Goodbye Popsicles and pain killers: How painless tonsillectomies are changing CHOC patients’ recoveries

After hearing her mother’s stories of the aftermath of her teenage tonsillectomy, Jenna Opp was a little worried before undergoing the procedure herself.

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But thanks to a different technique offered by CHOC Children’s otolaryngologists, Jenna drank a smoothie right after the procedure, and by that night, she enjoyed eggs and French toast for dinner. Only two days later she was back in school and ready for a hamburger.

“I was expecting a lot more pain and not being able to talk and all those typical things,” the 18-year-old says. “But I was totally fine. I could eat and drink. I talked to my mom while I was still in the recovery room.”

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Jenna, before her painless tonsillectomy

Jenna underwent a procedure called an intracapsular tonsillectomy, wherein CHOC otolaryngologist Dr. Nguyen Pham deftly shaved away at her tonsil, leaving a small portion behind.

In contrast, a traditional total tonsillectomy removes the entire organ, increasing bleeding risk and exposing muscle behind the tonsil, which increases pain.

In addition to decreasing the risk of post-operative bleeds, which can be fatal, the intracapsular tonsillectomy technique has shown to dramatically lower hospital readmission rates due to pain and dehydration.

Further, patients like Jenna do not require opioid pain medication and are returning sooner to school and a regular diet, Dr. Pham says.

“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 days for recovery. I was like,  ‘I’m sold on that’ and it was awesome.”

Here are some frequently asked questions about intracapsular or painless tonsillectomies:

Q: Do the tonsils regrow?

A: The regrowth rate of intracapsular tonsillectomy at CHOC is 0.5 to 1%.

Q: Does an intracapsular tonsillectomy take longer than a traditional tonsillectomy?

A: No. The procedure takes the same amount of time – 30 to 45 minutes.

Q: Has this procedure been practiced in other places?

A: Intracapsular tonsillectomy is growing in popularity in the United States. Elsewhere in the world, such as in Sweden and France this procedure is already the preferred method of tonsil removal.

Q: Will a patient need pain medication after this procedure?

A: Usually children will require only over-the-counter pain medication for a few days after surgery. Some children do not require any pain medication.

Q: How old does a child have to be for intracapsular tonsillectomy?

A: There are no age restrictions for this procedure.

Learn more about tonsillectomies at CHOC.

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From patient to advocate: Trinity’s journey with cleft lip and palate

After a normal pregnancy and healthy delivery, Trinity was diagnosed at birth with cleft lip and palate, birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy.

Her parents, Krisha and Jason, didn’t know much about these conditions at the time. They were quickly referred to the CHOC Children’s Cleft and Craniofacial Program, which includes a team of multidisciplinary specialists including plastic surgeons, otolaryngologists (ear, nose and throat), dentists, and more. Krisha and Jason relied on their CHOC team for help, education and resources regarding their daughter’s diagnosis.

Trinity underwent her first in a long series of surgeries when she was just 10 weeks old. Although it’s been a decade since that day, her parents still remember waiting for Trinity to emerge from that first surgery.

“In that first surgery, minutes felt like hours,” says Krisha. “Having to give up your 10-week-old baby knowing that they’re going to look different when they come out—it was a scary situation.”

Although Krisha and Jason knew their little girl was in good hands at CHOC, they were understandably worried about her surgery. What helped was memories of Jason’s own experience as a CHOC patient when he was a child.

“It’s been over 30 years since I was a CHOC patient, but I still remember that CHOC took really good care of me,” he says. “Even then, I remember CHOC being a really neat place. It’s so family-oriented.”

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Trinity at CHOC Children’s Hospital, before a surgery.

Over the last ten years, Trinity has returned to CHOC for more surgeries, check-ups and other care. This has included surgeries to improve the appearance and function of her lip and palate, multiple ear tube procedures, and a palate expander. She’s also undergone multiple bone grafts where bone is taken from her hip and grafted into her mouth and gum line. She has had multiple ear tube procedures, a palate expanded etc. Future surgeries include jaw surgery, nasal surgery, orthodontia, and potentially additional lip and palate repairs.

“People assume that cleft lip and palate is just a cosmetic deformity, but it’s so much more than that,” Krisha says. “Trinity sees a wide variety of specialists, including a craniofacial plastic surgeon, a craniofacial orthodontist, an otolaryngologist (ENT), a speech pathologist, an audiologist, and more.”

Becoming part of her own care team

As Trinity has gotten older, she’s taken a more active role in her care—especially when interacting with Dr. Daniel Jaffurs, medical director of plastic surgery and craniofacial services at CHOC.

“Dr. Jaffurs acknowledges Trinity first when he walks in the room, before he speaks to us as parents. He explains everything on her terms, and then he will address us as parents.”

This confirms to Krisha that Dr. Jaffurs knows that Trinity is the most important person in the room and has helped foster the bond between doctor and patient.

“Dr. Jaffurs is my favorite doctor,” Trinity says. “He’s really nice. When I was little, I was afraid of doctors, but I’m not afraid anymore.”

A lifelong love of music

Children with cleft lip and palate often have trouble speaking clearly because the structure of their mouth and nasal cavity makes it hard to produce certain sounds. Although Trinity underwent speech therapy when she was younger to normalize her communication abilities, anytime she sang, it always came out clear. She also taught herself to play piano when she was just 8 years old.

“Whenever I have surgery and I don’t feel good right after, I put on music and then I start to feel like my normal self again,” Trinity says.

Always the performer, Trinity also participates in school musicals and dreams of being a professional musician someday.

A budding advocate

Trinity has become an advocate for other craniofacial patients.

“She’s always made her story known,” says Krisha. “She’s had situations in school where other kids ask questions about how she looks, and instead of getting mad, she brings in her baby book and says, ‘I’m going to tell you why I’m different.’”

Before performing a song at an annual picnic that brings together craniofacial patients and families, she gave an impromptu speech about confidence to the 400-person crowd.

“If someone makes fun of you because of how you look, get back up again and don’t let them bother you anymore,” she told the crowd. “You are special, and you were born exactly who you were supposed to be.”

This message was in line with what her parents have been telling her since she was born.

“I never wanted her to forget where she came from,” Krisha says. “Even though she was undergoing all these surgeries, I wanted her to know that she was beautiful and perfect the way she was born.”

Trinity continues to increase craniofacial awareness in her community. She often shares her story with her classmates and once even spoke to her school board about her surgeries.

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Trinity with her family.

Trinity and her family find value in connecting with other craniofacial families. Their decade-long relationship with CHOC’s craniofacial team has given them an inside look on how CHOC and the department have evolved.

“The craniofacial program at CHOC has grown so much in the past 10 years. It’s incredible to see what they can do,” says Krisha. “This program has changed our lives for the better.”

The importance of community support

Support from their community means the world to Trinity and her family.

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Trinity paints a picture frame in a playroom at CHOC Children’s while recovering from surgery.

“Donors have a big role. They help CHOC be up to date on everything,” says Jason. “CHOC is constantly evolving and in terms of the latest technology and procedures. It’s neat to see everybody coming together to make all this accessible for families like us.”

To Trinity’s family, CHOC is an essential part of the community.

“It changes families’ lives,” says Krisha. “It definitely does. It changed our lives.”

Trinity plans to keep on singing, inspiring others and returning to CHOC to continue her treatments.

“Hands down, CHOC makes everything better,” she says. “CHOC is the friend you never knew you had.”

Learn more about CHOC's Cleft and Craniofacial Program

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What Parents Can Do to Prevent Ear Infections

February is ear, nose and throat health month, and any parent whose child has had an ear infection knows how important this is.  Ear infections are common in babies and children, but they can be prevented by focusing on cold and flu prevention and family hygiene, a CHOC Children’s physician says.

Frequent hand-washing by all family members helps cut down on the spreading of germs, and it’s also important to discourage children from rubbing their hands on their faces or in their eyes, says Dr. Nguyen Pham, an ear, nose and throat speciali20130425_2730st.

“Try to do whatever you can to keep your child from getting a cold or the flu because they lead to ear infections,” says Dr. Pham. “It’s rare a child will get an ear infection without having a cold.”

If a family member has a bad cold or cough, limit contact between the sick person and others at home. Keep children away from people who are sick to the extent possible. If a child has a bad cold, keep him or her home from school or daycare so the other children won’t be exposed.

Also, parents should ensure their child gets the influenza, or flu, vaccine every year, Dr. Pham advises.

“You can also get the pneumococcal conjugate vaccine,” he says. “This vaccine can lead to a reduction in frequent ear infections in some children. Parents can ask their pediatrician about this option.”

According to the Centers for Disease Control and Prevention, studies have shown that vaccinated children get far fewer ear infections than children who aren’t vaccinated.

Other things parents can do to prevent ear infections include avoiding exposing babies and young children to cigarette smoke (studies have shown that babies who are around smokers have more ear infections), and never putting a baby down for a nap or for the night with a bottle.

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