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.

2015 CHOC Children’s – UC Irvine Child Health Research Awards

We are pleased to announce that we just completed another round of the CHOC Children’s – UC Irvine Child Health Research Awards, our annual call for proposals that enhance research collaborations between CHOC and UC Irvine and further the Mission, Vision and strategic aims of the CHOC-UCI Child Health Research Strategic Plan. Intended to support research and collaboration in targeted areas of research excellence that align research strengths for focused growth and maximal translational impact, our call this year specifically solicited applications for two funding mechanisms, Pilot Collaborative Research Awards and Clinician Investigator Awards.

Child Health Research Award - UC Irvine Infographic

Pilot Collaborative Research Awards are intended to provide funds for collaborative projects in need of initial start-up funding to enable procurement of other independent support. These awards are designed to promote novel, translational research efforts that coalesce talented clinicians and researchers from CHOC and UC Irvine. Projects bring investigators from multiple disciplines from CHOC and UC Irvine together to identify targets for improved diagnosis, prevention, or treatment of a pediatric health problem relevant to the goals of the CHOC-UCI Child Health Research Strategic Plan.

Clinician Investigator Awards are intended to provide funds for clinician-investigator initiated projects in need of funding to advance study into a clinically relevant and important topic that has a high likelihood of impacting clinical practice and the positive experience of pediatric/ adolescent patients and their families. Priorities are given to proposals that are closely aligned with the research themes identified in the CHOC – UCI Child Health Research Strategic Plan. Projects identify targets for improved diagnosis, prevention, or treatment of a pediatric health problem relevant to the goals of the CHOC-UCI Child Health Research Strategic Plan. Collaborations between CHOC and UCI faculty are strongly encouraged, but not required.

This year we received 18 proposals, an increase of 13% over last year, covering a wide range of topics and specialties. After external academic peer reviews and committee discussions, we decided to fund 6 projects, 3 Pilot Collaborative Research Awards and 3 Clinician Investigator Awards.

Congratulations to the well-deserving recipients of the 2015 awards! They are listed below, in order of award type and Principle Investigator’s last name.

 

Pilot Collaborative Research Awards.

Principal Investigator: Dr. Gurpreet Ahuja

Collaborators: Drs. Nguyen PhamKevin Huoh, Naveen Bhandarkar, Carolyn Coughlan, Joon You

Project Title: NIR Imaging of Pediatric Sinuses

 

Principal Investigator: Dr. Tami John

Collaborators: Drs. Lilibeth Torno, Daniela Bota, Grace Mucci, Mary Zupanc, Jack Lin

Project Title: Cognitive Training to Promote Neuroplasticity and Neural Re-circuitry in Chemotherapy

Associated Cognitive Impairment

 

Principal Investigator: Dr. Calvin Li

Collaborators: Drs. John Weiss, Hong Yin, William Loudon

Project Title: A Tunable Engineered Tissue Graft Model for Repair of Traumatic Brain Injury

 

Clinician Investigator Awards

Principal Investigator: Dr. Antonio Arrieta

Collaborators: Drs. Katrine Whiteson, David Michalik

Project Title: Addressing the Fear Factor in Neonatal Serious Bacterial Infections: Distinguishing E Coli From Bacteremia, Urinary Tract Infection, and Bacteremic Urinary Tract Infection in Infants <28 Days vs. >28 Days to 90 Days Old by Pairing E. Coli Genome Analysis with Clinical Data

 

Principal Investigator: Dr. Joanne Starr

Collaborators: Drs. Richard Gates, Sharief Taraman, Mary Zupanc, Paul Yost, Michele Domico, Juliette Hunt, Tammy Yoon, Kimberley Lakes

Project Title: Seizures and Neurodevelopmental Outcomes in Mild Hypothermic Cardiopulmonary Bypass

 

Principal Investigators: Dr. Sharief Taraman and Ruth McCarty

Collaborators: Drs. William Loudon, Frank Hsu

Project Title: The Use of Traditional Chinese Medicine (TCM) as a Complementary Treatment of Pediatric and Young Adults with Post-Concussive Syndrome

In the Spotlight: Kevin Huoh, M.D.

Kevin Huoh, M.D. Born with a lymphatic malformation, Dr. Kevin Huoh brings uncommon insight into the care he provides for patients with head and neck disorders. Dr. Huoh is helping CHOC expand the Hemangioma Clinic to become the Hemangioma and Vascular Anomalies Program, which will treat hemangiomas, venous and lymphatic malformations, as well as all vascular anomalies.


 

“If I can help one child the way doctors have helped me, their work will not have been in vain.”

Those words were spoken in 2003 by class valedictorian Kevin Huoh, as he prepared to graduate summa cum laude from the University of Southern California. He was headed toward a career in medicine and already knew exactly what he wanted to do: pediatric otolaryngology.

Ten years later, after further distinguishing himself at the University of California, San Francisco, and at Lucile Packard Children’s Hospital at Stanford Hospitals and Clinic, Dr. Huoh returned to Southern California to open his practice.

“I was born to do this,” Dr. Huoh often says. And indeed he was.

Dr. Huoh spent the first six months of his life in a NICU. Born with a lymphatic malformation, he lived with a tracheostomy tube and endured more than 90 surgeries over the next eight years.

The physicians who treated him probably never dreamed their patient would grow up with such profound gratitude and desire to give back. But Dr. Huoh clearly meant what he said all those years ago.

His goal is to help expand CHOC into the premier center for pediatric otolaryngology in Southern California, in addition to providing comprehensive, multidisciplinary, evidenced-based care for children with vascular anomalies.

“I truly believe that all children with pediatric head and neck disorders should be evaluated at a tertiary children’s hospital like CHOC,” Dr. Huoh said. “My goal is to expand our service to reach more children throughout the region.”

Board-certified in pediatric otolaryngology, Dr. Huoh’s clinical interests include congenital and acquired head and neck tumors, vascular malformations, surgical therapy of sleep apnea, endoscopic airway management and otologic surgery.

During his fellowship at Lucile Packard Children’s Hospital, Dr. Huoh received many awards and honors. However, the Seymour Cohen Prize from the American Broncho-Esophagological Association for his research into pediatric airway management. was a highlight of his early career. Dr. Cohen was Dr. Huoh’s own pediatric otolaryngologist at Children’s Hospital Los Angeles all those years ago.

Additionally, Dr. Huoh has coauthored articles that have appeared in several medical journals, including The Laryngoscope and Otolaryngology — Head and Neck Surgery. He has contributed several medical textbook chapters, including “Infantile Hemangiomas of the Head and Neck,” for Pediatric Clinics of North America: Pediatric Otolaryngology. 2013.

From the IVs and repeated surgeries, to not being able to go swimming and having to face down school bullies — Dr. Huoh well remembers what it was like to grow up with a chronic medical condition. And when the occasion warrants, he will share his own personal story with patients and families.

In doing so, Dr. Huoh hopes to foster understanding and inspire hope. It’s yet another way of thanking the team of physicians who helped him so early in life.

Fluent in conversational Mandarin and Spanish, Dr. Huoh is in practice at CHOC Children’s Specialists in Orange. For more information or to arrange a referral, please call 714-633-4020.