Comparative Clinical Outcomes of Needle Aspiration and Incision & Drainage in Peritonsillar Abscess

Background: Peritonsillar abscess (PTA) is a common deep neck infection associated with significant healthcare resource utilization. Needle aspiration (NA) and/or incision & drainage (ID) are the most frequently used treatment modalities; however, their comparative clinical outcomes remain controversial. Methods: This retrospective cohort study included 185 adult patients hospitalized with a diagnosis of PTA between January 2018 and January 2026 at a tertiary care center. Patients aged ≥18 years who underwent NA or ID were included. Demographic characteristics, clinical findings, laboratory parameters at admission, treatment-related variables (type and number of interventions, drainage volume, adjunctive corticosteroid use), microbiological results, and length of hospital stay were recorded. Patients were categorized according to the drainage method performed (NA vs. ID). Results: A total of 185 patients were included, of whom 87 (47%) underwent NA and 98 (53%) underwent ID. There were no significant differences between groups in age, sex, or length of hospital stay (p > 0.05). CRP levels and lymphocyte counts were significantly higher in the NA group (p = 0.028 and p = 0.009, respectively), whereas drainage volume and number of interventions were significantly higher in the ID group (p < 0.001 and p = 0.005, respectively). Successful resolution on the first attempt was more frequent in the ID group (89.8% vs. 75.9%, p = 0.011), while steroid use was more common in the NA group (16.1% vs. 2.0%, p = 0.001). In multivariate analysis, drainage volume, first-attempt success, and corticosteroid use were independently associated with the choice of drainage method (p < 0.05). Conclusions: Both NA and ID are effective treatment options for PTA; however, ID was associated with higher first-attempt success and greater drainage volume. Indeed, NA was more frequently accompanied by steroid therapy. These findings suggest that treatment modality selection may influence short-term clinical outcomes in patients with PTA.