Ep. 285 Post-Operative Care & Complications in Coblation Intracapsular Tonsillectomy in Children with Dr. Kevin Huoh and Dr. Stephen Chorney

Most surgeons trained learning extracapsular tonsillectomies. What does the evidence say about intracapsular tonsillectomies? Two pediatric otolaryngologists explain why they made the switch and never looked back. On this episode of the BackTable ENT Podcast, hosts Dr. Ashley Agan and Dr. Gopi Shah sit down with pediatric otolaryngologists Dr. Stephen Chorney from UT Southwestern and Children's Health Dallas and Dr. Kevin Huoh from Children's of Orange County to examine post-operative complications after tonsillectomy and adenoidectomy, with a focus on coblation intracapsular tonsillectomy. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Smith + Nephew https://www.smith-nephew.com/en/ --- Timestamps 00:00 - Introduction 02:53 - Why Switch Techniques? 07:58 - Risk Stratification and Patient Selection 11:04 - Respiratory Complications and Management 15:57 - Preop Screening 21:35 - Risks for Post-op Bleeding and Counseling 26:16 - Managing Post-op Bleeding 31:56 - Surgical Tips to Prevent Bleeds and Management 39:30 - Intracapsular Tonsillectomy in Older Kids 43:44 - Post Op Pain Plan and Return To School 48:33 - Use of Toradol & Readmission for Pain and Dehydration 53:16 - Caution of Burn and Stenosis Injuries 61:01 - Final Takeaways --- More about this episode Dr. Chorney and Dr. Huoh share why they each committed fully to the intracapsular technique and what that shift has meant in practice, from secondary hemorrhage rates hovering around 0.5–0.6% to fewer nursing line calls, readmissions for pain and dehydration, and faster returns to school and normal activity. They walk through their approach to patient risk stratification and admission criteria (age <3, severe OSA/comorbidities, AHI >30/ICU consideration) as well as how to manage the most common post-operative respiratory complications. The conversation also covers practical guidance for handling outside-ER bleed calls, the role of nebulized TXA, toradol considerations, and managing dehydration. They also share for navigating intracapsular coblation in older children, strategies to reduce burn injuries, and a closer look at the rare but serious risk of pharyngeal stenosis. Check out this episode to hear Dr. Chorney and Dr. Huoh discuss how intracapsular tonsillectomy doesn't just improve outcomes but can transform the recovery experience for patients and their families. --- Resources Extracapsular vs Intracapsular Tonsillectomy: Outcomes in Children with a Focus on Developmental Delay https://pubmed.ncbi.nlm.nih.gov/34839135/ Current Status and Future Trends: Pediatric Intracapsular Tonsillectomy in the United States https://pubmed.ncbi.nlm.nih.gov/32969500/ Dr. Chorney Episode 259 - Understanding Coblation Tonsillectomy https://www.backtable.com/shows/ent/podcasts/259/understanding-coblation-tonsillectomy-benefits-outcomes-techniques Dr. Huoh Episode 110 - Intracapsular Tonsillectomy in Children https://www.backtable.com/shows/ent/podcasts/110/intracapsular-tonsillectomy-in-children --- BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app