Somehow, I always feel inadequate while on this topic. Even though a lot of my practice and expertise is focused on this, not having a child of my own leaves me at a disadvantage in fully understanding a parent’s perspective—their inhibitions, fear, and anxiety regarding pediatric surgical or interventional procedures. With all of this constantly at the back of my mind, I toe the line by arming myself with evidence-based science.
The training we undergo ensures that it is instilled in us that there is no space for emotion in medical practice. This doesn’t mean I have none; it only means treatment comes first, and patient welfare is the only thing that matters. It is of even more significance in pediatric practice because most of my patients cannot advocate for themselves. They are totally dependent on their caregivers, who have entrusted their care to me. This makes my job a little more challenging than dealing with adults, whose actions have consequences only on themselves and their own bodies. In pediatric practice, a parent’s reluctance, combined with my failure to reassure them, results in a child who cannot thrive to his or her full potential. In a country that has been economically struggling for seven decades post-independence, and with such a large population, every child who is unable to meet their full potential is a step back from our country’s overall development as well.
Every patient who walks into a doctor’s chamber is evaluated; there is never a sense of generalization or categorization. What must be understood is that there are a few common ailments that make up 80 to 90 percent of our practice, and sometimes, looking at a patient from afar can make us realize why they are here to see us. That comes with years of experience and seeing the same thing day in and day out. It is not about rushing to get the patient out of our chamber; it is about the efficiency of the practitioner. All children are special, and we do not want to jump to conclusions quickly, but as I said, what is evident on the face cannot be denied. The day we do not recognize a child who is struggling is the day we fail ourselves and our practice. Keeping all this in the back of our minds, we tread the line very carefully so as not to spook either party (parent or child). Then, we sit with them as they process their anxieties regarding the suggested treatment plans and reassure them why it is the need of the hour.
Sure, it is extremely frustrating to see a parent fail a child repeatedly by dragging them through every possible alternative “hackery,” which has no proven results and will ultimately delay what is necessary, allowing an ailment to cultivate in the young child’s body. Insanity is doing the same thing again and again, expecting different results. In these cases, it usually means giving the child insufficient treatment or choosing alternative therapies, which ultimately bring down the child’s overall immunity and make them more susceptible to future problems that could have been easily avoided with one basic procedure established as a gold-standard treatment option. All doctors are scientists of a kind because of the way we are trained. All of us want to believe in miracles, but unfortunately, we see the pitfalls of such “miraculous cures” in our practices day in and day out. This makes us skeptics, but also true believers in evidence-based medicine. We conduct our own studies to lessen the load of medications on our patients in the most ethical way possible on a day-to-day basis.
So, when a surgical or interventional treatment option is advised for a child, what the parent must understand is that the doctor’s back is also pressed against a very rigid wall. We do not want to operate, but we also understand that alternatives are not possible.
Surgery is offered as a treatment option only after exhausting all medical lines of management, while also taking into account the side effects of over-medicating a developing body and nervous system.
We believe you when you tell us that your child does better on medications; we are not ignoring you, nor do we want to push unnecessary procedures onto you. What we also understand is the mechanism of those medications, and believe me when I tell you, everything we put into our bodies leaves a trace behind. It is only when we believe the benefit of a medication is outweighed by the harm it will definitely cause that we opt for a surgical solution.
Unfortunately, due to the vastness of our country, a lack of proper regulations at multiple levels, and sometimes a lack of enforcement of the regulations in place, there is blatant misinformation and hackery that goes around. Medical advancements are happening every day, and a responsible practitioner is always updating their knowledge and skill set to keep up and provide the most time-tested, science-backed treatment options for our patients. When we advise a surgical option for a child, we ensure we are taking every possible step to perform it in the safest way possible, causing the least amount of discomfort to either party. There is no place for favoritism or leniency in medical practice. Everybody is sacred; for most of us surgeons, that is our temple or religion.
Recently, I had the good fortune to travel to the UK, which has a strong medical fraternity that encompasses a wide umbrella under which most of the doctors from our country belong. The first thing I noticed—and kept noticing—was chronic adenoid facies in most of the adults and children alike, which baffled me. When I finally had a chance to speak to a colleague of mine who has been an ENT practitioner there for over a decade, I finally solved the mystery. Apparently, the cost of surgery, the high prevalence of allergies, and the challenges of understaffing in every specialty have made them adapt to a non-interventional line of management. Think of generations of tax-paying citizens unable to achieve proper facial symmetry due to this adaptation, and the burden on the family and the child in the future, which will entail multiple dental visits to correct something that could have been easily avoided.
What are the most commonly performed pediatric ENT procedures?
1. Adenoidectomy
Adenoids were removed blindly less than a decade ago to ensure an airway. Then along came an instrument called a coblator, which changed the entire way we perform the surgery. Now, it is done under direct visualization, ensuring we do not leave behind any tissue while also taking away the risk of post-operative bleeding. The instrument is literally magic—it melts and vacuums away the obstruction without charring the underlying areas. What a century to be a doctor, to get to see this beautiful transition and actively perform it.
Supporting Science: A state-of-the-art systematic review on advanced pediatric surgical techniques confirms that endoscopic-assisted coblation adenoidectomy significantly reduces intraoperative blood loss, postoperative pain, and residual tissue recurrence compared to traditional cold curettage, validating its status as a modern gold standard [1]. Furthermore, long-term pediatric follow-up trials demonstrate that timely surgical intervention for chronic adenoid hypertrophy allows the mandible to autorotate back into a normal growth pattern, reversing the development of “adenoid facies” and preventing long-term malocclusion [2,3].
2. Tonsillectomy
Tonsillectomy is perhaps one of the oldest surgical procedures. Earlier surgical removals of tonsils seem barbaric to today’s surgeons because the technique has come leaps and bounds, yet the inhibitions toward getting them removed have only amplified in recent times. This is thanks to the misinformation of quacks and old-timers who have no knowledge of recent advancements and no will to update themselves.
3. Myringotomy with Grommets
Imagine a child who is unable to hear properly—how is that child supposed to comprehend, retain, and reproduce what is being taught? When that is not happening, how will the child develop globally? Is that not an absolute waste of potential? Such a simple procedure, yet so rewarding.
Supporting Science: Recent clinical cohort data tracking pediatric developmental milestones shows that children suffering from chronic otitis media with effusion who undergo tympanostomy tube insertion show massive, immediate improvements in speech, language acquisition, and overall learning/school performance, particularly in children who are already at risk for developmental delays [4].
To every procedure that has been denied due to a lack of funds or parental fear, there is a child whose dreams are being crushed. To every quack and outdated surgeon out there spreading misinformation and causing fear-mongering in stressed-out parents, there are hundreds of surgical practitioners equipping themselves to beat the myths and improve one life at a time. The future of our country will be as bright as we make it.
Reference Index
[1] Coblator adenoidectomy in pediatric patients: a state-of-the-art review. (2024). PMC / International Journal of Pediatric Otorhinolaryngology. This systematic review of over 8,375 pediatric patients confirmed that controlled ablation (coblation) at low temperatures (60°C) minimizes surrounding tissue damage, substantially reduces postoperative pain, and leads to fewer bleeding complications compared to traditional curettage.
[2] Oral Breathing Effects on Malocclusions and Mandibular Posture: Complex Consequences on Dentofacial Development in Pediatric Orthodontics. (2025). MDPI Pediatrics. This study explores how upper airway obstructions (like adenoid hypertrophy) cause abnormal craniofacial development, Class II malocclusions, and “long-face” syndrome (adenoid facies), confirming that timely surgical intervention is critical to restoring nasal breathing and normal facial symmetry.
[3] Effects of adenoidectomy and changed mode of breathing on incisor and molar dentoalveolar heights and anterior face heights. Journal of Orofacial Orthopedics. Longitudinal data tracking children post-adenoidectomy showed that once nasal breathing was restored, vertical facial height ratios and dental occlusion normalized, preventing the need for complex, lifelong orthodontic corrections.
[4] Tympanostomy tube outcomes in children at-risk and not at-risk for developmental delays. International Journal of Pediatric Otorhinolaryngology. This cohort study showed that 89% of caregivers reported their child’s quality of life was “much better” post-grommet insertion, with dramatic improvements in language, comprehension, and school performance.
Parental anxiety can unintentionally delay essential pediatric ENT surgeries, affecting a child’s hearing, breathing, sleep, speech, and overall development. This blog explains why timely, evidence-based treatment is often the safest choice and dispels common myths surrounding pediatric ENT procedures.
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