Peritonsillar abscess (quinsy): symptoms, treatment and when to get urgent help

The NHS lists the warning signs as a severe sore throat that quickly gets worse, swelling inside the mouth and throat, difficulty speaking, being unable to swallow, difficulty breathing and difficulty opening the mouth, and says these are signs of quinsy.

nidirect gives a fuller list, including that the sore throat is usually on one side, and notes that some people with quinsy may also have a high temperature, although this sometimes passes before the abscess develops.

• A severe and quickly worsening sore throat, usually on one side (nidirect).

• Swelling inside the mouth and throat (NHS, nidirect).

• Difficulty opening your mouth (NHS, nidirect).

• Pain and difficulty swallowing, which may cause drooling (nidirect).

• Changes to your voice or difficulty speaking (NHS, nidirect).

• Bad breath, earache on the affected side, headache and feeling generally unwell (nidirect).

• Difficulty breathing (NHS, nidirect).

NICE says peritonsillar abscess can pose a risk of airway compromise, aspiration of pus and death due to vascular involvement. In plain terms, swelling can threaten the airway, pus can be inhaled, and nearby blood vessels can occasionally be involved. These outcomes are described as risks, not expectations, but they are the reason the NHS advice is to call 999 or go to A&E.

The NHS adds that you should not drive to A&E: ask someone to drive you or call 999 and ask for an ambulance, and bring any medicines you take with you. NHS inform also notes obstructive sleep apnoea as another possible complication of tonsillitis, where the throat walls relax during sleep and cause breathing difficulties.

nidirect says people with quinsy usually need to be treated in hospital, which may mean staying in hospital for a few days and resting at home for a week or two afterwards. It says that if quinsy is suspected you will be referred immediately to a hospital ear, nose and throat (ENT) specialist, because it is important that it is diagnosed and treated quickly to prevent the infection spreading and to avoid problems from severe swelling, such as breathing problems.

Antibiotics are given to clear the infection, usually directly into a vein at first, then a short course of tablets or capsules once you are well enough to leave hospital. Painkillers such as paracetamol and ibuprofen are given, and occasionally corticosteroid medicine may be used to reduce the swelling in the throat.

nidirect says that in many cases antibiotics alone are not effective and it may be necessary to drain the pus from the abscess.

Quinsy is the traditional name for a peritonsillar abscess. NHS inform describes it as an abscess, a collection of pus, that develops between one of the tonsils and the wall of the throat.

It is not a condition that appears from nowhere in healthy throats. It is a complication of throat infection, and the NHS lists it under the rare complications of tonsillitis. NHS inform notes that complications of tonsillitis are rare and usually occur only if the tonsillitis was caused by a bacterial infection that spreads to another part of the body.

Most sore throats and tonsillitis are viral and settle within a week. NICE Clinical Knowledge Summaries says that symptoms resolve within 3 days in 40% of people and within a week in 85%, regardless of whether a streptococcal infection is the cause. A small number do not follow that pattern.

NICE lists peritonsillar abscess among the suppurative complications of streptococcal pharyngitis or tonsillitis, alongside middle ear infection, which is the most common, and rare sinusitis. It says quinsy occurs in approximately 2% of cases within 2 months of an acute tonsillitis. That figure is for people whose sore throat had a bacterial cause, so most people with a sore throat are never at meaningful risk.

nidirect says you may need to rest at home for a week or two after leaving hospital, and that it is possible to get quinsy more than once. It says one of the best ways to prevent it is to reduce your risk of tonsillitis by avoiding close contact with people with infections that cause tonsillitis, washing your hands regularly with soap and warm water, and not sharing glasses or utensils with people who are ill. Smoking may increase the risk, so stopping smoking may reduce it.

nidirect says that using antibiotics to treat viral tonsillitis does not significantly reduce the risk of quinsy and is not routinely recommended. NHS inform says tonsillectomy is usually only recommended when there have been several severe episodes of tonsillitis over a long time that disrupt normal activities, and that is a decision for the ENT team.

nidirect says quinsy can occur at any age but most commonly affects teenagers and young adults. If a child has any of the warning signs, treat it as an emergency in the same way: the NHS says to call 999 or go to A&E, not to drive yourself, and to bring any medicines. NICE CKS notes that acute throat infections are most common in people aged 5 to 24.

Quinsy is treated in NHS emergency departments and ENT units, so there is no meaningful choice of route in the acute phase. Whether you later have a private consultation about your tonsils is a separate decision that your ENT team or GP can help with.