] or placebo [PLAC], intravenously [IV]). Follow-up occurred at 24 hours, 48 hours, and 7 days. The primary outcome was pain; other outcomes were side effects and return to normal activities/diet.
Results: A total of 182 patients were screened for eligibility; 41 patients were enrolled (21 DEX; 20 PLAC). At 24 hours, those receiving DEX reported lower pain scores (1.4 vs. 5.1; P = .009); however, these differences disappeared by 48 hours (P = .22) and 7 days (P = .4). At 24 hours, more patients receiving DEX returned to normal activities (33% vs. 11%) and dietary intake (38% vs 25%); however, these differences were not significant and disappeared by 48 hours and 7 days. Side effects were rare and did not differ between groups (P > .05).
Conclusions: Combined with PTA drainage and IV antibiotics, 10 mg IV DEX resulted in less pain at 24 hours when compared to PLAC, without any serious side effects. This effect is short-lived, and further research is required on factors associated with PTA treatment success.
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