Search

Introduction: Peritonsillar abscess (quinsy) is one of the most common ENT emergencies. A 2002 UK audit of quinsy management revealed that an average ENT department treated 29 cases annually; the most common treatment was needle aspiration with intravenous antibiotics, and culture of the aspirate was often performed routinely. The aims of our study were to evaluate the value of routine culture of quinsy aspirates, and to establish whether the information thus gained was clinically useful., Methods: We examined the notes of patients admitted with quinsy to two hospitals in south-west England, from January 1998 to January 2004 in one hospital and from January 1995 to January 2005 in the other. A total of 577 cases was found. Aspirated pus had been sent for culture in 119 (21 per cent). These cases were examined in more detail., Results: Of the 119 patients, 78.2 per cent (93/119) were treated with either a cephalosporin or penicillin, plus metronidazole. Streptococcal species were cultured in 43.7 per cent (52/119) and anaerobes in 23.5 per cent (28/119; of these cultures, 5.9 per cent (7/119) were pure anaerobes only). All the anaerobes were sensitive to metronidazole. One of the 119 cultures, growing aerobic bacteria, was resistant to penicillin; however, this patient improved clinically on a combination of penicillin and metronidazole. No patients had their treatment changed because of culture results., Conclusions: There appears to be no need to routinely culture quinsy aspirates, based upon our findings (of 16 hospital years) and previous studies (which found no recorded episodes of treatment change as a result of culture sensitivities). The combination of penicillin or a cephalosporin, plus metronidazole appeared to be theoretically effective in 99.2 per cent (118/119) of our specimens; this finding is supported by other studies. However, the rare but potentially life-threatening complications of quinsy must be recognised.

Objectives: To explore the interpretation of words commonly used to describe lumps. Specific words were explored to assess their understandability and implication of threat to the patient., Methods: A cross-sectional, questionnaire-based study was undertaken. Age, gender, level of education, employment and socio-economic group were determined. The questionnaire explored the following words: malignant, tumour, carcinoma, lymphoma, sarcoma, lipoma, lymph node, nodule, ganglion, benign, cyst and gland. Participants comprised 204 consecutive adult patients attending the ENT out-patient clinic at a Bristol teaching hospital., Results: Patients found 'malignant' and 'tumour' the most threatening words and were most unsure of the meaning of 'sarcoma' and 'lipoma'. Nineteen per cent (n = 37) thought a 'benign' lump was a cancer. Results did not significantly differ between demographic groups., Conclusions: A significant misunderstanding of some words commonly used to describe lumps was found. This study provides important guidance on which terms to use and which to avoid in consultations with patients.

Objectives: To determine the levels of intra- and inter-grade variability of the vetting of general practice (GP) letters as well as the intra-rater reliability of letter prioritization., Design: Prospective assessment of letter vetting and questionnaire survey., Setting: Three otolaryngology secondary referral centres in Bristol and Bath, UK., Participants: Twelve consultants, nine registrars, four staff and associate specialists (SAS) and 16 senior house officers (SHOs) in otolaryngology., Methods: Fifty GP letters (not including 'fast-track' referrals) addressed to one of the ENT departments were chosen sequentially. These were anonymized, photocopied and included in the questionnaire to all participating staff. Participants were asked to vet the letters as 'urgent', 'soon' or 'routine' according to supplied waiting time criteria. The same letters were sent out again six weeks later., Results: There was no significant difference between grades for the mean number of letters vetted into each category. Intra-grade variability was high; the number of letters vetted urgent varied from one out of 50 to 15 out of 50 for the consultants. The intra-rater reliability was high., Conclusion: The grade of trainee seems to make little difference with regard to ability to prioritize referrals, but within grades there is little agreement on what constitutes an urgent referral. We suggest further research, looking at the final outcome of patients, needs to be done to try to establish evidence-based guidelines to assist with letter vetting.