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Purpose: The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA. Methods: A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety. Results: Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2–4) in the aspiration group versus 2.0 days (IQR 2–3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups. Conclusion: Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings. [ABSTRACT FROM AUTHOR]

We welcome the opportunity to continue the discussion and to clarify issues you raised in your letter. You will find enclosed a point-by-point response to your comments. Please note that all of these points are already discussed in the "discussion" section of our article "Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess". Regarding the retrospective design of our study, we think that the length of hospital stay was the best criterion to be used as primary outcome because it is a clinical endpoint and a composite criterion, reflecting the global improvement of the patient. Our study included PTA patients aged under 15 because the management of peritonsillar abscess in children follows specific guidelines and requires specific care, and due to evident issues of understanding, compliance and pain handling, incision and drainage under local anaesthesia is not routinely used in younger children. We fully agree that this subject remains an area of debate and we are perfectly aware that due to methodological limitations and especially the retrospective design, the level of evidence of our study is not sufficient to draw firm conclusions on the superiority of one technique on the other. At this day, only low-quality evidence studies have been published on this subject and the debate remains opened to determine whether needle aspiration or incision and drainage is the most safe and effective technique in treating peritonsillar abscess. [ABSTRACT FROM AUTHOR]