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Quinsies not infrequently occur in those who have suffered previous episodes of tonsillitis.
The pain with a quinsy is frequently so severe that swallowing is almost impossible and oral antibiotics cannot be given. The dominant hemisphere is adept at sequential reasoning while the nondominant hemisphere is adept at spatial reasoning. The symptoms may be extremely severe, with absolute dysphagia and pain referred to the ear and trismus, as well as malaise, fever, and marked swelling of the tonsillar lymph node. Complications are uncommon, but bleeding from a quinsy is an important and serious sign: It is due to erosion by the peritonsillar pus of one of the adjacent vessels—either one of the tonsillar arteries or the internal carotid artery (bleeding quinsy).

Tonsillectomy, which is often indicated after a quinsy, is delayed by four to six weeks until the acute phase has passed. Intravenous antibiotics, for example, penicillin supplemented with metronidazole (for there is a high instance of anaerobic organisms on culture) are given intravenously and usually bring about resolution in 24-48 hours.
Examination shows the signs of acute tonsillitis with medial displacement of the tonsils to the mid-line. Vascular fibrous tissue found lateral to the tonsil after a quinsy make tonsillectomy technically difficult, and some advocate tonsillectomy at the time of the acute quinsy (quinsy tonsillectomy). How To Win Your War Against Snoring And Sleep ApneaAre You Frustrated With Yourself For Snoring Away To Glory Every Night?

High doses of intramuscular penicillin for five days followed by a further five-day course of oral penicillin is the treatment. A large tonsil with medial displacement will persist with inadequate treatment, repre-senting a chronic quinsy in which recurrence of an acute episode is common. A throat swab of the pus is taken at the time of diagnosis, and the result may later require changing the penicillin to another antibiotic.

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