Procedures: Incision and Drainage of Peritonsillar Abscess
Draining the pus is the main treatment for a peritonsillar abscess. It is usually done with numbing medicine while the patient is awake, and it is combined with antibiotics.
Why drainage is needed
A peritonsillar abscess is a pocket of pus that forms next to one of the tonsils, usually as a complication of a throat or tonsil infection. It can cause a severe one-sided sore throat, pain with swallowing, a muffled "hot potato" voice, drooling, fever, and difficulty opening the mouth fully (trismus).
Draining the pus is the main treatment. Antibiotics alone usually are not enough, because the pus pocket needs to be physically emptied. Drainage relieves symptoms and helps recovery go faster. It is usually combined with antibiotics and, often, medicines to reduce pain and swelling. The full range of treatments is described on the peritonsillar abscess treatments page.
How the abscess is drained
There are two common ways to drain the abscess at the bedside, and both work well. The clinician, usually an ear, nose, and throat (ENT) specialist or an emergency physician, chooses based on the individual situation.
Needle aspiration (drawing the pus out with a needle): A numbing spray or injection is applied to the area. The pus is then drawn out with a syringe and needle. This is quick, often less painful, and can confirm the diagnosis at the same time. Sometimes the needle is inserted in more than one spot to find and empty the pocket.
Incision and drainage (a small cut to let the pus out): After the area is numbed, a small cut is made at the most swollen spot. A blunt instrument may be gently opened inside the pocket to break up compartments and let all the pus drain out. This creates a wider opening and may drain the abscess more completely.
Both methods are usually done while the patient is awake and sitting upright, using local (numbing) anesthesia. The pus that comes out may be sent to the lab to identify the bacteria.
When drainage is done in the operating room
Most people can have the abscess drained at the bedside in an emergency department or clinic. Drainage in the operating room under general anesthesia (fully asleep) is reserved for certain situations, such as:
Children, or anyone who cannot stay still for an awake procedure
Severe trismus, when the mouth cannot open enough for the area to be reached safely
A deep or complicated abscess, or concern that the infection has spread beyond the tonsil area
Bleeding or airway concerns, or when bedside drainage has not worked
In some cases, the surgeon removes the affected tonsil at the same time the abscess is drained (called "quinsy" or abscess tonsillectomy). This is usually reserved for people who have complications, whose infection has not responded to other treatment, or who already meet the criteria for having their tonsils removed.
What to expect during an awake procedure
The patient sits upright. Numbing medicine is applied first, so the main sensation is pressure rather than sharp pain.
When the pus is released, a sudden bad taste is common. Suction is used to clear it quickly, and spitting rather than swallowing is encouraged.
The procedure itself is usually brief, often just a few minutes.
Many people feel noticeably better soon afterward, as the pressure is relieved.
After drainage
Most people go home on antibiotics, typically for about 7 to 10 days. The full course is generally completed as prescribed, even once symptoms improve.
Pain relief, fluids, and rest are part of recovery. Cool drinks and soft foods are often easier to manage.
A follow-up visit is usually scheduled, because occasionally the pocket refills and needs to be drained again.
Hospital admission may be needed instead of going home when a person cannot drink enough fluids, pain is hard to control, there is no safe way to follow up, or a complication develops.
Warning signs after drainage
The following symptoms call for prompt contact with the treating clinician or a return to the emergency department:
Difficulty breathing, noisy breathing, or trouble swallowing saliva
Significant bleeding from the mouth or throat
A high or worsening fever, worsening pain, or neck swelling and stiffness
Inability to keep down fluids
Key points
Drainage is the core treatment; antibiotics support it but do not replace it.
Needle aspiration and incision and drainage are both effective, and most drainage is done awake with numbing medicine.
The operating room and general anesthesia are reserved for children, severe trismus, complicated abscesses, or when bedside drainage is not possible or has failed.
Completing antibiotics, staying hydrated, and keeping the follow-up visit are part of recovery.
More on related topics: peritonsillar abscess treatments, tonsillectomy & adenoidectomy, and tonsils and adenoids in the Learning Center.