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.

jenna-underwent-painless-tonsillectomy

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.”

jenna-painless-tonsillectomy-preop
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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The dangers of loud noises and little ears: What parents should know

If ear buds or head phones are seemingly permanently attached to your child’s head, they might be at more risk for hearing loss than you’d expect.

A new study co-authored by Dr. Jay Bhatt, a CHOC Children’s otolaryngologist, finds that nearly a quarter of U.S. children are at risk for hearing loss from exposure to loud sounds.

dr-jay-bhatt-choc-childrens-ent
Dr. Jay Bhatt, CHOC Children’s otolaryngologist (ENT)

The study, published in a medical journal called “Laryngoscope,” also found several differences between boys and girls when it comes to exposure to loud noises: Though one in five children have been exposed to firearm noise, boys were much more likely to be than girls.

Further, despite less exposure to loud noises, girls were less likely than boys to wear hearing protection when exposed to loud sounds, Dr. Bhatt and his co-authors found. Overall, only 16 percent of children always used hearing protection in the last 12 months during explosive sound exposures.

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The study found that girls were less likely to wear hearing protection than boys.

This discrepancy underscores the importance of parents and healthcare providers educating both boys and girls of the dangers of exposure to loud noises, as well as the importance of wearing hearing protection, such as earplugs or ear muffs, Dr. Bhatt says.

The study also surmises that the frequency of children being exposed to loud noises is likely the cause of the noise-induced hearing loss noted in one in five adults ages 20 to 29. The study also found that up to 96% of parents perceived their children to be at no to minimal risk of hearing loss from excessive noise.

Here are some things parents can do to help protect their children’s hearing:

  • Teach children to turn the down the volume on devices and to take breaks from listening.
  • Model good listening habits yourself.
  • Use hearing protection. Bring earplugs or ear muffs to events with a potential for loud noise.
  • Keep children away from speakers or other large noise sources.
  • Leave an environment if your child complains about noise, ear pain or ear ringing; covers their ears; or seems uncomfortable, consider an early exit.

Here are some signs that your child may be suffering from hearing loss and should be evaluated by a specialist:

  • They have difficulty achieving academically, especially in reading and math
  • They are socially isolated and unhappy in school
  • They have persistent ear discomfort after exposure to loud noise
  • They show inattentiveness
  • They have buzzing or ringing in their ears
  • They don’t respond to spoken words
  • They have muffled hearing
  • They have frustration hearing speech and other sounds
  • They avoid conversation
  • They show signs of social isolation or depression
Explore otolaryngology (ENT) services at CHOC

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Cochlear Implants as a Journey to Hearing: Gracie’s Story

Since Kathleen had experienced a healthy pregnancy, she and her husband Mike were expecting a healthy baby girl.

“Out she popped, and everything was perfect,” Kathleen recalls. “When she failed her newborn screening test, we weren’t that concerned. We knew that babies could fail that test for a number of reasons, even if they have no hearing problems.”

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Baby Gracie

Two weeks later during a visit with her pediatrician, Gracie failed another hearing test. Her family was referred to Providence Speech and Hearing Center.

More testing provided a diagnosis: Gracie had severe to profound bilateral hearing loss. What hearing ability she did have would not be enough to allow her to speak and learn language.

“When I realized my daughter couldn’t even hear me tell her that I love her, I was a mess,” Kathleen recalls. “It felt like the world was falling apart in that moment.”

Gracie tried hearing aids, and although she was finally able to hear her parents say her name, the hearing aids were not enough to compensate for her hearing loss.

Since Kathleen is a special education teacher, she was already familiar with cochlear implants—surgically implanted devices that offer the hope of gaining the ability to sense sound.

“Deciding to pursue cochlear implants was a pretty easy decision,” says Mike. “We didn’t really give it a second thought. As a parent, you just want to give your kid every opportunity possible—especially the chance to hear.”

gracie-with-cochlear-implants-sign
Gracie was thrilled to get cochlear implants.

The cochlear implant artificially stimulates the inner ear area with electrical signals, which sends those signals to the auditory nerve, letting a person hear. The surgery is safest in most children around one year of age.

Meanwhile, Kathleen and Mike had been teaching sign language to Gracie and her older sister.

A few months after Gracie’s first birthday, she underwent bilateral cochlear implantation surgery at CHOC Children’s Hospital with pediatric otolaryngologist (ENT) Dr. Nguyen Pham.

gracie-cochlear-implant-surgery-day
Gracie was excited and happy the day of her cochlear implant surgery.

“When I first met Dr. Pham, I felt like I had known him forever,” Kathleen says. “He answered every single question we had and was honest with us throughout the process.”

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Gracie’s parents were thrilled that her bilateral cochlear implant surgery went perfectly.

Kathleen knew the benefits for Gracie outweighed the potential complications that come with surgery, but as a parent, she was naturally worried about her child’s well-being.

“Every time I saw Dr. Pham I was frantic, and he was always so calming. It was nice to have that reassurance,” Kathleen says. “Dr. Pham is a miracle worker.”

Surgery went perfectly, and Gracie spent just one night in the hospital. A few weeks later it was time to officially activate her cochlear implants.

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Gracie was all smiles on activation day for her cochlear implants.

Even though Kathleen had faith the cochlear implants would work, but she was still anxious for activation day.

“Activation day was amazing and terrifying at the same time,” she recalls. “Everyone said not to worry, but I thought it might be too good to be true. I just kept thinking, ‘How could this little device be the thing that allows my baby to hear?’”

As soon as the cochlear implants were activated, Gracie’s face lit up and she pointed to her ears. Her parents let out a sigh of relief. When they took her home, they found the most joy in the small, mundane sounds around their house. Gracie could finally hear the front door open, the dog bark, and most importantly—her parents say I love you.

Before a child with cochlear implants will begin talking, they need time to get comfortable wearing their implants and undergo speech therapy. For Gracie, that time was just a few weeks. She still undergoes speech therapy twice per week, once at Providence Speech and Hearing Center and once at home.

To say Gracie is thriving is an understatement, according to Kathleen. Not only does Gracie talk and sing non-stop with her big sister Tess, but she mastered her ABC’s just shy of her second birthday. Her language skills now exceed most normal hearing children. Gracie loves going to Disneyland, and her family appreciates any opportunity to spread education about cochlear implants to inquisitive people they meet.

gracie-with-cochlear-implants-pumpkin-patch
At Disneyland and other places, Gracie’s family appreciates any opportunity to spread education about cochlear implants to inquisitive people they meet.

Gracie’s family has much to celebrate this year, but there’s something a few years down the road that Kathleen is most excited for.

“I am excited for her to go to kindergarten at a typical school. You have all these visions of your kids growing up, and for me to just drop my daughters off at one school is a big thing.”

Meet the cochlear implant team

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  • Music to a Little Girl’s Ears
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Music to a Little Girl’s Ears

Penelope Grand had normal hearing from the day she was born. She loved to dance to music and she was easily woken by noises. Her parents, Luci and Paul, anxiously awaited her first word. Then, when she was about 10 months old, something changed.

“We really knew there was something wrong when I went to get her out of her crib after her nap one day,” mom Luci says. “She was calling out and fussing, she wanted out of there, and I came into the room but she wasn’t facing the door. I stood right in front of her crib and I called out her name, I clapped, but I got no response from her.”

Genetics are the cause of roughly half the cases of prelingual deafness, even when symptoms don’t appear at birth, as in Penelope’s case. Hearing tests and an auditory brainstem response (ABR) test revealed that Penelope had developed profound hearing loss in both ears. She had become essentially deaf.

“We were devastated,” Luci says. “I was preparing to hear ‘mild to moderate,’ not ‘profound.’ The air sucked out of my lungs. I wondered why. She is so sweet and loving, why did she have to lose her hearing?”

cochlear implant

Penelope’s audiologist prescribed hearing aids, but she had no benefit from them. That made her an ideal candidate for a cochlear implant, a new treatment offered at CHOC Children’s in close partnership with Providence Speech and Hearing Center. A cochlear implant is a small electronic device that is surgically implanted under the skin behind the ear, and has an electrode that extends into the cochlea in the inner ear. The implant’s electrode directly stimulates the cochlear nerves that perceive sound.

Dr. Nguyen Pham, CHOC pediatric otolaryngologist and head and neck surgeon, performed two outpatient surgeries on Penelope to place a cochlear implant on each of her ears.

“A cochlear implant can be life-changing for a child,” Dr. Pham says. “Children who would have been in the deaf community are now joining the hearing community because of cochlear implants. It is essentially restoring nearly normal hearing in these children.”

A Sense of Sound Restored

Oct. 13, 2015, was a memorable day for the Grands. That’s the day Penelope’s cochlear implant was activated, amidst her family and a crowd of supporters from CHOC and Providence.

Penelope begins to hear at 0:06.

“The first moment we knew she could hear was, well, it’s hard to describe what that felt like: joy, pride, happiness, excitement,” Luci says. “The look on her face was beautiful. We must have rewatched that video a hundred times.”

A cochlear implant does not translate sound perfectly. Those who wear an implant hear sounds with a robotic, mechanical quality. Following the implant’s activation, Penelope’s team of audiologists at Providence fine-tuned the frequencies of the electrodes—a process called mapping—until they produced the optimal sounds for her ears.

Now, she is undergoing comprehensive speech and language therapy, a crucial step in helping her interpret the sounds she hears and learn to communicate. She also uses American Sign Language.

“We are in awe of her, how much she’s already progressed,” Luci says. “She responds to her name now when we call out to her. She finally said her first word, bye bye, and she can now say mom. She has begun to dance again. She also has started singing in the car with me along to the music. We realized that she is so smart and so very happy, and her potential is endless. We are happy and grateful every day that she had this opportunity.”

Learn more about the CHOC Children’s Cochlear Implant Program.

 The Cochlear Implant Program is generously supported by Wildcard Army, in memory of Nixon Wildcard Hunter. 

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Infantile hemangiomas

hemangiomasInfantile hemangiomas are the most common of benign tumors in children, and most often occur in the head or neck area, a CHOC Children’s otolaryngologist says.

Because of their location, these masses can cause trouble breathing, swallowing or speaking, and in some cases can be life-threatening if they cause an airway obstruction, Dr. Kevin Huoh says.

Infantile hemangiomas are more likely to occur in babies born under certain circumstances:

  • a premature birth
  • being born from a multiple pregnancy
  • birth as a result of in vitro fertilization
  • being Caucasian and female

Parents of children with a head or neck mass should talk to their pediatrician and request a referral to an otolaryngologist, which is also known as an ear, nose and throat doctor.

“If there is any persistent mass or growth on the head or neck that doesn’t go away, we would really advise parents to have their child evaluated by a pediatric head and neck specialist,” Dr. Huoh says. “Neck masses are common in children, and they can pop up at any time.”

CHOC’s hemangioma clinic treats young patients with various vascular anomalies. A team of experts including otolaryngologists, plastic surgeons, cardiologists, hematologists, laser surgeons and interventional radiologists work together to help these patients.

Learn more about otolaryngology services at CHOC.

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