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 CHOC 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, 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.”

Frequently asked questions about intracapsular or painless tonsillectomies

Do the tonsils regrow?

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

Does an intracapsular tonsillectomy take longer than a traditional tonsillectomy?

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

Has this procedure been practiced in other places?

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.

Will a patient need pain medication after this procedure?

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

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

There are no age restrictions for this procedure.

Learn more about tonsillectomies at CHOC.

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,” says Dr. Ahuja, CHOC 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.

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.

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.


  • 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 Otolaryngology
    (Ear, Nose and Throat)


    Dr. Ahuja is the CHOC 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.”

    All India Institute of Medical Sciences, New Delhi, India


    More about Dr. Ahuja | CHOC Pediatric Specialties Otolaryngology

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

Kids and Snoring

Child_sleepingLISTEN CLOSELY

“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 more in infants, but obstructive is the form that’s becoming of greater concern,” says Dr. Ahuja. “Studies suggest that while 10 to 12 percent of children may snore, as many as one to three percent may have obstructive sleep apnea,” he notes.


“Obstructive sleep apnea happens when there’s a blockage in the airway that can impact the child’s ability to exchange air,” says Dr. Ahuja. If you notice some of these symptoms, your child could be experiencing sleep apnea:

  • Thrashing or moving around in bed
  • Periods of choking or gasping for breath while asleep
  • Frequent nighttime awakenings
  • Mouth breathing
  • Excessive daytime sleepiness, irritability or hyperactivity
  • Behavioral issues or poor performance at school
  • Bed wetting (especially over the age of five)
  • Poor growth


“While snoring by itself doesn’t necessarily mean that the child has sleep apnea, it is definitely a  manifestation of sleep disordered breathing,” says Dr. Ahuja. “It is important to watch for other  symptoms and signs and to discuss it with your child’s pediatrician.” Sometimes, a sleep study is necessary to confirm the condition. Your pediatrician, or an  Otolaryngologist (ear-nose-and-throat specialist), can guide you.


Previously, the most frequent indication for removal of tonsils was throat infections. That is less frequently the case today, because of better antibiotic treatment and more stringent guidelines. However, tonsillectomy and adenoidectomy remain a critical, and usually the first, management option for children with sleep apnea and obstructive breathing. “In fact, nearly 80 percent of normal healthy children will show resolution of their sleep apnea and obstructive symptoms after removal of their tonsils and adenoids,” says Dr. Ahuja, “but the results are less gratifying in children who are obese or have other associated conditions or syndromes.” Treatment considerations also include advising overweight children to shed some pounds. “The accumulation of fat in the body can also lead to the narrowing of the available airway in the throat,” he explains.


  • The age range when obstructive sleep apnea is commonly found: 3-6 Years Old
  • The number of tonsillectomy and adenoidectomy surgeries performed annually in the U.S., in
    children 15 years and younger : 530,000
  • The percentage of sleep apnea cases that can be cured by removing the tonsils and adenoids: 80%

View the full feature on Kids and Snoring

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


Dr. Ahuja is the CHOC Specialists division chief of otolaryngology/head and neck surgery. He completed his residency at the Manhattan Eye, Ear and Throat Hospital, New York and a fellowship in pediatric otolaryngology at the Children’s National Medical Center, Washington, DC. He is director of pediatric otolaryngology training for the residency program at UC Irvine.

Dr. Ahuja’s philosophy of care: “My belief is that every child should be treated like my own. It’s my responsibility, as a surgeon to give them the best of care.”

All India Institute of Medical Sciences, New Delhi, India


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

This article was featured in the Orange County Register on November 12, 2013 and was written by Shaleek Wilson.