ENT doctor predicts tonsillectomy procedure he championed at CHOC will become the new standard nationally

In a recently published research paper, a CHOC pediatric otolaryngologist predicts a “paradigm shift” in the next five to seven years to make intracapsular tonsillectomies (ITs) the standard surgical technique for removing tonsils in children either for snoring and sleep disordered breathing or for chronic/recurrent tonsillitis.

CHOC was among the first pediatric hospitals in the country to adopt ITs as its standard technique, but Dr. Kevin Huoh notes in his paper, “Current Status and Future Trends: Pediatric Intracapsular Tonsillectomy in the United States,” published in Laryngoscope, the foremost publication for otolaryngologists, and co-written by Dr. Yarah Haidar and Dr. Brandyn Dunn, both of the UCI School of Medicine, only 20 percent of the 540 pediatric otolaryngologists who responded to a survey the three doctors sent perform ITs.

“The reasons (most other ENTs) are not doing ITs are probably psychosocial,” Dr. Huoh says. “They’re not exposed to it. They’ve been doing tonsillectomies the same way for forever and they have a lack of exposure to this new procedure. Simply, they are set in their old ways.

“But this procedure is very, very favorable. It’s very easily learned, and it really works.”

Intracapsular tonsillectomies have steadily gained popularity in the United States and across the world since the procedure first was described in 2002.

Dr. Huoh brought the technique to CHOC when he started there in September 2013 after learning it during his fellowship at Stanford University Medical Center. So, too, did fellow pediatric otolaryngologist Dr. Nguyen Pham, who joined CHOC around the time Huoh did.

Since then, more than 1,000 children have undergone intracapsular tonsillectomies at CHOC, with the rate of tonsillar regrowth – the most cited concern for not performing ITs – remaining extremely low, Dr. Huoh says. In addition, the rate of post-tonsillectomy bleeding, the most feared post-operative complication, is pretty much zero, much lower than with traditional extracapsular tonsillectomy.

That is certain to change in the coming years as the benefits of the technique become more widely recognized, Dr. Huoh says.

Dr. Huoh and other CHOC doctors mainly perform intracapsular tonsillectomies on children whose large tonsils cause obstructive sleep apnea.

Such was the case with Madison Boehm.

When she was 2, her parents noticed she snored a lot and woke up tired. She was sluggish and lethargic and took one or two three-hour naps per day.

“We went online and did some research, and sleep apnea popped up,” Lisa recalls.

Lisa says she and her husband, Cameron, researched the best hospital to take Madison to and they quickly settled on CHOC, where Dr. Pham diagnosed Madison as having large tonsils and adenoids as well as obstructive sleep apnea.

Madison had the surgery on Aug. 3, 2019.  Then 3, she had an intracapsular tonsillectomy, in which 95 percent of the tonsils are removed, preserving the “capsule,” and thus protecting the muscle underneath.

The result is less risk of postoperative bleeding, vastly decreased postoperative pain and a rapid return to normal diet.

The vast majority of the nearly 300,000 children who have tonsillectomies in the United States every year have both of his tonsils completely removed via a technique known as an extracapsular tonsillectomy (ET).

“The doctors at CHOC were all dialed in, and I was holding her an hour after she went under,” says Lisa, Madison’s mother. “The recovery part is what was amazing. By the time we were home, she was totally out of the anesthesia fog and asking to eat.”

So, Lisa got Madison a cheeseburger.

She never complained about her throat – just soreness on the top of her hand from the IV.

“She completely recovered in a couple of days,” Lisa says of Madison, who enjoys dancing and gymnastics. “From that first night after surgery, she has been sleeping normally, and I feel that her personality has come out a little more.”

Lisa says she has referred her friends who have kids with tonsillar problems to CHOC pediatric otolaryngologists.

“The doctors treat their patients like they are their own kids,” she says. “I had total confidence in them. They carefully explained everything that was needed, and I could always be in touch with them. They are second to none.”

Refer a patient to CHOC otolaryngology

Virtual CHOC pediatric lecture series launches

The inaugural session of a new CHOC virtual pediatric lecture series will cover the management of acute chronic otitis media.

Held Aug. 27 from 12:30 to 1:30 p.m., the session is designed for general pediatricians, family practitioners and other healthcare professionals and will address:

  • Indications for antibiotic therapy and the recommended choice of antibiotics in the management of acute otitis media.
  • Appropriate otolaryngology referrals of a child for placement of ventilation tubes in the management of acute and chronic otitis media and discerning the role of adenoidectomy in the management of otitis media.

The session will feature CHOC pediatric otolaryngologists Drs. Gurpreet Ahuja, Nguyen Pham, Kevin Huoh, Jay Bhatt and Qiu Zhong.

The series is part of CHOC’s continued commitment to bring the latest, most relevant medical news to community providers. Additional sessions will follow.

Register for the series here.

How CHOC otolaryngologists are changing tonsillectomy recovery

For many children undergoing tonsillectomies at CHOC, 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 – UC Irvine Child Health Research Awards

We are pleased to announce that we just completed another round of the CHOC – 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

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 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.