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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Kids and Tonsils

Tonsils_300WHEN SHOULD TONSILS BE REMOVED?
Tonsils are removed much less frequently than in the past, but removal may be necessary under specific circumstances. “There are two predominant reasons for removing tonsils and/or adenoids in children,” says Dr. Ahuja, CHOC Children’s Specialists Division Chief of Otolaryngology. “The primary reason is obstruction, or difficulty breathing, sleep-disordered breathing or sleep apnea. The second reason is recurring infection. Tonsils may need to be removed if a child has seven tonsillar infections in one year, or five infections each year for two years, or three infections each year for three or more years, with the infections being accompanied by one or more of the following features: a fever of 1010F or above, a strep throat infection confirmed on a swab from the throat, white coating on the tonsils, large lymph nodes in the or mouth sores.” Surgical removal of the tonsils is called a tonsillectomy. Surgery should be considered only when necessary, but in appropriate situations, it can make a substantial difference in the quality of life.

SIGNS OF TROUBLE
There are many signs that the tonsils are causing a child enough trouble to warrant removing them, says Dr. Ahuja. A child who has trouble breathing, breathes often through the mouth, snores heavily, sleeps poorly, wakes up tired and fussy, exhibits behavior problems like hyperactivity or aggressive behavior, or is significantly underweight because he is having a hard time eating and breathing at the same time may be a candidate for a tonsillectomy, often with adenoidectomy, says Dr. Ahuja.

WHAT ARE TONSILS AND ADENOIDS ANYWAY?
The tonsils are part of the body’s immune system. Specifically, they are two oval-shaped masses of tissue in the back of the throat that trap germs that could enter the body’s airway and cause an infection. Tonsils also produce antibodies to fight infection. Sometimes, they get infected and swollen, and lead to a condition common in kids called tonsillitis. The adenoids are small pads of lymphoid tissue like tonsils, located in the upper portion of the throat, behind the nose. They serve a similar purpose as the tonsils. “The majority of the time if we are removing the tonsils for obstruction or blockage, we remove the tonsils and adenoids,” says Dr. Ahuja.

FAST FACTS

  • Age range of children most commonly affected by tonsillitis: 3 -7
  • Number of tonsillectomy procedures performed annually in children younger than 15 in the U.S.: 530,000+
  • Percent of healthy children who have tonsils and adenoids removed due to obstruction who will show a marked improvement. The success rate falls for obese children, or children with certain birth disorders: 80

    View the full feature on Kids and Tonsils

    Dr. Gurpreet Ahuja
    Dr. Gurpreet Ahuja
    CHOC Children’s Specialists Otolaryngology
    (Ear, Nose and Throat)

    PHYSICIAN FOCUS: DR. GURPREET AHUJA

    Dr. Ahuja is the CHOC Children’s Specialists’ Division Chief of Otolaryngology, and past president of the medical staff at CHOC. He is a Clinical Professor of Otolaryngology at the University of California, Irvine, and Director of Pediatric Otolaryngology training for UCI’s residency program in Otolaryngology. He completed his residency in Otolaryngology/Head and Neck Surgery at the Manhattan Eye, Ear, and Throat Hospital in New York, followed by a fellowship in Pediatric Otolaryngology at the Children’s National Medical Center in Washington, D.C. Dr. Ahuja specializes in pediatric airway reconstruction, pediatric sinus surgery, childhood hearing loss and congenital head and neck disorders. Dr. Ahuja is actively involved in the Orange County community, serving on the Board of Directors of the OC Human Relations Council.

    Dr. Ahuja’s philosophy of care: “My philosophy is to treat every child as I would have my own child treated. It’s
    very important for me to engage the parents in the care of their child and to have them on board with what I am
    recommending so we have a consistent approach to treatment. I always make it a point to follow the standard of care with up-to-date information about the child’s medical condition. I also consider it important to educate the parents about the child’s condition.”

    EDUCATION:
    All India Institute of Medical Sciences, New Delhi, India

    BOARD CERTIFICATIONS:
    Otolaryngology

    More about Dr. Ahuja | CHOC Children’s Pediatric Specialties Otolaryngology

    This article was featured in the Orange County Register on April 14, 2014, and was written by Amy Bentley.

Tips for Tonsillectomy Recovery

_T2V0782More than 530,000 tonsillectomies are performed each year in children ages 15 and younger, but the common procedure does require some recovery time.

Children will typically have a sore throat for a week to 10 days following surgery, and they usually feel well enough to resume their normal activities after two weeks, says Dr. Gurpreet Ahuja, an ear, neck and throat specialist and the CHOC Children’s Specialists Division Chief of Otolaryngology.

Children who are otherwise healthy and not obese or underweight typically leave the hospital the same day as their surgery, and most children can return to school a week later, he says.

Dr. Ahuja noted there is a small risk for bleeding after surgery, so children recovering from a tonsillectomy should stay close to home as a precaution. If excessive bleeding occurs, parents should contact their surgeon or physician immediately or take the child to the nearest emergency department.

Here are some tips for parents of children recovering from surgery to remove the tonsils and adenoids:

  • Ensure your child is drinking lots of water and fluids. Proper hydration is important to help prevent fever, bleeding or infections.
  •  To soothe the throat, have the child drink lots of chilled fluids like water and Gatorade, and eat soft, cold foods after surgery such as Popsicles, smoothies and ice cream.
  •  Have the child eat soft foods that are easy to swallow, such as pasta, rice, noodles, bananas and yogurt.
  • For pain management, patients ages 10 and younger can take over-the-counter pain medications such as ibuprofen and acetaminophen. Children older than 10 tend to have a little more pain and discomfort and may need a prescription pain medication. Contact your physician to ask about prescriptions for pain if needed, and also if you have any questions or concerns about your child’s recovery.

Learn more about otolaryngology at CHOC Children’s.

Related articles:

  • 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. But thanks to a different technique offered by ...
  • Kids and Tonsils
    Tonsils are removed much less frequently than in the past, but removal may be necessary under specific circumstances. “There are two predominant reasons for removing tonsils and/or adenoids in children,” ...
  • Kids and Snoring
    “When you hear snoring coming from your child’s room, a condition called sleep apnea may be the reason. There are two types, central and obstructive. Central sleep apnea, typically, occurs ...