Traditional incision and drainage of a quinsy may be more efficacious than aspiration
Reviewed by Sid Nagala

Peritonsillar abscess drainage has always been one of the first procedures an ENT junior doctor performs. Traditionally incision and drainage (I&D) was the mainstay of treatment. In recent years, needle aspiration of the abscess has become much more commonplace, perhaps due to more apprehensive clinicians and possibly patient compliance. This retrospective French study analysed 182 patients who either underwent I&D (n=100) or aspiration (n=82) and reviewed their outcomes. It is important to note that the I&D patients only had an I&D after an initial aspiration showed the presence of pus. The main findings were that the aspiration group had a statistically significant longer stay in hospital (median one day longer) than the I&D group. There was also a greater need for repeated drainage in the aspiration group (46.3%) compared with the I&D group (10%), with a greater proportion of the aspiration group requiring formal drainage under general anaesthetic. The study shows that an I&D may be more efficacious than an aspiration. There are obvious limitations that the authors concede, and there is no reason a formal randomised controlled trial cannot be performed in the future to confirm these findings.

Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess.
Mansour C, De Bonnecaze G, Mouchon E, et al.
EUROPEAN ARCHIVES OF OTORHINOLARYNGOLOGY
2019;276:2595-2601.