POST-OPERATIVE INSTRUCTIONS
ADENOIDECTOMY
DIET
A common side effect from the anesthesia is mild nausea and
vomiting. Until this resolves, the patient should have clear liquids in small amounts. After they are feeling better, they may advance to a regular diet.
ACTIVITY
Avoid strenuous activity for the first 24 hours; after that, the
patient may resume their normal activity.
FEVER/PAIN
Occasionally, a temperature may be present for the first few days
after surgery. If this happens I recommend taking Tylenol. If the
temperature continues for more than 48 hours, and is greater than 101.5, please call the office for instructions. For pain control, Tylenol should be used.
BLEEDING
Bleeding is an uncommon complication of this surgery. Any bright red blood measuring greater than 2 tablespoons should be reported to the office.
HEALING
Occasionally, the patient will have a blocked-up sensation in
their nose for up to 2 weeks while their adenoid bed is healing. If this continues beyond this time, please let us know.
FOLLOW UP
Your post-operative appointment should be made for approximately 2 weeks after your surgery. Please call the office if you have any questions or problems
POST-OPERATIVE INSTRUCTIONS
TONSILLECTOMY AND ADENOIDECTOMY
DIET
A common side effect from the anesthesia is mild nausea and
Vomiting. Until this resolves, the patient should have clear liquids in small amounts. After they are feeling better, they may advance to a regular diet. Not wanting to eat for the first several days is not unusual but ITIS VERY IMPORTANT TO DRINK PLENTY OF FLUIDS.
These fluids may be in any of the following forms: popsicles, tea, apple and grape juice, soups, jello, pudding, ice cream, milk shakes, custard, and so on. I suggest that you avoid highly seasoned, salted, or sharp foods such as potato chips or breadsticks. Also, avoid acidic foods such as oranges or tomatoes as they burn. However, beginning the first day, a patient may eat a diet as tolerated. After 2-3 days, it is important to keep the pharyngeal muscles in motion. To do this, I would suggest that the patient start chewing gum on the 2nd day through the 10th day after surgery. This usually decreases the muscle spasms of the pharyngeal muscles and will decrease the pain.
ACTIVITY
Avoid strenuous activity during the recovery period. Children do not
need to stay in the bed, but to remain relatively quiet for the first
couple of days. Their activity should be gradually increased over the
next several days. Children should not return until they have been
without a temperature for 24 hours and have adequate fluid intake.
They may go back to school as soon as 72 hours after the surgery,
but it is usually 5-7 days before they are ready to return to school.
NO PHYSICAL EDUCATION OR SPORTS FOR 2 FULL WEEKS!
Adults should avoid strenuous activity, exercise or heavy lifting for 2
Weeks and may return to work when they feel able. An ice pack
should be placed around the neck for the first 24 hours as this will help
decrease the swelling. Avoid strenuous activity for the first 24 hours;
after that, the patient may resume their normal activity.
FEVER/PAIN
Occasionally, a temperature may be present for the first few days
after surgery. If this happens I recommend taking Tylenol. If the
temperature continues for more than 48 hours, and is greater than 101.5, please call the office for instructions. DO NOT TAKE ASPIRIN OR ASPIRIN PRODUCTS AS THEY MAY CAUSE BLEEDING.
A sore throat may persist for up to 2 weeks. In children, the pain is usually easily controlled with Tylenol. A prescription for stronger medicine may be given in older children or adults. Usually in 5-7 days the pain is residing. However, on occasion, especially if the patient has not taken enough fluids, the pain may be increased or associated with earaches. These earaches are not usually related to an ear infection, but are related to the healing process of the tonsil. If pain is not controlled by the pain medicine you are given, please call the office.
BLEEDING
An uncommon complication of this type of surgery is bleeding. Blood streaks in the saliva may occur for the first 2 days. Bright blood, measuring more than 2 tablespoons SHOULD BE REPORTED TO THE OFFICE. It is usually easily controlled by having the patient rest quietly and by applying an ice collar to the neck. If the patient is old enough to gargle, ice water may be used to gargle and this may be helpful. Bleeding may occur at 7-10 days when the scabs are coming off the tonsils. This usually has happened when the patient has been involved in strenuous activity. This type of bleeding is rarely a problem and will stop with the above measures. Coughing or clearing the throat should be avoided as much as possible during the recovery period. Bleeding is an uncommon complication of this surgery. Any bright red blood measuring greater than 2 tablespoons should be reported to the office.
OTHER SYMPTOMS
Bad breath and an unpleasant taste are not unusual. The tongue is often coated and the tonsils may have a white appearance. This is part of the healing process and does not mean that they are infected. To decrease the bad breath and unpleasant taste, we recommend brushing your teeth several times a day, and you may use a warm salt water gargle, teaspoon of salt and a large glass of water.
FOLLOW UP
Your post-operative appointment should be made for approximately 2 weeks after your surgery. Please call the office if you have any questions or problems.
MYRINGOTOMY AND TUBES
WHAT DOES THE SURGERY INVOLVE?
A myringotomy is an opening that is surgically created in the eardrum to allow the removal of fluid and entrance of air into the middle ear. This is usually done when the ears are repeatedly infected and do not respond to antibiotics. The most common secondary cause is chronic fluid, which remains behind the eardrum for around 8-12 weeks in spite of adequate medical therapy. Occasionally, if the eardrum is retracted (sucked in), a tube will be placed in an effort to restore it back to normal position. The tube is placed after the hole in the eardrum is made in to prevent the opening from closing. Chronic ear problems can result from allergies, sinusitis, tonsil and adenoid enlargement, or infections.
WHAT IS THE PURPOSE OF TUBES?
The function of the ventilation tube is to allow the exchange of air between the middle ear and external environment. This, hopefully, will allow the return of normal middle ear function over a period of time. The tube takes over the function of the patient's own Eustachian tube. It allows drainage outward to relieve pressure should an ear infection occur. Its main advantage, however, is to prevent serious complications that occurred in the past, such as mastoid infections, disruption of hearing bones, hearing loss, or meningitis.
HOW LONG DOES THE TUBE STAY IN THE EAR?
The tube usually remains in the eardrum for eight to twelve months. It will occasionally come out in a few days or a few weeks if a severe ear infection occurs. It is very important that you see a physician within 24 hours if you notice any drainage from the ear which is indicative of an infection. This will lessen the chances of the tube falling out prematurely. When the tube comes out, the slit in the eardrum usually closes by itself. However, on rare occasions, it will not close spontaneously and may need to be closed surgically. You may not see the tube when it comes out because of its small size. Occasionally, if the tube stays in longer than 3 years, it will be necessary to have it removed surgically.
WILL TUBES BE NEEDED AGAIN?
Over 80% of the time only one set of tubes will be needed for the initial problem to resolve. However, on occasion, a tube will come out too early or after it comes out, the fluid reoccurs and persist necessitating a second set of tubes. When it does, this may be quite silent and, if left unattended, may result in a significant problem. This is why it is very important to have your child checked by their primary care physician every 4 to 6 months to make sure that the tubes are functioning properly. If it is necessary to replace the tubes, we usually remove the adenoids the second time this procedure is performed.
POST-OPERATIVE INSTRUCTIONS
DIET
Occasionally, there may be nausea and vomiting so we recommend starting with clear liquids an switching to a regular diet as tolerated.
PAIN
Generally, this procedure causes no pain, but Tylenol may be given as needed. The child may complain of a popping sensation in his ear until the Eustachian tube function returns to normal. Occasionally, a young child will continue to pull at his ears out of habit.
ACTIVITY
The child may resume his normal activity the evening of surgery.
EAR DRAINAG
This is not an emergency; however, the child should be checked within 24 hours to see if a medicine needs to be prescribed. Ear drainage for the first 2-3 days following surgery is not uncommon and need not be worried about. However, after 3 days, we ask that you notify us for advice as to what you should do. After the routine post-op visit, we recommend that you contact your primary care provider for this problem. Often the drainage may be bloody if there is an infection present, and this should be treated in the same manner as if there is pus draining from the ear.
EAR PROTECTION
Your child's ears should be kept as dry. It is okay to wash the ears normally with a cloth, but keep water out of the ears. Usually the easiest way to do this is to place a small piece of cotton, with the outside greased with Vaseline, in the ear. This will form a watertight seal and allow you to wash your child's hair. Other mechanisms to keep water out of your child's ear include: over-the-counter earplugs or custom ear molds. The custom ear molds are available in our office. I feel very strongly that anyone with a tube in place has to be careful about keeping water out of their ears and should swim with earplugs. Swimming should take place only in chlorinated water. Submersing the head under the surface is okay as long as it is not deeper than one foot below the surface.
EAR DROPS
Post-operatively, you will be given eardrops, which help keep the tube open and heal the middle ear. The patient must remain still for a few minutes when the drops are placed in the ear. Keep the extra drops handy in case of any drainage in the future. Most times the eardrops do not burn; if they do we may prescribe eye drops instead. The best way to instill the drops is to first wipe away any visible drainage to allow the drops to get down in the ear. Then shake and warm the container of drops in the hand. Instill the drops into the ear canal then gently massage in front of the ear to allow drops to run down into ear canal.
POST-OPERATIVE INSTRUCTIONS
SEPTOPLASTY
DIET
You may resume your normal eating habits immediately after your surgery. There are no restrictions on your diet. If nauseous stick with clear liquids for a few hours to see if it resolves
ACTIVITY
For the first two weeks after your surgery You SHOULD NOT do any heavy lifting, straining or vigorous activities. The risk of post-operative bleeding is greater in patients who do not avoid these types of activities. During the first 3-5 post-operative days it may be more comfortable for you to sit in an upright position and even sleep in a reclining chair. Most people can return to their normal activities, including their jobs within 7-14 days, as long as they avoid the activities mentioned above.
DO NOT try to blow your nose after surgery until the packing is removed. If you need to sneeze, SNEEZE WITH YOUR MOUTH OPEN. If you try to suppress a sneeze, the pressure may disrupt the surgery results.
HEALING
We strongly suggest that you obtain a cool mist vaporizer and run this at night, as this will loosen the nasal secretions and lessen your nasal congestion. Following surgery, most of your discomfort will be secondary to congestion from swelling of the membranes of the nose. If a nasal splint is used this will be removed in the office in 3-5 days. AS SOON AS THE SPLINT IS REMOVED, YOU MAY GENTLY BLOW YOUR NOSE. The first few days following surgery, a small amount of bleeding may occur. You may contain this bleeding by placing small 2x2 gauze across your nostrils and taping with 1-inch tape to the cheek area. You may change this gauze as needed. After the first post-operative visit, you will be given instructions for mixing and using salt-water nose drops. THE USE OF THESE DROPS IS VERY IMPORTANT TO YOUR HEALING PROCESS, SO PLEASE FOLLOW THE INSTRUCTIONS CAREFULLY.
You will have stitches inside your nose. These stitches are dissolvable and do not need to be removed. Occasionally, a stitch will come loose and it will feel like a long thread. This should be cut rather than pulled out as it may affect your surgical result. On rare occasions, it may be necessary to place splints inside your nose. If this is done, they will be removed in the office following the surgery. Occasionally, the cut surface of your nose will be raw. If this is a troublesome area, apply Bacitracin ointment, which can be obtained over-the-counter, 3 or 4 times a day. You may use q-tips soaked in peroxide to remove the dried blood at the tip of your nostrils.
PAIN
The post-operative pain associated with nasal surgery is usually moderate to minimal. You have been given a prescription for pain medicine that you may take as necessary. You also may take regular Tylenol, but we ask that you stay away from aspirin or aspirin products as they may cause bleeding. The pain medicine should only be taken as needed and is best taken with meals or food to prevent nausea