Ear, Nose, and Throat (Otolaryngology)

Otolaryngology (ENT) Surgery Outcomes

Surgery is a big part of our comprehensive otolaryngology (pronounced oh/toe/lair/in/goll/oh/jee) care for kids. Selected as some of the “Best Doctors in America®,” our board-certified otolaryngologists at Nemours/Alfred I. duPont Hospital for Children are surgeons who specialize in evaluating and treating all kinds of pediatric disorders of the ears, nose, and throat (which is why they’re also called ENT doctors). We also take care of kids’ head and neck masses, airway abnormalities, hearing loss, and communication problems.

To help us gauge how we’re doing and identify areas where we need to make improvements, we keep track of our surgical outcomes (that is, the results of our care). Then, we compare ourselves to the outcomes at other children’s surgical programs across the country. And our results show that we’re delivering top-quality ENT care by treating all of the children we see as if they were our own.

What Does This Graph Mean?

Here’s how our 2010 ENT results for three key outcomes compare to other top children’s surgical programs nationwide:

• Unplanned return to the operating room (when kids had to have another surgery within 30 days because of problems following their previous operation): Far more children have to come back to the operating room elsewhere, on average, than here — 2.9% versus our rate of only 1.7%.
• Non-infectious postoperative occurrences (when a child has complications or problems that happen after surgery and may involve the heart, lungs, eating): The national average is exactly on par with our low rate of 1.42%.
• Wound occurrences (when a child has complications with the surgical wound, such as infections): On average, 1.13% of children’s surgical programs nationwide have problems with wounds after surgery, versus just 0.85% here.

One way we’re able to achieve such good ENT surgical outcomes is a new technique we use to remove enlarged or infected tonsils (those clumps of tissue on both sides of the throat). The method (called “intracapsular tonsillectomy”) involves taking out most of the tonsil tissue, while leaving a thin patch of tonsil to protect the underlying muscles. Studies show that kids who get this procedure have less pain and less bleeding after surgery — and they can get back to eating the foods they love sooner.

Another way we’re able to help prevent complications is by curbing bleeding after surgery (this is called, “postoperative bleeding”). We do our best to keep postoperative bleeding to a minimum because bleeding after the operation could mean a trip back to the operating room. And when there’s little or no bleeding, the recovery period goes more smoothly. (Read about our low bleeding rate after tonsillectomy below.)

Our Excellence in ENT Care

Our ENT physicians are highly-trained in the latest techniques for common procedures like tonsillectomies, adenoidectomies (removal of a mass of tissue in the passage connecting the back of the nasal cavity to the throat), and myringotomies with tube placement (removal of the fluid from the middle ear and insertion of tubes). But we’re also skilled in the medical and surgical management of airway and voice disorders, sinus disease, as well as masses and tumors of the head and neck.

Our surgeons work with other specialists to try to combine one or more surgeries a child may need during one hospitalization, in order to reduce the number of times your child needs to go to the operating room and receive anesthesia. For example, a child who needs plastic surgery for a cleft lip and palate may also need to get ear tubes at the same time. Whatever kind of operation your child needs, every member of our ENT care team is dedicated to ensuring your child’s health, safety, and comfort — and reducing complications.

Nemours’ Low Bleeding Rates After Tonsillectomies
Much Better Than National Average

At Nemours, we have one of the largest ear, nose, and throat (“ENT” or “otolaryngology”) programs in the country. From 2006 through 2009, we saw nearly 82,000 ENT patients across all of our Nemours locations. So when you come to Nemours for your child’s ear, nose, or throat issue, you can expect top-level care from experienced, highly skilled physician specialists and health care professionals who not only know your child’s condition, but the best treatment options available for your child.

One of the most common operations in children is a tonsillectomy (when a doctor removes the tonsils — those clumps of tissue on both sides of the throat that help fight infections). Often, adenoids (a mass of tissue in the passage connecting the back of the nasal cavity to the throat) are taken out at the same time as the tonsils. When these operations are done together it’s called a “T&A,” for short. One of the ways we deliver top-quality care is by keeping bleeding rates really low for children who need a tonsillectomy or T&A.

As a parent, bleeding is probably something you hadn’t even thought about if your child needs a tonsillectomy. To our ENT surgeons, preventing and minimizing bleeding after surgery (called “postoperative bleeding”) is a top priority. Why? Because bleeding after the operation could mean a trip back to the operating room. When there’s little or no bleeding, the recovery period is smoother.

Every member of our care teams (from our doctors to our nurses) is dedicated to ensuring your child’s health, safety, and comfort while reducing complications.

Our Bleeding Rates Keep Going Down

At Nemours, we’re making huge strides in keeping the frequency of bleeding to a minimum. Based on the number of procedures we did in 2009, less than 1% (just 0.88%) needed intervention for bleeding. Considering the national average is 2%, we’re doing far better than many hospitals and surgical centers throughout the country performing tonsillectomies in kids.

How We Do It

Our bleeding rates at Nemours are so low because our ENT doctors are meticulous in the procedures they perform and in the care they provide. We’ve done the research and have both established the standards and adopted practices based on evidence about what works best for each patient. Our goal is to help kids who’ve just had a tonsillectomy recover with little or no complications.

Better outcomes, such as a significantly reduced bleeding rate, translate to an uninterrupted recovery period, more comfortable patients — and less worried parents. At Nemours, we treat the children we care for as if they were our own – whatever it takes.

Nemours Center for Pediatric Auditory Speech Sciences is participating in acoustic analyzing through software development to look at speech outcomes and ways to apply them. Typically speech outcomes are subjective, and they can’t be compared to other outcomes. With speech lab acoustic analysis, Drs. Linda Valeno and Tim Bunnell are utilizing tools to compare one patient to another or groups of patients to other groups in order to gain accurate feedback. This can be developed into a strong tool nationally.

Family-Friendly Resources from Nemours Kidshealth.org

Apnea

• Apnea (for Parents)

Chronic Ear Infections

• Middle Ear Infections (for Parents)
• Middle Ear Infections and Ear Tube Surgery (for Parents)

Developmental

• Auditory Processing Disorder (for Parents)
• Delayed Speech or Language Development (for Parents)

Ear Injuries/Damage

• Ear Injuries (for Parents)
• Ototoxicity (Ear Poisoning) (for Parents)

Hearing Impairment/Balance

• Going to the Audiologist (for Kids)
• Hearing Evaluation in Children (for Parents)
• Hearing Impairment (for Teens)
• Hearing Impairment: Kristin’s Story (for Teens)
• Helping Sam Hear: A Family’s Journal (a video for Parents)
• What’s Hearing Loss? (for Kids)
• ANSD 
• Cochlear Implants 

Tonsils/Adenoids

• Chronic Hoarseness
  
• Enlarged Adenoids (for Parents)
• Snoring (for Kids)
• Tonsils and Tonsillectomies (for Parents)

Parent Support Services

• Caring Bridge
• Nemours’ Family Advisory Council
• Ronald McDonald House of Delaware