How CHOC otolaryngologists are changing tonsillectomy recovery

For many children undergoing tonsillectomies at CHOC Children’s, gone are the weeks missing school, a liquid diet and powerful narcotic painkillers.

Instead, a new technique for tonsillectomies practiced at CHOC means patients return to school and a regular diet sooner and require only over-the-counter pain medication such as Tylenol.

More importantly, the risk for potentially life threatening post-operative bleeds – 3 to 8 percent in traditional tonsillectomies – and hospital readmissions drop dramatically when children undergo procedures using this technique.

During an intracapsular tonsillectomy, the surgeon deftly shaves away at the tonsil, leaving a small portion (the outer wall called the capsule) behind. In contrast, a traditional total tonsillectomy removes the entire organ,   exposing raw muscle  and blood vessels behind the tonsil, which increases pain and bleeding risk.

Due to the significant benefit to patients, the technique has become routine at CHOC. These physicians are working to raise awareness about this technique in the community, as well as with their physician peers nationwide.

Drs. Kevin Huoh and Nguyen Pham presented a joint lecture to otolaryngologists at the recent American Academy of Otolaryngology–Head and Neck Surgery Foundation’s annual meeting teaching an instructional course for other surgeons on this technique.

Drs. Huoh and Pham learned the intracapsular technique as fellows, but for years practiced the traditional tonsillectomy version they learned as residents, they said. 

But a few years after joining CHOC, they made a change. Drs. Huoh and Pham lamented the number of patients complaining of pain after surgery; the number of narcotic pain prescriptions they wrote; and the number of patients returning to the hospital post-surgery with dehydration, pain and bleeding.

After largely switching to the intracapsular technique, they’ve had zero bleeds after more than 1,000 procedures – and, anecdotally, they have happier patients.

For example, Jenna Opp underwent the new procedure with Dr. Pham about nine months ago as a high school senior.

Jenna Opp, a CHOC intracapsular tonsillectomy patient, was able to avoid narcotic pain relievers and to eat solid food the night of the procedure.

Her mother had also undergone a tonsillectomy as a teenager and prepared Jenna for the  worst. But after the surgery, Jenna drank a smoothie and by that night, she enjoyed eggs and French toast for dinner. Two days later she was back in school and craving a hamburger.

The experience was an about-face from her mother’s memories of weeks of pain coupled with a steady oatmeal diet. And even better – after a lifetime of chronic bouts of strep throat, Jenna has been healthy ever since.

Jenna returned to her normal routine two days after her intracapsular tonsillectomy procedure.

“They offered to do it the old way or the new way,” Jenna says. “They told me the new procedure is way less painful and only takes a couple of days for recovery. I was like,  ‘I’m sold on that,’ and it was awesome.”

Here are some keys things to know about the intracapsular tonsillectomy technique:

  • The tonsil regrowth rate following an intracapsular tonsillectomy at CHOC is 0.5 to 1%.
  • The procedure takes the same amount of time as a traditional tonsillectomy – 30 to 45 minutes.
  • Intracapsular tonsillectomy is growing in popularity in the United States. Elsewhere in the world, such as in Sweden and France, it’s the preferred method of tonsil removal.
  • Usually children will require only over-the-counter pain medication such as Tylenol for a few days after surgery. Some children do not require any pain medication.
  • There are no age restrictions for this procedure.

Learn more about referring a patient to CHOC’s otolaryngologists.

Dr. Nguyen Pham Addresses Choking Hazards, Prevention

Choking is the leading cause of death and injury among children, particularly in children ages 3 and younger, a CHOC Children’s otolaryngologist tells “American Health Journal.”

Food, toys and coins are the primary causes of choking in children in this age group, says Dr. Nguyen Pham. Spherical toys are of particular concern, as are latex balloons. Hotdogs, grapes and nuts are especially dangerous foods, Dr. Pham says.

Learn more about choking hazards, including prevention and treatment, in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 40 million households.

Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit www.discoverhealth.tv.

Nguyen Pham, M.D., attended medical school at UC Irvine, and then completed his internship and residency in otolaryngology at the UC Davis Medical Center in Sacramento. He conducted his fellowship in pediatric otolaryngology at Stanford University in Palo Alto.

Dr. Gurpreet Ahuja Addresses Tonsils, Adenoids

Severe, long-term enlargement of tonsils and adenoids can lead to strain on the heart and lungs, Dr. Gurpreet Ahuja, CHOC Children’s Specialists division chief of otolaryngology, tells “American Health Journal.”

About 530,000 tonsillectomies occur annually in the United States in patients ages 15 and younger, says Dr. Ahuja. A patient would meet the criteria for a tonsillectomy if he or she has experienced seven infections in a one-year period; five episodes each year for two years; or three episodes each year for three or more years, he says.

Learn more about diagnosis and treatment of this condition in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 30 million households.

Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit www.discoverhealth.tv.

More About Dr. Ahuja

Gurpreet Ahuja, M.D., is the CHOC Children’s Specialists division chief of otolaryngology. Dr. Ahuja attended medical school at the All India Institute of Medical Sciences, New Delhi and completed his residency in Otolaryngology/Head and Neck Surgery at the Manhattan Eye, Ear and Throat Hospital, New York, followed by a fellowship in pediatric otolaryngology at the Children’s National Medical Center in Washington, D.C.

Learn more about otolaryngology at CHOC, by clicking here: http://www.choc.org/search/index.cfm?keyword=otolaryngology