From the Research
All peritonsillar abscesses require drainage as this is the definitive treatment for this condition. Drainage should be performed when there is clinical evidence of abscess formation, including severe sore throat, trismus (difficulty opening the mouth), muffled "hot potato" voice, uvular deviation, and unilateral tonsillar swelling with fluctuance. The procedure can be accomplished through needle aspiration or incision and drainage, typically performed under local anesthesia. Prior to drainage, patients should receive antibiotics (such as penicillin 1.2 million units IV q6h or clindamycin 600-900 mg IV q8h for penicillin-allergic patients) and pain management. Drainage is necessary because antibiotics alone cannot adequately penetrate the abscess cavity, and without drainage, the infection can spread to adjacent spaces causing potentially life-threatening complications like airway obstruction, jugular vein thrombosis, or mediastinitis. In very small or early abscesses, aggressive antibiotic therapy might be attempted first, but most clinically evident peritonsillar abscesses will ultimately require drainage for resolution.
Key Considerations
- The most recent and highest quality study 1 suggests that bilateral peritonsillar abscesses can be safely managed with quinsy tonsillectomy and bilateral drainage.
- The study 2 found that incision and drainage may be associated with a lower chance of recurrence than needle aspiration, although the evidence is of very low quality.
- The American Family Physician study 3 recommends drainage of the abscess, antibiotic therapy, and supportive therapy for maintaining hydration and pain control as the cornerstones of treatment.
- The Acta oto-laryngologica study 4 found that immediate tonsillectomy in patients with peritonsillar abscess is a safe and effective treatment that should be considered as an alternative to conventional incision and drainage.
Treatment Approach
- Drainage should be performed as soon as possible to prevent complications and promote resolution of the infection.
- Antibiotics and pain management should be initiated prior to drainage.
- The choice of drainage procedure (needle aspiration or incision and drainage) should be based on the individual patient's needs and the clinical presentation of the abscess.
- Quinsy tonsillectomy may be considered in patients who will undergo anesthesia for abscess drainage, as it may be a safe and effective treatment option 1.