Tonsils and Adenoids – PediaCast 128


  • Golf Cart Injuries
  • Tweens Staying Home
  • Delayed School Start Times
  • INTERVIEW: Dr. Nina Shapiro – Tonsils and Adenoids



Announcer 1: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Birdhouse Studio. It is Monday, June 16th, 2008 and this is PediaCast 128, "Tonsils and Adenoids".

And coming up a little bit later on in the show, I'm very pleased that we are able to be joined by Dr. Nina Shapiro. She's a pediatric ear, nose, and throat surgeon from Los Angeles, California and she's going to join us to talk a little bit about tonsils and adenoids, when do you take them out, what things can go wrong with them, what type of procedures are involved when ticking the mouth and when should you leave them in. So, that's all coming up a little bit later on in the show.

We also have some News Parents Can Use, like we usually do every week. And this week, what are we going to talk about in the news department? Golf cart, injuries, also tweens – that 11 to 13 age group – what about them staying at home? Is it safe and what sort of things should parent think about?

And then, also an interesting study that looked at delaying school start time, meaning, if you make the beginning of the school day a little bit later, do kids get better sleep, more sleep or do they do better in school that sort of thing. So we're going to talk about that as well.


So, lots of things coming your way. Before we get started with the news, I do want to mention, one of my goals would be to make the Show Notes a little bit more of a useful place. Right now, as it stands, the Show Notes,, it's a place where people can listen to the show; you can listen to the PediaCast player or to the individual entries in the blog. There's a link to listen to each show if you're not subscribed. Now, if you do have iTunes on your computer and you're listening at the Show Notes page, please make sure you also subscribe through iTunes because that helps with our numbers which helps with ranking and exposure and that sort of thing.

So, the Show Notes at, obviously, it's a place you can listen. It's a place to see what topics are discussed in each show and it's also a place to find the links that we talked about each week. But there's another function that the Show Note could serve, but they really aren't serving that function right now. And that is, support for one another as parents out there.

Now, I know a forum or bulletin board system would be better for that. And that likely will come in time. I've been talking about it sort on-and-off for a couple of years now. It's hard to believe we've been doing PediaCast almost two years. But I don't have the time or the energy to put forth a forum or bulletin board quite yet. But at least for starters, one thing that we could be doing is making comments on each show's content and that certainly is welcome in the Show Notes.

Now, why am I talking about this? Well, the reason is I get lots of emails and messages through the Contact page at the website with suggestions about topics we talk about, sort of like hints for other moms and dads. And, unfortunately, I just don't have time to get to all of those on the show. Now, obviously sometimes we do, but there are many, many more that we don't get to.

So, if you have an idea, a comment, an opinion, a suggestion, write about it on the blog at as a comment rather than sending it directly to me. Because, really, your voice is likely to be heard by many more people than if you only write to me, and then I don't have time to get that message out in the show.


Plus, with lots of listener participation there, the Show Notes can become a great resource for parental support. You can search by topic and since each show is topic-driven, then the comments will be lined up under that show. So, parents can use that as a resource as well.

Now, I'm hoping I'm making sense here with what I'm saying because we don't get a lot of comments to the blog. And I know there are thousands of you out there. I think that the Show Notes could become more than what they are with a little participation from the audience.

Now, having said that, if your comment and your writing in the Show Notes is only to change my mind about some topic or some opinion that I have, I want to warn you right now, it's not going to be so easy. I often get emails and notes through the Contact page from people trying to change a particular opinion that I have. Some reason examples of things that some of you disagree with is my pro-vaccine stands, my anti-homebirth opinion and my support of the cry-it-out technique for older babies.

Look folks, save your energy on that one. You're not going to change my opinion with an email or a comment no matter how well-worded it is and no matter how many so-called research articles that you cite.

Now, that's not to say your voice doesn't counts or that your opinion is invalid, I'm just saying if your true and honest objective is to change my mind, it's probably not going to happen. And the reason is, I've been doing this for a while now, folks – taking care of kids. Certainly long enough to have a good idea in my mind of what works and what doesn't work and a clear idea of what constitutes good research and what makes for bad research. And then, I see hundreds of kids in my office every week. I stay current by reading peer review journals and opinion pieces, so whining about my position on various topics is not likely going to work.


So, please, if your goal is to change my mind, save your breath. On the other hand, if you just want to share your opinion, you have ideas, suggestions, tips, that sort of thing; go for it because there's room for everyone at the blog, also which we also call the Show Notes. If that sort of thing catches on and we got lots of comments and an active community there, then there will be some forum boards in the future.

All right, so let's go ahead and get started. Don't forget if there is a topic that you would like us to talk about, it's easy to get a hold of us. Just go to, click on the Contact Link. You can also email or call the voice line at 347-404-5437 which spells KIDS, 347-404-KIDS.

It's been a while since we've taken questions from the Skype line, the voice line. And I believe next week, we're going to get to that. So if you phoned in a question, those ones are coming probably next week.

All right. Also, don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreements which you can find at

And with all that in mind, we will be back with News Parents Can Use right after the short break.



Dr. Mike Patrick: Our News Parents Can Use is brought to you in conjunction with the news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at

The popularity of golf carts has skyrocketed in the recent years, and unfortunately, so has the number of golf cart-related injuries. In fact, a new study conducted by researchers in the Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital found that the number of golf cart related injuries rose 132% during the 17-year-study period.

According to the report published in the July issue of the American Journal of Preventive Medicine, there were an estimated 148,000 golf cart-related injuries between 1990 and 2006, ranging from an estimated 5,770 cases in 1990 to approximately 13,411 cases in 2006.

As golf carts have become faster and more powerful, they are no longer limited to use on the golf course. In addition to their traditional role, golf carts are now routinely being used at sporting events, hospitals, airports, national parks, college campuses, business parks and military bases. While the study found that the majority of golf cart-related injuries, in fact more than 70 percent, took place at sports or recreational facilities, individuals injured in carts on the street had an increased risk of concussions and were more likely to require hospitalization than individuals injured in other locations.

While the most common cause of injury for all ages was falling or jumping from the cart, study co-author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital, and an associate professor of pediatrics at The Ohio State University College of Medicine explained, "Children are even more likely than adults to fall from the golf cart, and these falls are associated with higher rates of head and neck injuries and hospitalizations. Greater efforts are needed to prevent these injuries."


More than 30% of golf cart-related incidents involved children under the age of 16. "Because golf carts are not designed for children and the majority offer no child safety features, we recommend that children under the age of six not be transported in golf carts and that drivers be at least 16 years of age to operate the vehicle," said Tracy Mehan, another of the study's authors.

The report recommends that more effective safety features, such as improved passenger restraints and four-wheel brakes, in combination with training programs and safety policies would reduce the overall number of golf cart-related injuries. Following a few safety precautions, such as driving at a reasonable speed, wearing seat belts when they are available, braking slowly and considering the terrain and weather conditions can reduce the potential for injuries.

Facilities where golf carts are used can help prevent golf cart-related injuries by establishing safety policies, requiring driver's licenses and operator training and considering safety when designing the pathways that golf carts will be using.

Whether it be for two hours or an entire day, millions of tweens – children age 11 to 13 – will be left home alone this summer despite their parents concern that they may not have the knowledge and skills they need to stay safe at home. According to a report released by the University of Michigan, many parents worry that their stay-at-home tweens do not know how to safely use kitchen appliances, where to go to stay safe during a severe storm, or that they should not give out personal information online or over the phone. Yet, one in five parents polled say that they have left tweens home alone for an entire day.
 "There is no magic age at which a child can be left home alone. It typically depends on a parent's judgment about how mature that child is, and how ready they are to take on the responsibility," says Matthew Davis, director of the National Poll on Children's Health at CS Mott Children's Hospital in Michigan. "Regardless, when parents decide to leave their children home alone, there are several common at-home safety concerns they need to consider and address with kids ahead of time."

Parents who generally are more confident in their children's safety skills are more likely to leave them at home for more than an hour, finds the National Poll on Children's Health. Still, more than 25% of parents polled reveal that they had not talked a lot with their tweens about neighborhood, Internet or home safety before leaving them home alone.

The National Poll on Children's Health finds nearly two-thirds of parents left tweens home alone for one to two hours. One of out five parents have left tweens home alone for an entire day. Parents have more confidence in their tweens' ability to follow guidelines for gun and fire safety than for Internet or storm safety. Twenty-eight percent of parents whose tweens stay home alone lack confidence that their children would not give out personal information via the Internet. Similarly, 30% of parents lack confidence that their child would not give out personal information over the phone.

Before making the decision to leave children home alone, Davis recommends that parents review and discuss common safety questions and situations with tweens. "We were surprised to find the proportion of parents who are not very confident their children will follow safety guidelines, even though they are having their tweens stay home alone," says Davis. "This suggests that more parents need to have conversations with their kids about safety before they leave them home alone."

There are plenty of online resources for parents which focus on leaving kids home and we'll have a few of them for you in the Show Notes at These include child care awareness – is your child ready to stay at home? Internet safety, gun safety, thunder storm safety, and fire safety. So be sure to check those out.


High school students with a delayed school start time are more likely to take advantage of the extra time in bed, and less likely to report daytime sleepiness, according to a research abstract presented at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies.

The study focused on 259 high school students who completed the condensed School Sleep Habits Questionnaire. Prior to the delay, students reported sleeping a mean of 422 minutes or 7.03 hours per school night, with a mean bed-time of 10:52 p.m. and a mean wake-up time as 6:12 a.m.

According to the results, after a 40-minute delay in the school start time from 7:35 a.m. to 8:15 a.m., students slept significantly longer on school nights. Total sleep time on school nights increased 33 minutes, which was due mainly to a later rise time. These changes were consistent across all age groups. Students' bedtime on school nights was marginally later, and weekend night sleep time decreased slightly. More students reported "no problem" with sleepiness after the schedule changed.

"Following a 40-minute delay in start time, the students utilized 83% of the extra time for sleep. This increase in sleep time came as a result of being able to sleep in to 6:53 a.m. with little delay in their reported school night bedtime. This study demonstrates that students given the opportunity to sleep longer, will, rather than extend their wake activities on school nights," said Mary O'Malley, one of the study's authors.

So, how much sleep should teens get each night? Well, according to the American Academy of Sleep Medicine, nine hours is ideal. The group also recommends that adolescent should follow a consistent bedtime routine, establish a relaxing setting at bedtime, get a full night sleep every night, avoid caffeine and stimulant medication prior to bedtime. Do not stay up all hours of the night to finish homework and cram for an exam.


And if after-school activities are too time-consuming, cut back. Keep computers and TVs out of the bedroom. I'm going to repeat that one – Keep computers and TVs out of the bedroom. Do not go to bed hungry, but don't eat a big meal before bedtime either. Avoid any rigorous exercise within six hours of your bedtime. Make your bedroom quiet, dark and a little bit cool. And get up at the same time every morning.

And I'm going to add one of my own. Use a soft white noise in the background like a fan or a sleep machine.

Those who suspect that they might be suffering from a sleep disorder are encouraged to consult with their primary care physician or a sleep specialist.

I mentioned in the intro that the study also looked at if there was a difference in how well kids did at school if you backed up the start time. And as I'm reading through this, I realized it didn't actually address that. I think it's because when I was going over it for the show, I thought to myself, "Well, they should have address that." And then, in the intro, for some reason, in my brain the signals got crossed and I thought they did. But they didn't, but they should have. That would have been interesting.

OK, we're going to take a quick break and we will be back with our guest, Dr. Nina Shapiro, an ENT specialist – a pediatric ear, nose & throat specialist – in Los Angeles and she's going to talk about tonsils and adenoids. So, stay with us.


Dr. Mike Patrick: Today, we are joined by Dr. Nina Shapiro, a pediatric ear, nose, and throat specialist at the UCLA Medical Center. Dr. Shapiro is a graduate of Harvard Medical School and completed her surgical training at Beth Israel Hospital, the Massachusetts Eye & Ear Infirmary, the Great Ormond Street Hospital for Sick Children in London, and the Children's Hospital and Health Center, San Diego.


Dr. Shapiro's research interest include obstructive sleep disorders in children and post-transplantation lymphoproliferative disorders. She is a recipient of the Faculty Teaching Award for the UCLA Head & Neck Surgery Department and is proficient in laser endoscopic and open surgical procedures of the pediatric airway, including the tonsils, adenoids and sinuses.

She joins us today on PediaCast to talk about tonsil and adenoid surgery including indications for these procedures, ways to do them, benefits and complications. So, let's get right to it.

Welcome to the show, Dr. Shapiro.

Dr. Nina Shapiro: Thanks, Dr. Mike. Thanks for having me.

Dr. Mike Patrick: We really appreciate you stopping by. I think a good place to start would be just a discussion on what exactly are the tonsils and adenoids.

Dr. Nina Shapiro: OK. The tonsils sit at the back of the mouth and the adenoids are really like a third tonsil that sits behind the nose. They are lymph nodes actually. So they are the same type of tissue as when a child gets a cold and they have what we oftentimes called swollen glands in the neck. Those are actually swollen lymph nodes. So, the tonsils and the adenoids are the exact same type of tissue as lymph nodes tissue.

The only difference is that they're visible. You can actually see the tonsils in the back of the mouth and the adenoids, you don't usually see directly but those are sitting in the very back part of the nose, sort of up behind the roof of the mouth.

Dr. Mike Patrick: OK. And as lymphatic tissue or like lymph nodes, what is the job of the tonsils and adenoids?

Dr. Nina Shapiro: Well, it's a very debatable area as far as what their job is. Oftentimes, what thought in the past is that the tonsils and the adenoids are "first line of defense for infection". So, they would be thought to be a protective area to sort of collect bacteria and collect viruses and any sort of debris and prevent kids from getting sick elsewhere.


Nowadays, we're not really sure if they're actually there for any reason except that they are just part of the immune system and part of the lymph node systems. So, one camp is that they are sort of filters of bacteria and infection, and then the other thought is that they aren't necessarily servicing a direct purpose per se.

Dr. Mike Patrick: OK.

Dr. Nina Shapiro: But it's not really clear if they're there as our friends or they're there as our foes.

Dr. Mike Patrick: OK, great. Sure, sure.

I was going to bring this up a little bit later on but since we're sort of talking about this. Have there been any studies to your knowledge that look at people who have their tonsils out as children, and then as adults, do they have more sinus infections, ear infections, pneumonia? In other words, if they are acting as a first line of defense, if you took them out, you think in that group of people you would see more, I guess, deeper infections?

Dr. Nina Shapiro: Right. So what is looked at actually related to that first line of defense issue is children and then later in childhood. So there have been some studies looking at, for instance, children who have bad sinus disease or children who have asthma or chronic pneumonia, and then you remove their tonsils. So, would you be making these children more susceptible to chronic pneumonia or sinusitis or less? And, actually, what the study had found is that removing the tonsils and adenoids have relieved other areas of infections.

So for instance, if the child has chronic pneumonia or chronic sinusitis, tonsil and adenoid surgery actually reduces their incidence of other types of respiratory infection.


Dr. Mike Patrick: Sure.

Dr. Nina Shapiro: So an adult study hasn't really been looked at definitively to say that if an adult has had tonsil surgery 30 or 40 years ago, are they more susceptible? But, in sort of shorter term, it's been found that children who had their tonsils and adenoids out has fewer respiratory infection and complications.

Dr. Mike Patrick: It would be an interesting study, don't you think?

Dr. Nina Shapiro: Absolutely.

Dr. Mike Patrick: [Laughter]

So, what types of a problems then can develop with tonsils and adenoids?

Dr. Nina Shapiro: Well, what we're seeing nowadays is most commonly kids who have problems with their tonsils and adenoids is due to an obstruction. So what happens during childhood is that as the immune system develops, the tonsils and adenoids can enlarge. And if they enlarge out of proportion to the growth of the child's nose, nasal airway and their oral airway, like the back of their mouth, they can cause problems related to obstruction.

And so in that area, what we see primarily is tonsil problems would be, for instance, the childhood chronic nasal airway obstruction or a chronic stuffy nose, chronic mouth breathing – so children who have difficulty breathing through their nose – and then, also, more commonly, kids with snoring or progressing to actual sleep apnea or obstructive sleep apnea.

So when we were kids, or at least when I was a kid, the people were sort of known for tonsil problems where the kids who have strep throat or recurrent tonsillitis. And we're seeing less of that nowadays, I would say at least 80 to 90% of children who have tonsil problems, it's from an obstructive problems. So just that the tonsils become large. And the other 10 or 20% are the kids who have recurrent tonsillitis or recurrent strep throat.

Dr. Mike Patrick: And you think that's because we have better weapons in our arsenal to get rid of strep and to get rid of the carrier state?


Dr. Nina Shapiro: Yes. The antibiotics has improved and we just don't see a whole lot of the strep and sort of the virulent strep that was not safely treated years back. And also, the complications from strep were so high that if a child had one or two strep infections, oftentimes the whole family got their tonsils out.

Dr. Mike Patrick: Right. Because of rheumatic fever or something.

Dr. Nina Shapiro: Exactly.

Dr. Mike Patrick: Now, so let's focus in, then, on obstructive problems. I guess, of course, being a surgeon, the surgical options are what we going to talk about mostly. But what are some of the non-surgical treatments that you could try first for someone who had obstruction cause from enlarged tonsils or adenoids?

Dr. Nina Shapiro: So, there are some non-surgical options for a child, let's say, if they have enlarged tonsils and adenoids. And a lot of that just really depends because of the obstruction. The obstructions is on a spectrum. So if a child has a little bit of snoring, a little bit of mouth wheezing, for instance, it becomes worse in the winter time and it becomes worst with respiratory tract infection, often times we can observe those children and see if they will grow out of it and if their growth will develop and their tonsils and adenoids may shrink down spontaneously. Certainly, observation is an option if their symptoms are not severe.

Other possible option would be, if the child may have a history of environmental allergy, perhaps an allergy evaluation and allergy therapy. It wouldn't necessarily shrink the tonsils and adenoids but it may shrink the tissue around the tonsils and adenoids and reduce their symptoms. So allergy intervention is another possibility. Something as simple as using saline in the nasal cavities at night, sort of as a little irrigation sometimes reduces some of the mucus that develops from enlarged tonsils and adenoids. And that may temporarily relieve the symptoms.

Dr. Mike Patrick: Yeah. How can you tell whether it's really a problem or not? Because a lot of kids snore. What point is the snoring an issue or not an issue?


Dr. Nina Shapiro: Right. Actually, most children – that's a good point – most children do have some degree of snoring, about 80 to 90% of children. If you ask a parent, "Does your child snore?" "Yes, my child snores sometimes."

But the issue is really, again, on that spectrum whether the child has developed some problems due to snoring. And often times, it's really just a parent history and a lot of what we're doing in our field is trying to make parents more aware of even knowing to look for this, because snoring again is not considered an abnormal problem. However if it's anything more than just a little bit of noise, it is potentially an abnormality.

So, we often times try to elicit a history from the parents. Does your child seem to be uncomfortable at night? Do they have restless sleep? Do they mouth breathe? Do they have sort of unusual breathing pattern? Do they have gas pain? Do you stand over their bedside hoping that they'll take another breath for each period of apnea that they have? Are they tired in the morning? Do they seem sort of unrested? So, those are sort of what we like to look for as far as the history go.

Dr. Mike Patrick: Do you subscribe to doing a sleep study to see if their oxygen saturations drop down at night time when they have these episodes? Or do you just go on history alone?

Dr. Nina Shapiro: We do. It's a little bit of a combination. The gold standard for evaluation for tonsil and adenoid problems causing sleep apnea is a sleep study. So, it is still considered the gold standard. It's not practical from a logistic and a physical standpoint to get a sleep study on every child, because often times, the history and the exam are consistent enough to confirm obstructive breathing from tonsils.

Dr. Mike Patrick: Sure.

Dr. Nina Shapiro: But we do sometimes do sleep study. The groups would be, for instance, the child were, well, the exam is slightly abnormal, the history is lightly concerning but we're really not quite sure what's going on. And getting a sleep study will certainly help piece out the problem and push us in one direction or another as far as the severity of the child's breathing – whether they are desaturating, whether they are having sleep apnea which is often times is not so easy to pick up just by observing the child.


The problem with pediatric sleep studies is most children, even if they do have obstructive sleep apnea, do not desaturate. And a lot of it then sort of turns towards the quality of life of the child and the quality of sleep, again, just that the parents and the child are experiencing.

Dr. Mike Patrick: Sure. So let's say you decide to take out the tonsils and/ or adenoid because of obstructive symptoms. So what options are available in terms of doing that type of surgery?

Dr. Nina Shapiro: Well, there are several different options for the surgical techniques, sort of the original standard, older style back to several years BC was using.

Dr. Mike Patrick: [Laughter]

Dr. Nina Shapiro: It's an old operation. Using what's called cold steel. It sounds horrible when you say it, a cold knife tonsillectomy. I mean, it's quite a difficult picture.

Dr. Mike Patrick: Not something you really want to…


Dr. Nina Shapiro: But that is sort of the standard technique that was used for many years, a cold knife tonsillectomy. Then, the electrocautery or the Bovie is another term for it. It became more commonly used in the 60s, 70s and 80s.

And after that there were sort of the laser fad. And that really came and went and everyone wants a laser surgery because for some reason, a laser is equivalent to no surgery or very non-invasive sort of rocket science surgery. And there are many problems with the lasers. There can be laser fire; there can be a burn from a laser. There could be irreversible scar tissues. So the laser tonsillectomy really came and went.


And now, what we're using is something called the coblator or coblation. And the way coblation works is it's actually a much colder temperature than an eletrocautery, much colder temperature than a laser. And it removes the tissue, but at the same time it's irrigating with the cold saline, it's cooling the tissue and it's a much more superficial tissue touch than the prior techniques. And, at the same time, your result is the same because you're removing the whole tonsil; you're removing the adenoids without that sort of deep burn and risk of scarring that you see with these older techniques.

Dr. Mike Patrick: Sure. We have some folks in the audience who are little bit deeper into the science aspect of things and really like to know how things work. So, I did a little research on this and it's really pretty interesting, isn't it?

Dr. Nina Shapiro: It is, yeah.

Dr. Mike Patrick: You want to talk a little bit about exactly what happens?

Dr. Nina Shapiro: With the coblator?

Dr. Mike Patrick: Yeah, yeah.

Dr. Nina Shapiro: So, the way it works, it's actually really a neat little instrument. And I show it to the kids sometimes when they come in to the operating room because they often like to see how this work and how this works. And what's nice about it also is it's just one wand that we use and in that wand, it has a suction port, it has an irrigation port and it also has a little tiny screen which consist of three little wires that act as the energy source.

And the way that the energy works is that it has to be done through saline. You can't just touch the pedal of the instrument and it will work. It needs to work through saline and the energy that's created, it's an electrical apparatus, but the way that the energy is created is that it breaks down the sodium chloride bond in the saline. So it has to be done in a saline solution, not even water and the energy that's created from that bonds breakdown causes the energy to cut through the tissue.


Dr. Mike Patrick: That's really cool.

Dr. Nina Shapiro: Really cool.

Dr. Mike Patrick: And I didn't realize this. In looking it up, it actually makes plasma which is that state of matter other than liquid, solid, and gas.

Dr. Nina Shapiro: Right. That's true.

Dr. Mike Patrick: Yeah.

Dr. Nina Shapiro: You can actually see, when you're doing that procedure, you can see that it's not really as direct a contact with the tissue as an electrocautery, because it's that plasma layer that's causing the heat, that's actually developed the heat source. You can sometimes see this little orange glow at the tip of the wand that it's actually the energy that's cutting through the tissue.

So, it's almost like a little layer without a direct touch that's creating the heat source.

Dr. Mike Patrick: Now, what are the benefits of this compared to – obviously, it's a lower temperature, so there's less risk for burning surrounding tissue. Does it take less time in the OR or about the same?

Dr. Nina Shapiro: Actually, I did a little study looking at a time issue specifically and comparing a coblation tonsillectomy to a cold knife tonsillectomy, and there was a significant reduction in surgical time.

Now, this tonsil surgery is a very quick procedure to begin with. So, we're talking about a difference of 20 minutes down to about 10 minutes. So, it's quicker, quicker, but it is a much quicker surgery. From the surgeon standpoint, we only use one instrument. So it's very nice sort of slick procedure to do.

But really what matter is the benefit to the patient. And, again, whether it's 10-minute surgery or 20-minute surgery, it's significant to a surgeon. But as for a patient, it's really not that significant. What we found is there have been several studies looking at the recovery because that's really what matters for a tonsillectomy. Tonsillectomy these days are, the majority are done as outpatients. The anesthesia is so good now that there's minimal recovery from anesthesia. Kids usually go home about an hour after surgery and that's really not too different from one technique to the other.


What really matters is during the week or so after the surgery, what happens? And that's really what has been found to be a significant benefit of coblation versus other techniques. It really cuts the recovery by about – it's about a third of days, about 2 1/2 days for recovery from a coblation tonsillectomy on average as opposed to 7 to 10 days for the traditional techniques, with significant discomfort, pain medicine, not being able to get back to activities, bad sore throat, not being able to eat. So that's really one of the main benefits of coblation, is that the recovery is so much faster.

Dr. Mike Patrick: And then fewer complications I would assume, too.

Dr. Nina Shapiro: Right. It's really a few main complications of tonsillectomy; the most significant complications that we, as surgeons, and also the parents would worry about would be post-operative bleeding. Because the surgery is done in the back of the mouth, if there's a little scab that falls off, it's not like your knee where you can just put a Band-Aid on it. If there's bleeding from the mouth, it's a more significant problem and there has been a lot less in the way of post-operative bleeding using a coblation technique as opposed to an electrocautery.

Dr. Mike Patrick: Sure. Now, how does a parent find a surgeon who would do this procedure? I guess they're going to rely on their primary care doctor who's referring but their primary care doctor may not know that there's this difference between techniques. So, is there a way that they can find out who does it this way and who doesn't?

Dr. Nina Shapiro: Well, frankly more and more surgeons are using this technique. But there is a website, it's, and that has a list of the surgeons by area who are doing coblation surgery. So that's one way of finding out.


And then, pediatricians, I think if they have a sort of regular referral to an ENT doctor, they usually over time get to hear about what techniques they're using. So the pediatricians that refer to me know, for instance, that I do coblation tonsillectomy. So, it's also just a matter of time before the pediatricians knowing and learning a little bit more about coblation, as well. But again, there's always the website that parents can look at. And on that website, there's a lot of information about tonsils, how the surgery works, what the tonsils are for, a little bit of the instrument itself. So, it's also very informative website about tonsils in general.

Dr. Mike Patrick: And you said that's

Dr. Nina Shapiro: Correct.

Dr. Mike Patrick: Yeah, and we'll put a link to that in the Show Notes, too. And we also have a lot of pediatricians and family practice doctors in the audience as well. So I guess I would encourage them whoever it is that you typically refer to give them a call and ask them how they do their tonsillectomy.

Dr. Nina Shapiro: Right, right. It's again one of the most common procedures that ENTs do. And it's one of the most common procedures in this country that's done in children. So, it's not something – if an ENT is doing tonsillectomy, that's not something that's done once every month or so. It's something that we do quite regularly. And so, whatever technique a particular surgeon uses is something that's good for the pediatricians to know.


Dr. Mike Patrick: Right. And if you're in an area where none of the doctors are doing coblation, then you probably don't want a doctor whose only done a couple of them anyway.

Dr. Nina Shapiro: Correct.

Dr. Mike Patrick: Then, it's better to do the older fashion way.


Dr. Nina Shapiro: Right. Or to find someone. You know, I've had patients travel a little bit because I was the coblation lady for a while.

Dr. Mike Patrick: Right, right, right.

Dr. Nina Shapiro: Now, it has become more popular. But some people would come from quite a distance for the technique and I was sort of the surgeon behind the technique.

Dr. Mike Patrick: There you go. Well, thanks for stopping by. We really appreciate it.

Dr. Nina Shapiro: Sure, my pleasure.

Dr. Mike Patrick: And we'll have to have you back sometime, if you don't mind, because I want to talk about tongue-tied.

Dr. Mike Patrick: But that's a whole another discussion.

Dr. Nina Shapiro: Sure. Happy to.

Dr. Mike Patrick: All right. Well, thanks a lot.

Dr. Nina Shapiro: Take care.

Dr. Mike Patrick: Bye-bye.


Dr. Mike Patrick: All right, a big thanks goes out to Nationwide Children's Hospital for providing the bandwidth for our show today; also, Vlad over at – he helps out with the artwork – Medical News Today, Dr. Nina Shapiro for stopping by and lending her expertise on the topic of tonsils and adenoids.

Thanks to my family for allowing me to do this crazy project. And, of course, thanks to listeners like you because you really make the show.

The PediaScribe blog, that's Karen's, my wife's blog on parenting. I'm highlighting the post "Who Wants To See The Inside Of My Cat?" It deals with a little incident we had a couple years ago involving our cat, sewing needle and an X-Ray machine. That's all I'm going to tell you. So be sure to check that out at You can also find the link to that particular post at the blog Show Notes.

Also, while you're at it, swing by "All that in A Bagga Chips". It is my daughter's brand new blog at, and welcome her to the world of responsible teenage blogging.

See, shameful family plugs here, folks. But, you know what; my family lets me do the show, so we got to give back a little. So the shameless family plugs, it's worth it.




Dr. Mike Patrick: Don't forget the PediaCast shop is open if you'd like to get a t-shirt. We don't make any extra money on those t-shirts, just helps us spread the word around and you can find that at There's a link.

iTunes review, if you haven't done that, please do. We're almost to 300. The last I looked I think we had about 289 reviews. The vast majority of them five-star reviews. I just cannot thank you guys enough for doing that. And if you have not taken time out, really, it literally takes like 60 seconds to write a review on iTunes, as long as you have it installed and you have an account. So, again, please do that if you haven't and let's try to hit 300 here soon.

There's a poster page if you'd like to download a PDF, print it out, hang it up on bulletin boards, just spread the word about the show. And the Listener's Survey at also helps us out with the demographics and advertising and that sort of thing.

And, as I was mentioning in the intro, if you have a comment about a topic or suggestion, an idea, any of those kind of things that you think would help other parents out, please comment in the Show Notes directly under the show that pertains to your comment. And then, hopefully we can start helping each other out that way too by providing a community for moms and dads. And as I said if that catches on, then we'll try a forum in the future.

All right, well, I hope everyone has a great week. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids.

So long, everybody!


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