In order to compare the efficacy of permucosal needle drainage with that of incision and drainage in the outpatient management of peritonsillar abscess, 52 patients with aspiration-proven peritonsillar abscess were entered into a randomized, prospective protocol. A symptomatic scale scoring system was employed to evaluate treatment results. In the needle drainage group, 92% (22/24) were cured with a single aspiration. Ninety-three percent (26/28) of the patients in the incision and drainage group were cured on the initial attempt. The remainder of the patients in both groups were cured with a single retreatment. Only one patient required hospitalization, and no patients required tonsillectomy to resolve the abscess. These data indicate that outpatient permucosal needle drainage of peritonsillar abscess is an acceptable, inexpensive treatment comparing favorably with incision and drainage.