Surgical Treatment of Tonsillar Abscess

NCT04543708 | Terminated

• 1 other identifier: 2020-01516
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

The diagnosis and treatment of tonsillar abscess are very physician-dependent, as sufficient prospective medical literature is lacking to choose the most efficient regimen. The proposed study aims to assess the therapeutic efficacy of tonsillectomy compared to drainage under local anesthesia. This is a prospective, randomized clinical trial in adults in a tertiary care center in Geneva (Switzerland).

Conditions

Tonsillar Abscess

Keywords

Tonsil; Abscess; Tonsillectomy; Local anesthesia; CT-scan

Outcome Measures

Primary Outcomes (1)

• Proportion of treatment success (%)

  Disappearance of fever if any + decrease in leukocytosis and CRP value + no sign of recollection nor cervical extension of the infection.

  3 days

Secondary Outcomes (1)

• Recurrence rate (%)

  3 and 12 months

Study Arms (2)

Incision drainage

ACTIVE COMPARATOR

Adult with clinical suspicion of tonsillar abscess who underwent a CT-scan confirming the abscess will be randomly assigned to one arm or the other. "Incision drainage" arm will benefit from drainage of the tonsillar abscess under local anesthesia and then be hospitalized for intravenous antibiotics. If the incision drainage fails, they will get a tonsillectomy under general anesthesia.

Procedure: Incision drainage

Tonsillectomy

ACTIVE COMPARATOR

Adult with clinical suspicion of tonsillar abscess who underwent a CT-scan confirming the abscess will be randomly assigned to one arm or the other. "Tonsillectomy" arm will benefit from tonsillectomy under general anesthesia and then be hospitalized for intravenous antibiotics.

Procedure: Tonsillectomy

Interventions

Incision drainage PROCEDURE

Oropharyngeal pre-anesthesia is performed with 10% xylocaine spray, then submucosal anesthesia of the anterior pillar of the tonsil is performed with 2 ml of Rapidocaine or Rapidocaine 1 or 2% adrenaline. A scalpel incision is made with the search for the abscess pocket with a crile. If pus is present, a NaCl / Betadine rinse is performed. A syringe puncture can help locate the abscess if needed. The duration is approximately 15 minutes. If no purulent pouch is found, the procedure is completed with tonsillectomy under general anesthesia.

Incision drainage

Tonsillectomy PROCEDURE

Under general anesthesia, in dorsal decubitus, an autostatic mouth opener is placed, an incision of the anterior pillar of the tonsil allows the opening of the capsular space, along which the entire tonsil is dissected until complete extraction, hemostasis is performed, then the patient is awakened. The duration is approximately 30 minutes.

Tonsillectomy

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients ≥18 years of age with clinical suspicion of unilateral tonsillar abscess without signs of "extra-capsular" complication.
• Obtaining informed consent.

You may not qualify if:

• Contraindications to injected CT or drainage in local anesthesia (allergy to iodinated contrast product, allergy to local anesthetics, phobia of needles, major trismus).
• Parapharyngeal or retropharyngeal abscess, or associated venous thrombosis found on CT.
• Imminent threat to the upper respiratory tract (glottic edema, acute dyspnea).
• Inability to understand the different procedures (dementia, impossible communication, substance abuse).
• Anamnestic pregnancy.
• Antiaggregant or anticoagulant treatment.
• Treatment of corticosteroids during the management of emergencies and in hospital.

Sponsors & Collaborators

• University Hospital, Geneva: lead

Study Sites (1)

University Hospitalas Geneva

Geneva, Canton of Geneva, 1211, Switzerland

Location

Related Publications (19)

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  PMID: 23612569 BACKGROUND

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• Powell J, Powell EL, Conroy K, Hopkins C, Moor JW, Wilson JA. Throat-related quality of life in peritonsillar abscess sufferers: application of the adult tonsil outcome inventory. J Laryngol Otol. 2013 Dec;127(12):1190-3. doi: 10.1017/S0022215113003071. Epub 2013 Nov 20.

  PMID: 24252628 BACKGROUND

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  PMID: 29808740 BACKGROUND

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  PMID: 10435129 BACKGROUND

• Salihoglu M, Eroglu M, Yildirim AO, Cakmak A, Hardal U, Kara K. Transoral ultrasonography in the diagnosis and treatment of peritonsillar abscess. Clin Imaging. 2013 May-Jun;37(3):465-7. doi: 10.1016/j.clinimag.2012.09.023. Epub 2012 Oct 25.

  PMID: 23102927 BACKGROUND

• Carratola MC, Frisenda G, Gastanaduy M, Guarisco JL. Association of Computed Tomography With Treatment and Timing of Care in Adult Patients With Peritonsillar Abscess. Ochsner J. 2019 Winter;19(4):309-313. doi: 10.31486/toj.18.0168.

  PMID: 31903053 BACKGROUND

• Patel KS, Ahmad S, O'Leary G, Michel M. The role of computed tomography in the management of peritonsillar abscess. Otolaryngol Head Neck Surg. 1992 Dec;107(6 Pt 1):727-32. doi: 10.1177/019459988910700603.1.

  PMID: 1470448 BACKGROUND

• Teschner M, Aljeraisi T, Giesemann A, Gotz F, Lenarz T, Kontorinis G. [The role of CT in the diagnosis of peritonsillar abscesses after Punctio Sicca]. Laryngorhinootologie. 2013 Jan;92(1):25-9. doi: 10.1055/s-0032-1327709. Epub 2012 Nov 19. German.

  PMID: 23165703 BACKGROUND

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  PMID: 12646835 BACKGROUND

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  PMID: 22321140 BACKGROUND

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• Fagan JJ, Wormald PJ. Quinsy tonsillectomy or interval tonsillectomy--a prospective randomised trial. S Afr Med J. 1994 Oct;84(10):689-90.

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• Chowdhury CR, Bricknell MC. The management of quinsy--a prospective study. J Laryngol Otol. 1992 Nov;106(11):986-8. doi: 10.1017/s002221510012153x.

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• Clerc S, Soldati D. [Socioeconomic aspects in the therapy of peritonsillar absscess]. Schweiz Med Wochenschr. 2000;Suppl 125:17S-19S. French.

  PMID: 11141930 BACKGROUND

• Voruz F, Revol R, Mermod M, Senn P, Monnier Y, Dulguerov N. A randomized clinical trial of peritonsillar abscess treatment comparing drainage and tonsillectomy. Am J Otolaryngol. 2025 Nov-Dec;46(6):104745. doi: 10.1016/j.amjoto.2025.104745. Epub 2025 Oct 20.

  PMID: 41192203 DERIVED

MeSH Terms

Conditions

Abscess

Interventions

Tonsillectomy

Condition Hierarchy (Ancestors)

Suppuration; Infections; Inflammation; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Otorhinolaryngologic Surgical Procedures; Surgical Procedures, Operative

Study Officials

• François Voruz, MD

  University Hospital, Geneva

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal investigator

Study Record Dates

• First Submitted: September 2, 2020
• First Posted: September 10, 2020
• Study Start: October 1, 2020
• Primary Completion: February 22, 2024
• Study Completion: February 22, 2024
• Last Updated: May 1, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

CH (1)