Experience Summary

In this 360-degree video, observe a clinician guiding you through the steps of draining a quinsy. The drainage of a quinsy is a common procedure performed by an emergency ENT on call doctor.

Clinical Context

A quinsy, or peritonsillar abscess, is a collection of pus that forms in the peritonsillar space, typically as a complication of acute tonsillitis. It is most common in young adults but can occur at any age. Patients typically present with severe sore throat (often unilateral), trismus (difficulty opening the mouth), muffled "hot potato" voice, fever, and ipsilateral ear pain. Examination reveals swollen, inflamed tonsils, uvular deviation away from the affected side, and peritonsillar swelling. Prompt drainage is the cornerstone of management to relieve symptoms, prevent airway compromise, and reduce the risk of further complications.

Counselling Points:

Before the procedure, patients should be counselled clearly and sensitively:

• Diagnosis Explanation: Explain that a collection of pus (abscess) has formed near the tonsil, causing their severe pain, swelling, and difficulty swallowing.
• Need for Procedure: Emphasise that drainage is necessary to relieve discomfort, prevent worsening infection, and avoid serious complications such as airway obstruction or spread of infection.
• Risks and Benefits:
  • Benefits: Rapid symptom relief, reduced swelling, improved swallowing, and prevention of further complications.
  • Risks: Bleeding, pain, recurrence of abscess, damage to surrounding structures, and very rarely, aspiration or airway compromise.
• Alternatives: Needle aspiration, incision and drainage, or referral for specialist management. In some cases, antibiotics alone may be trialled, but drainage is often required.
• Post-procedure Care: Patients should expect temporary discomfort, may be prescribed antibiotics and analgesia, and should avoid strenuous activity for 24-48 hours.

Procedural Steps:

1. Preparation:
   • Obtain informed consent.
   • Ensure resuscitation equipment is available.
   • Position the patient sitting upright with good head support.
   • Apply topical anaesthesia (e.g., lidocaine spray) to the oropharynx.
2. Examination:
   • Use a headlamp or good lighting.
   • Identify the area of maximal fluctuation or swelling, usually superior to the tonsil, with uvular deviation.
3. Aspiration or Incision:
   • Use a wide-bore needle with safety guard or a small scalpel.
   • Insert into the abscess at the point of maximal fluctuation, keeping clear of the carotid artery (typically located posterolaterally).
   • Aspirate or incise to release pus.
   • Suction may be used to clear the airway if needed.
4. Post-procedure:
   • Observe the patient for airway patency and signs of bleeding.
   • Provide analgesia and antibiotics (commonly penicillin or clindamycin).
   • Arrange follow-up or admission.

Learning Outcomes

1. Learn the procedural steps in the drainage of a quinsy.
2. Understand how to examine the mouth and decide whether there is a quinsy present.
3. Understand the importance of effective communication throughout an invasive procedure.

External Resources

• ENT-SHO Instructional Material
• Tonsil anatomy