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

CHOC ENT study finds kids more often exposed to loud noises, infrequently use hearing protection

A new study co-authored by a CHOC otolaryngologist finds that nearly a quarter of U.S. children are at increased risk for hearing loss due to exposure to loud sounds and infrequent hearing protection use.

Dr. Jay Bhatt and his co-authors examined the incidence and gender differences in pediatric recreational and firearms noise exposure in the United States. The study, published in the May 2019 issue of the otolaryngology journal “Laryngoscope,” is the largest evaluation of loud noise exposure patterns and the use of hearing protection in children to date. 

Drawing on data gathered by the National Health Interview Series (NHIS), the study makes several key findings:

  • The most common source of recreational noise was personal music players, now used by up to 90% of school children
  • One in five children have been exposed to firearm noise, with boys significantly more likely to have exposure than girls.
  • Only 16% of children always used hearing protection in the last 12 months during explosive sound exposures, and girls were less likely to use protection than boys.
  • Up to 96% of parents perceived their children to be at no to minimal risk of hearing loss from excessive noise.
  • The prevalence of pediatric loud noise exposure is the likely cause of the noise-induced hearing loss noted in one in five adults ages 20 to 29.

The gender disparities found by the study underscore the importance of hearing protection education to not just boys, who are more frequently exposed to loud noises, but also girls, who are less frequently exposed but less likely to wear hearing protection, the authors write.

Further, public health initiatives could identify children and families at risk for loud noise exposure and provide appropriate counseling to prevent hearing related consequences as adults.

Learn more about otolaryngology at CHOC.

Meet Dr. David Chang

CHOC wants its referring physicians to get to know its specialists. Today, meet Dr. David Chang, a pediatric otolaryngologist.

Q: What is your education and training?

A: I attended University of Michigan for undergraduate studies in chemical engineering. I then attended Case Western Reserve University School of Medicine, in Cleveland, for medical school and graduate school where I obtained a PhD in biomedical engineering. I completed my otolaryngology residency at Stanford University and a pediatric otolaryngology fellowship at Boston Children’s Hospital.

Q: What are your special clinical interests?

A: As a pediatric ear nose and throat specialist I love working with kids and managing the variety of ENT disorders affecting children.  I do have a special interest in treating kids with airway, breathing issues, and obstructive sleep apnea.

Q: What are your most common diagnoses?

A: Obstructive sleep apnea and recurrent ear infections.

Q: Are you working on any current research?

A: My background is in biomedical engineering and biomaterials.  My goal is to develop new technologies and devices that will improve the care of children.  We have several research pursuits in our division currently.  We are applying new imaging technology to the management of ear infections, obstructive sleep apnea, sinusitis, as well as cholesteatoma.

Q: How long have you been on staff at CHOC?

A: This is my first year at CHOC.

Q: What are some new programs or developments within your specialty at CHOC?

A: In our division, I’m leading two multidisciplinary clinical programs. Our aerodigestive clinic treats kids with airway and feeding issues. The sleep surgery clinic will open in the near future and will treat kids with persistent obstructive sleep apnea after initial tonsillectomy and adenoidectomy.

Q: What would you most like community/referring providers to know about you/your division at CHOC? 

A: Our pediatric otolaryngology group at CHOC is all fellowship trained and love caring for children. We work collaboratively to provide high quality, evidence-based care. We have expertise in the breadth of disorders in ENT and have established a multidisciplinary approach in our cochlear implant, thyroid, aerodigestive, vascular anomalies, cleft and craniofacial programs.  Our newest multidisciplinary program will be in sleep surgery.

Q: What inspires you most about the care being delivered here at CHOC? 

A: I’m inspired by CHOC’s dedication to continually improve patient care and safety. CHOC was named a 2016 Healthcare Information and Management Systems Society (HIMSS) Enterprise Davies Award recipient for achieving improvements in patient care through the use of health information technology.

Q: Why did you decide to become a pediatric otolaryngologist? 

A: I have always been interested in working with kids.  In medical school I enjoyed head and neck anatomy and surgical procedures which led me to an otolaryngology residency. My experience on the pediatric otolaryngology rotations confirmed my decision to focus on caring for children.

Q: If you weren’t a physician, what would you be and why?

A: I would either be a musician or a biomedical engineer. I grew up playing the violin, piano, and percussion and have always had a love for music. I would have wanted to be in percussion performance. As a biomedical engineer, I like to think of ways to apply engineering principles or biomaterials towards developing innovations to bring to patients.

Q: What are your hobbies/interests outside of work?

A: I love spending time with my wife and two daughters. I am thankful for their support and appreciative that my daughters make me laugh every day.  I also enjoy playing basketball and salsa dancing.