Fourth-Grader Recovers Quickly After New Tonsillectomy Procedure

When Hannah O'Donovan learned that daughter Maggie's tonsils, a pair of oval masses at the back of the throat, would have to come out, she prepared for the worst.

"My nephew had his out the year before at another hospital, and he was knocked out for two weeks," she says. "So I laid in the broth, the Jell-O, and all kinds of ice cream and sorbets."

But Maggie, 10, an active fourth-grader at St. Cecilia School in San Francisco, had her surgery around 1 p.m. on a Thursday afternoon, was discharged by 7 p.m., stayed in bed Friday and half of Saturday, and then was up and going by Sunday. Maggie's quick recovery was due to a new procedure called Coblation that uses radiofrequency energy with a saline solution to gradually break down the tonsils and adenoids. The adenoids, located at the base of the tongue, and the tonsils are part of the body's defense system against infection, but they can become infected themselves or just grow to be too large. During electrosurgery, which is the standard way of removing tonsils and adenoids, heat is generated to burn through the tissue, leaving damaged tissue behind. Coblation doesn't generate heat and reduces the usual two-week recovery period by half. UCSF Children's Hospital pediatric otolaryngologist Kristina Rosbe, a specialist in head and neck surgery, has a large practice of children with sleep-disordered breathing for which tonsillectomy is the first-line treatment. "Coblation has been shown in controlled clinical trials to reduce pain, and it allows patients to resume their normal lives more quickly," she says. The low complication rates - rare cases of dehydration or bleeding several days after surgery - are comparable to the rates for more traditional techniques. Rosbe has performed dozens of tonsillectomies using Coblation - removing adenoids, as well as tonsils - and she now uses it for about half of the tonsillectomies she performs, including all outpatient tonsillectomies. Because of the reduced recovery times, all doctors training to specialize in otolaryngology at UCSF are learning the procedure, along with standard techniques. Patients with multiple, complex medical problems or bleeding disorders may not be appropriate for Coblation. The availability of this technique comes at a good time because tonsillectomies are on the rise. Enlarged tonsils and adenoids are increasingly recognized as a significant cause of sleep disturbances in children. In fact, research indicates that children with sleep disturbances who receive tonsillectomies rest more easily. Sleeping better after tonsillectomy often leads to improved attention and learning in school. Enlarged tonsils can cause difficult breathing, including breathing interruptions called apnea. This breathing problem can result in poor-quality sleep and is the most common health issue leading to tonsillectomy. Maggie's tonsillectomy may have averted a breathing disturbance. She snored loudly, according to her mother, a nurse at UCSF Medical Center at Mount Zion. "I had concerns that she had apnea," Hannah says. "She hasn't snored since she had her tonsils out." After a period of unnecessary tonsil removal during the 1940s and 1950s, there was a backlash against performing tonsillectomies. But today's climbing tonsillectomy rates generally reflect the procedure's valuable role in treating nighttime breathing difficulties, Rosbe says. She recommends that all children be screened for snoring. If a child appears to have breathing problems at night, it may be due to other factors such as allergies or, more rarely, sleep apnea. UCSF offers sleep studies through the pediatric sleep lab. X-rays to check the size of adenoids also may be useful. "If the other causes are ruled out and if tonsils are enlarged, tonsillectomy may solve the problem," Rosbe says. Source: Sandra Burnett Photo by Elisabeth Fall Links: UCSF Children's Hospital