Muhammad Tariq, A Kalan, A Ahmed Shuaib, D Roy.
Intractable Unilateral Quinsy Secondary to Impacted Foreign Body in Tonsil.
Ann King Edward Med Uni Jan ;7(2):152-3.

We report a case of an impacted foreign body in the tonsil presenting as an intractable unilateral quinsy. A completely embedded foreign body should be considered in cases of unilateral quinsy not responding to aggressive medical line of treatment. Key words: Foreign body, tonsil, quinsy

Case Report: A 45 year-old gentleman was referred to the ENT department complaining of unilateral sore throat for 4 days with pain radiating to the left ear. There was no history of accidental insertion or impaction of any foreign object in the oropharynx. There was no history of recurrent sore throats. General examination revealed the patient to be mildly febrile (37.8°C) and dehydrated. Examination of the throat showed the presence of a moderately enlarged left tonsil with erythema in the region of the supra-tonsillar cleft and appearance suggestive of a collection of debris in this region. The uvula appeared pushed towards the opposite side. The patient was admitted and started on intravenous antibiotics and intravenous fluid alimentation. Haematological investigation revealed slightly raised white blood cell count (12.9 x 10e9/ lit). Screening for glandular fever was negative. A diagnosis of a left para-tonsillar abscess (Quinsy) was made and an attempt done to drain this region. However only a small amount of blood with pus returned. The returning pus was sent for culture sensitivity. This did not grow any organisms. Over the ensuing 48 hours two further unsuccessful attempts at draining the collection was made. As the patients symptoms did not improve a CT scan was done to rule out any pus in the para-tonsillar neck spaces. The CT scan revealed marked soft tissue swelling of the left tonsillar bed and oropharynx, measuring up to 4cm in maximum diameter. In the centre of this region was a 2cm in diameter low attenuation area representing a necrotic centre. There was a focal hyper-dense area of bone density within this necrotic area. Bilateral tonsillectomy was then performed. On sectioning the left tonsil, inspissated material surrounding a small bony spicule was noted the origin of which could not be ascertained. The patient had an uneventful post-operative recovery. A year on he has had no further problems.

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