Peritonsillar abscess: needle aspiration and incision
- Procedure
Pus beside the tonsil is drained by needle or incision by a trained doctor, together with antibiotics and pain relief.
What it is
A peritonsillar abscess (quinsy) is a collection of pus between the tonsil capsule and the superior constrictor muscle. Treatment combines drainage, antibiotics and pain control. Drainage by needle aspiration or incision is done by ENT or a trained emergency physician, in the emergency room or clinic, with the patient sitting and awake; young children or uncooperative patients need theatre. The internal carotid artery lies behind and lateral to the tonsil, which is why depth and direction matter. This page is an educational overview, not a guide to performing it.
Indications and contraindications
- Indications: a clinically or radiologically confirmed abscess in a patient who can cooperate.
- Theatre instead of the emergency room: airway compromise, young or uncooperative patient, or extension to deep neck spaces on CT.
- Caution: a pulsatile mass or suspected vascular anomaly needs imaging first, never blind aspiration.
- Bleeding disorders or anticoagulation need correction or a specialist plan before drainage.
How it is done
- Confirm the diagnosis clinically; use intraoral ultrasound or contrast CT when the diagnosis or spread is uncertain.
- The patient sits upright with suction ready; topical and local anaesthesia are given.
- Aspiration is made at the point of greatest bulging, usually the upper pole above the tonsil, with a shallow needle.
- If no pus is found, a second, slightly lower site may be tried; persistent failure suggests cellulitis or needs imaging.
- Incision and drainage: a short, shallow incision at the point of bulging, opened bluntly to release pus.
- Pus is sent for culture; antibiotics, analgesia and fluids continue, with review within a day or two.
Complications
- Bleeding, and rarely injury to the internal carotid artery.
- Aspiration of pus or blood into the airway.
- Incomplete drainage or recurrence.
- Spread to the parapharyngeal space or beyond if untreated.
Next step / Initial management
- Workup: diagnosis is clinical; full blood count and a test for infectious mononucleosis when suspected; contrast CT if spread is suspected.
- First-line antibiotics after drainage: penicillin with metronidazole, or amoxicillin–clavulanate; clindamycin in penicillin allergy; plus analgesia and fluids.
- Refer to ENT the same day (urgent) every suspected peritonsillar abscess; airway signs or deep neck spread are an emergency.
- Refer routinely to ENT after recovery to discuss tonsillectomy for recurrence or recurrent tonsillitis.
Test yourself
Think of the answer, then tap the question to see it.
A 20-year-old has severe left-sided sore throat, trismus and a muffled voice; the uvula is pushed to the right. What is the diagnosis and the treatment?
Left peritonsillar abscess. It is drained (needle aspiration or incision) by a trained doctor and treated with antibiotics, analgesia and fluids.
Why does aspiration of a peritonsillar abscess stay shallow and directed near the upper pole?
Because the internal carotid artery lies posterolateral to the tonsil; a deep or lateral needle can injure it.
How do you tell peritonsillar cellulitis from an abscess when the exam is unclear?
Intraoral ultrasound or contrast CT shows a collection in an abscess; cellulitis has none and is treated with antibiotics alone.
Connections
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Peritonsillar Abscess (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2026).
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Representative model, for educational purposes only.