How to get rid of that lump in your throat

Modern medicine still deals with many antique-sounding diseases: scarlet fever, carbuncles, “dropsy” (heart failure) and tuberculosis. Of all the illnesses that have sadly failed to become obsolete, the one that sounds the most old-fashioned is quinsy. A quinsy is an abscess – a collection of pus – that forms in the space between your tonsil and the back of your throat, usually following an episode of tonsillitis. The name is derived from a Greek phrase meaning “dog strangling”, which manages to capture the condition’s unpleasantness quite well. The sufferer tends to sit with his mouth open, drooling, like a dog with its head stuck out of a car window, and the swelling can be large enough to cause a sensation of being throttled, especially when you try to lie down.

Quinsies are relatively uncommon – the average ear, nose and throat department will see about 30 a year – though if you ever work on an ENT ward, it can feel as though they’re a daily occurrence. (Exposure to any speciality can bias your understanding of medicine out in the everyday world.)

A quinsy feels, as a patient whispered to me, like “the worst sore throat ever”. The change in speech quality can be diagnostic, as the pain and swelling produce a characteristic muffling known as a “hot potato voice” : it’s thought to be the sound you’d make if you tried to speak while balancing a hot potato on your tongue. Often the patient finds their mouth opening is restricted due to their jaw muscles going into a spasm – a condition called trismus, also seen, more dramatically, in tetanus. It can be hard to elicit enough of an “aaaaah!” to get a proper view down someone’s throat, but once you have, a quinsy is unmistakeable – an angry-looking bulge that can look as though it is filling the entire throat. They can grow so large that they push the uvula (the dangly bit) over to one side.

As with any abscess, a quinsy can be dangerous; the infection can spread, and because of its location, it may potentially interfere with your breathing. You need antibiotics, but you also need hands-on intervention. The treatment, as with any abscess, is what surgery calls an I&D – incision and drainage. The difference with quinsies is that they tend to be done on the ward, without anaesthetic. The treatment, like the disease, is essentially old-fashioned; a 16th-century barber would’ve done something similar.

There are a couple of different approaches available. You can aspirate (suck out) the pus with a needle and syringe, but this has a couple of drawbacks. First, the pus tends to recur; second, many unanaesthetised patients balk at the sight of someone approaching their throat with a green needle (fairly large) attached to a 20 millilitre syringe (even larger). The more definitive option is to nick the quinsy with a scalpel (quinsy is one of those conditions, like toothache, where the pain is so bad that patients are usually willing to submit to more pain in the hope of relieving it).

You need suction to hoover up the pus; the tiny wound heals itself. The scalpel approach has the advantage of allowing you to smuggle the knife – you can cover most of it with your fist. In a further crafty touch, I was taught to wrap the blade in surgical tape first, exposing only the point – this ensures you don’t plunge too deeply into what is, after all, a sensitive area full of major blood vessels.

The first time you cut someone’s throat from the inside is alarming for both of you. Thankfully the relief is instant.

Sophie Harrison is a hospital doctor in South Yorkshire

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