# Introduction

The SARS-CoV-2 (COVID-19) pandemic led to necessary changes in the management of common ENT emergency presentations internationally, including tonsillitis and peritonsillar abscess (quinsy, PTA), two of the most common emergency presentations to ENT.1 It has been demonstrated that COVID-19 infection leads to high viral titres in the nasal and oral cavities,2 with virus transmission thought to be predominantly via aerosols or droplet formation.3,4 Aspects of the management of tonsillitis and PTA, including oral examination, PTA drainage and flexible nasendoscopy, were considered to represent a potential route of transmission of COVID-19.5,6
In March 2020, new UK guidelines were issued for the management of tonsillitis and PTA presenting to emergency departments (ED), in light of COVID-19.7 The major shifts in practice proposed were: the avoidance of oral examination; the routine discharge of patients who could swallow fluids and medications; the routine administration of intravenous (IV) medications to effect this; and the avoidance of PTA drainage if possible. These changes aimed to minimise the personnel involved in managing the acute presentation, reduce oral instrumentation, and to reduce admission rates, thus preserving hospital bed capacity for the anticipated COVID-19 demand.
The implementation of these relatively untested guidelines resulted in significant changes to established practices that had been shown to be safe over many years. This article aims to:

1. Report the findings of a 12-week prospective audit of acute tonsillitis and PTA care, conducted during the initial peak of COVID-19 in the UK.
2. Explore factors relating to unscheduled re-presentation to hospital in tonsillitis and PTA patients discharged from the ED.