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Acute Management of Peritonsillar Abscess (Quinsy)

Three Part Question

In [adults and adolescents with peritonsillar abscess (quinsy)] is [needle aspiration or incision and drainage more effective] at [reducing symptoms and preventing recurrence]?

Clinical Scenario

A 23 year old man presents to Accident and Emergency with a 3 day history of painful swallowing and feeling unwell. On examination he is pyrexial and has trismus. Oropharyngeal examination confirms the clinical suspicion of right sided quinsy. You wonder whether needle aspiration or incision and drainage is the best initial treatment.

Search Strategy

MEDLINE database (OVID 1966 - Sept week 4 2004)
{exp peritonsillar abscess OR peritonsillar OR} AND {exp treatment OR OR OR incis$.mp}
LIMIT to Human AND English

Search Outcome

202 papers found of which 185 irrelevant and 12 of insufficient quality for inclusion. (Leaving 5 papers)

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Spires JR et al
62 patients with confirmed peritonsillar abscess. I+D vs. needle aspirationPRCTTime to return to eating meal comfortablyIdentical recovery rate for 2 procedures (3.7 days). 2 patients had recurrence following I+DLow number of patients
Stringer S et al
52 patients with confirmed peritonsillar abscess. I+D vs. needle aspirationPRCTResolution of symptoms using 1-5 scale92% of needle aspiration, 93% of I+D patients cured following initial treatmentLow number of patients
Maharaj D et al
South Africa
60 patients with confirmed peritonsillar abscess. I+D vs. needle aspirationPRCTFailure rate (reaccumulation of abscess)Failure rate 13% for needle aspiration, 10% for I+DLow number of patients, no statistical analysis
Wolf et al
Case notes of all patients treated for peritonsillar abscess over 4 year period reviewed (n=160)Retrospective case seriesRecurrence rate23.3% of needle aspiration group and 4.1% of I+D group had recurrenceLow patient numbers, retrospective study design
Johnson R et al
Not a clinical study but a review of the literature on treatment of quinsyMeta-analysisPooled data from previous studiesInitial success rate 93.7% for I+D, 91.6% for needle aspiration. NNT 47.6 in favour of I+DEven combined studies had low power (ie high chance of type II error)


These papers compare the two treatment techniques using two different outcome measures - resolution of symptoms or recurrence of the peritonsillar abscess. None has sufficient power to show a significant difference between the techniques for either of the outcome measures. Note that a third technique for treatment of peritonsillar abscess, 'quinsy tonsillectomy', was not included in this BET.

Clinical Bottom Line

On the evidence available, both incision and drainage and needle aspiration appear to be effective methods of reducing the symptoms and preventing recurrence of a peritonsillar abscess.


  1. Spires JR, Owens JJ, Woodson GE, Miller RH Treatment of Peritonsillar Abscess Arch Otolaryngol Head Neck Surg Sept 1997; 113, 984-6
  2. Stringer SP, Schaefer SD, Close LG A Randomized Trial for Outpatient Management of Peritonsillar Abscess Arch Otolaryngol Head Neck Surg March 1988; 114, 296-8
  3. Maharaj D, Rajah V, Hemsley S Management of Peritonsillar Abscess Journal of Laryngology and Otology Sept 1991; 105, 743-5
  4. Wolf M, Even-Chen I, Kronenberg J Peritonsillar Abscess: Repeated Needle Aspiration Versus Incision and Drainage Ann Otol Rhinol Laryngol 1994; 103, 554-7
  5. Johnson RF, Stewart MG, Wright CC An Evidence-Based Review of the Treatment of Peritonsillar Abscess Otolaryngology Head and Neck Surgery Mar 2003; 128, 332-43