Peritonsillar Abscess (Quinsy) Treatment in Sydney

A peritonsillar abscess (quinsy) is a collection of pus that forms beside the tonsil, usually as a complication of acute tonsillitis. It causes severe one-sided throat pain, difficulty opening the mouth and swallowing, and requires urgent drainage. Peritonsillar abscess is the most common deep neck space infection and most frequently affects young adults.

What Is a Peritonsillar Abscess?

A peritonsillar abscess develops when infection spreads from the tonsil into the peritonsillar space: the area of loose connective tissue between the tonsil capsule and the surrounding pharyngeal muscles. Pus accumulates in this space, pushing the tonsil medially (towards the midline) and the soft palate forward.

The condition most commonly follows an episode of acute bacterial tonsillitis, though it can occasionally develop without a preceding sore throat. The bacteria most frequently involved are Group A Streptococcus, Staphylococcus aureus, and mixed anaerobic organisms. Peritonsillar abscess is most common between the ages of 15 and 35 and occurs equally in men and women.

Symptoms

Peritonsillar abscess typically presents with rapidly worsening symptoms over two to five days:

Severe sore throat, markedly worse on one side
Difficulty swallowing (dysphagia): patients often cannot swallow their own saliva
Trismus: difficulty or inability to open the mouth due to spasm of the jaw muscles
Muffled, thick or “hot potato” voice
Drooling due to inability to swallow saliva
High fever (often above 38.5°C) with rigors and malaise
Ear pain on the affected side (referred otalgia)
Swelling and tenderness of the neck below the jaw on the affected side
Foul breath
The uvula is pushed to the opposite side (a classic examination finding)

Causes and Risk Factors

Factors that increase the risk of developing a peritonsillar abscess include:

Recurrent tonsillitis: repeated infections damage the tonsil tissue and increase susceptibility to abscess formation
Incomplete antibiotic treatment: not completing a course of antibiotics for acute tonsillitis allows bacteria to persist and spread
Smoking: increases the risk of throat infections and impairs immune response in the oropharynx
Dental infections: periodontal disease and dental caries can introduce bacteria into the peritonsillar space
Immunosuppression: diabetes, HIV and immunosuppressive medications increase susceptibility to deep infections

Diagnosis

Peritonsillar abscess is primarily a clinical diagnosis based on the characteristic presentation:

Clinical examination: The ENT surgeon will see a unilateral swelling of the soft palate above the tonsil, with the tonsil pushed towards the midline and the uvula deviated to the opposite side. The soft palate is red, swollen and tender. Trismus may limit the examination, requiring careful technique.

Needle aspiration: Inserting a needle into the swelling and aspirating pus confirms the diagnosis and simultaneously begins treatment. The aspirated material can be sent for culture and sensitivity testing.

CT scan with contrast: A CT scan of the neck is performed if there is concern about spread of infection to the deeper neck spaces (parapharyngeal or retropharyngeal abscess), if the diagnosis is uncertain, or if the patient is not improving after initial drainage. CT defines the extent and location of the collection.

Blood tests: A full blood count typically shows elevated white cell count, and inflammatory markers (CRP) are raised.

Treatment Options

Needle Aspiration

Needle aspiration is the first-line treatment for most peritonsillar abscesses. Under local anaesthetic spray, a wide-bore needle is inserted into the abscess and the pus is aspirated. This provides immediate relief of pain and swelling. The procedure can be performed in the emergency department or ENT clinic and takes only a few minutes. If the abscess re-accumulates, repeat aspiration or incision and drainage may be required.

Incision and Drainage

For large or recurrent abscesses, or when needle aspiration fails to resolve the collection, a formal incision and drainage is performed. A small incision is made in the abscess membrane under local anaesthesia and the pus is evacuated. The wound is left open to continue draining. This is a definitive procedure with lower recurrence rates than aspiration alone.

Intravenous Antibiotics

All patients receive antibiotics, initially given intravenously if the patient is unable to swallow tablets. The typical regimen includes a combination effective against both aerobic and anaerobic bacteria, such as amoxicillin-clavulanate or benzylpenicillin with metronidazole. Intravenous corticosteroids (dexamethasone) are commonly administered alongside antibiotics to reduce swelling and pain, accelerating recovery.

Tonsillectomy

Tonsillectomy is recommended after a peritonsillar abscess in several situations:

Recurrent peritonsillar abscess (second episode or more)
History of recurrent tonsillitis
Failed drainage or abscess not resolving with antibiotics
Concern about an underlying tonsillar malignancy (rare, typically in older adults or those with risk factors)

An interval tonsillectomy is usually performed 6 to 8 weeks after the acute episode, allowing inflammation to settle. In selected cases, a “hot” or quinsy tonsillectomy may be performed during the acute admission, which drains the abscess and removes the tonsils simultaneously. Our surgeons, including Dr Arjuna Ananda, Dr Jareen Ebenezer and Dr Rahuram Sivasubramaniam, manage peritonsillar abscesses and perform tonsillectomy regularly.

Complications

Peritonsillar abscess requires urgent treatment to prevent serious complications:

Parapharyngeal abscess: spread of infection to the deep neck space lateral to the pharynx
Airway compromise: severe swelling can narrow the airway and cause breathing difficulty
Aspiration: spontaneous rupture of the abscess can lead to aspiration of pus into the lungs
Sepsis: systemic spread of infection
Lemierre syndrome: a rare but serious complication involving thrombophlebitis of the internal jugular vein and septic emboli

When to Seek Urgent Care

You should seek urgent medical attention or present to an emergency department if:

You have severe sore throat with difficulty opening your mouth
You are unable to swallow fluids or your own saliva
You have a high fever with worsening one-sided throat pain
You are drooling or have a muffled voice
You have any difficulty breathing
Your sore throat is worsening despite antibiotics

Related Conditions

Peritonsillar abscess is related to other throat conditions treated at Central Sydney ENT:

Dysphagia (Difficulty Swallowing): peritonsillar abscess is an acute cause of severe dysphagia requiring urgent assessment
Hoarse Voice: deep neck infections can affect the voice and require ENT assessment
Neck Lumps: swollen lymph nodes accompanying throat infections may need investigation to exclude other pathology

Common Questions

Peritonsillar Abscess FAQ

What is a peritonsillar abscess (quinsy)? +

A peritonsillar abscess, also known as quinsy, is a collection of pus that forms in the soft tissue next to the tonsil. It usually develops as a complication of acute tonsillitis when infection breaks through the tonsil capsule into the surrounding tissue. It causes severe one-sided throat pain, difficulty opening the mouth, and difficulty swallowing, and requires urgent treatment.

Is a peritonsillar abscess an emergency? +

Yes. A peritonsillar abscess requires urgent medical attention. If left untreated, the infection can spread to the deep neck spaces, causing a parapharyngeal or retropharyngeal abscess, which can compromise the airway and become life-threatening. If you have severe sore throat with difficulty opening your mouth, difficulty swallowing or breathing difficulty, seek emergency care immediately.

How is a peritonsillar abscess treated? +

Treatment involves draining the abscess, either by needle aspiration or a small incision, combined with intravenous antibiotics and pain relief. The drainage procedure provides rapid relief of symptoms. If the abscess recurs or the patient has a history of recurrent tonsillitis, a tonsillectomy is usually recommended to prevent further episodes.

Will I need a tonsillectomy after a peritonsillar abscess? +

A tonsillectomy is recommended if you have had more than one peritonsillar abscess, if you have a history of recurrent tonsillitis, or if the abscess is large and complex. An interval tonsillectomy is typically performed 6 to 8 weeks after the acute episode. In some cases, a quinsy tonsillectomy (performed during the acute episode) may be appropriate.

Does Central Sydney ENT treat peritonsillar abscesses? +

Yes. Central Sydney ENT surgeons manage peritonsillar abscesses including urgent drainage and subsequent tonsillectomy when indicated. Our surgeons are available for urgent consultations and operate across seven Sydney locations including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda.