\s=b\ Forty-one patients with proved peritonsillar abscesses were treated during a five-year period with needle aspiration as the sole initial surgical treatment. Ninety percent (37/41) of the patients' abscesses resolved without further invasive therapy. All but two of the patients were treated as outpatients. Fifty percent (21/ 41) of the patients were treated by nonotolaryngologists. These data indicate that outpatient needle aspiration is the simplest, most cost-effective therapy for peritonsillar abscess. (Arch Otolaryngol 1984;110:104-105) Peritonsillar abscess is one of the most common abscesses of the head and neck. It is seen in both sexes and has been reported in patients from 7 to 70 years of age.1 The classic recommendation for treatment has been incision and drainage and hospitalization followed in one to three months by a tonsillectomy. Abscess tonsillectomy is an additional ac¬ cepted treatment for peritonsillar abscess.2 5 More recently, however, two initial reports6·7 detailed the first treatment of peritonsillar abscesses For editorial comment see 103.with needle aspiration alone com¬ bined with antibiotic therapy. This article is a follow-up of one of those reports, which now includes a fiveyear experience with this approach.
PATIENTS AND METHODSFifty-four patients with the presumptive diagnosis of peritonsillar abscess had nee¬ dle aspirations during a five-year period at the University of New Mexico Hospital, Albuquerque. The patients were treated in an ambulatory care setting either in the emergency room or the otolaryngology clinic. The aspiration was accomplished using a 10-mL syringe with an 18-gauge spinal or a 3.81-cm needle. It was per¬ formed at the point of maximum bulging. If no pus was obtained, a second aspiration was accomplished 1 cm lower. A third aspiration was not attempted. All the patients, except two, were treated as out¬ patients with oral antibiotics (usually pen¬ icillin G potassium) and pain medication. They were followed up in the otolaryngolo¬ gy clinic.
RESULTSThirteen of the needle aspirations yielded no pus. The abscesses of all of these patients, except the two who were unavailable for follow-up, re¬ solved while they were receiving oral medication. Pus was drawn from the abscesses of 41 patients, and they were the only ones considered to have a true peritonsillar abscess. Of those, 37 abscesses resolved without further treatment; four abscesses did not resolve, and they required further therapy. Of those four, one patient had an abscess tonsillectomy and three underwent classic incision and drainage. The average amount of pus removed was 4.5 mL; the average res¬ olution time was 2.6 days. COMMENT