Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be talking to you about Quincy.

And you can find written notes on this topic at zero to finals.com slash Quincy or in the ear, nose and throat section of the zero to finals surgery book.

So let's get straight into it.

Quincy is the common name for a peritonsular abscess.

Peritonsular abscess arises when there is a bacterial infection with trapped pus, which forms an abscess in the region

of the tonsils. A pro-tonsular abscess is a complication of untreated or partially treated

tonsillitis or inflammation of the tonsils, although it can arise without tonsillitis. Quincy can occur just as frequently in

teenagers and adults as it does in children, which is unlike tonsillitis which is much more

common in children. Let's talk about the presentation. Patients present with similar symptoms to

tonsillitis, with a sore throat,

painful swallowing, a fever, neck pain, referred ear pain and swollen tender lymph nodes.

Additional symptoms that can indicate a peritonsular abscess rather than just a simple tonsillitis include

trismus, which refers to when a patient is unable to open their mouth, a change in their voice

due to the pharyngeal swelling, which is described in textbooks as a hot potato voice, as though the patient is talking with a hot potato

in their mouth, and swelling and erythema in the area beside the tonsils rather than on the

tonsils themselves. Let's talk about the bacteria. Quincy is usually due to a bacterial infection, and the most

common organism is streptococcus pyogenes, which is group A strep. It's also commonly caused by

staphlococcus aureus and hemophilus influenzae. Finally, let's talk about management. Patients should be referred into hospital

under the care of the ear, nose and throat team for incision and drainage of the abscess under a

general anaesthetic. This involves cutting into the abscess and draining the pus. Quincy typically has an underlying bacterial cause, therefore antibiotics are appropriate

before and after surgery.

A broad spectrum antibiotic, for example, coomoxiclav, would be an appropriate choice

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