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Post-Op Instructions

Tonsillectomy and/or Adenoidectomy - Post Op Instructions

A toddler runs through a field

Instructions for Patients Undergoing Tonsillectomy and/or Adenoidectomy

  • Use no aspirin or aspirin products or ibuprofen medications for two weeks before and two weeks after surgery. These medications can thin your blood and increase your chance of serious bleeding. Tylenol use before and after surgery is not a problem.
  • Following surgery, expect some pain in swallowing and eating.
  • Expect some ear pain. (It is "referred" pain from the throat.)
  • Expect some nasal discharge and bad breath.
  • Call the doctor if there is marked bleeding or a temperature elevation of more than 101.5.
  • Use the medicines as prescribed.
  • Do not eat sharp, spicy or very hot foods. Avoid acidic drinks or foods such as orange juice.
  • If you have had your tonsils removed, eat a soft diet for approximately two weeks. You may resume a regular diet as tolerated following just the removal of your adenoids.
  • Do not do strenuous activity for at least 2 weeks or until checking with the doctor at your first postoperative visit.
  • Do not blow your nose forcefully for 2 weeks following removal of your adenoids.
  • Do not use aspirin, and do not smoke.
  • Rinse the mouth with a saline (salt water) solution three or four times a day (one teaspoon of salt to one quart of warm tap water), if it seems to help alleviate pain or bad breath.
  • Keep your head elevated by sleeping on an extra pillow for approximately 24 hours.
  • Children may return to school in 3-10 days after a tonsillectomy, and 3 days after an adenoidectomy, but should not go to play period/gym class for at least 2 weeks.
  • Be careful brushing your teeth and avoid mouthwashes with alcohol.
  • Do not be alarmed if you should see white patches at the back of your throat. These patches are indications that the surgical area is healing.
 

Ear Tubes (Bilateral Myringotomy with Tubes) - Post Op Instructions

A baby whose ears hurt

Instructions for Patients Undergoing Ear Tubes (Myringotomy with Tubes)

  • Some ear pain may be expected for a day or more after surgery from the incision made in the ear drum. This pain should be relieved by Tylenol.
  • Drainage from the ear is not more dangerous than drainage from the nose. A little drainage, and possibly even a little blood-tinged drainage, is relatively common during the first few days after myringotomy with tube insertion. However, if the drainage continues for more than 24 hours, fill the prescription for the ear drops and use them for 5 days.
  • You have been given a prescription for ear drops, which you do not necessarily have to fill unless the patient experiences drainage. If the patient does experience drainage, fill the prescription and use 3-5 drops to the involved ear three times a day for 4 days.
  • If water gets into the ear canal, and then finds its way through the tube into the middle ear behind the ear drum, this can cause pain and infection. However, this is pretty uncommon and usually happens only when the patient is swimming under water, submerged more than 2-3 feet. Therefore, we recommend ear plugs only during active swimming. The ear plugs we recommend are called "Physician's Choice" silicon "Ear Putty".
  • The type of myringotomy tubes we place usually stay in on an average of 6-12 months. However, sometimes they fall out much sooner than this, especially if they are pushed out by an infection.
  • Your first follow-up appointment will be made for you at the time of your discharge from the outpatient surgical center. It will be approximately one week from the date of surgery.

Patient Information for Myringotomy Tubes

Middle-ear ventilating tubes are used to treat eustachian-tube dysfunction and its complications. The eustachian tube is responsible for ventilating and draining the space behind the eardrum into the back of the nose. If the eustachian tube is obstructed, the space behind the ear will not drain, and fluid may collect. If there are bacteria present, it may become infected. Possible causes include bad colds, allergy reactions, enlarged adenoids, chronic sinusitis, and anything else which may cause the tissue in the back of the nose to swell.

The middle-ear ventilating tubes simply bypass the faulty eustachian tube and allow the ear to drain to the outside through the ear canal. Approximately 80% of individuals having ventilating tubes will not require placement of tubes after the first set is gone. Twenty percent of individuals having tubes may require more than one set if trouble develops after the first set falls out. This does not mean the tubes "failed". The individual has simply remained ear-infection prone, and the tubes are no longer there to help.

Middle-ear ventilating tubes are small plastic or metal tubes, which are designed to artificially ventilate the middle-ear space behind the eardrum. These tubes are inserted through a small, surgically produced hole in the eardrum and are generally left in place until they spontaneously come out. The short operative procedure is usually performed under general anesthesia for infants and children. In most teen-agers and adults, the operation can be done in the office under a mild form of local anesthesia. If there is fluid in the middle ear at the time of surgery, most of it is removed.

The average time for tubes to remain in the eardrum is 6-12 months. Some will come out within 2-3 months, some may stay 2-3 years. After 2 years if tubes are still through the drum, often they are removed to reduce eardrum damage. The tubes generally come out because the eardrum heals behind the tubes and literally pushes the tube out of the eardrum. 98-99% of the time, the eardrum will be totally healed when the tube comes out. In less than 1% of cases, a small hole may remain in the eardrum for an extended period. This hole may require surgical closure at some later date.

The major problems related to placement of middle-ear ventilating tubes include the following:

  • With infants and small children, a short general anesthetic is required. There is always some risk of heart, lung, or other serious problems developing with general anesthesia. Serious problems are extremely rare and occur perhaps no more frequently than 1 in 100,000 cases.
  • Occasionally, the tube itself may act as a source of infection, or may cause a "foreign-body" reaction, which causes ear drainage and perhaps mild bleeding, but usually no pain and rarely is a serious problem.
  • A persistent hole will remain in the eardrum after the tube comes out in less than 1% of patients.
  • Rarely, the individual having a tube placed in his eardrum will notice some slight drop in the hearing, rather than an improvement. This is extremely rare and generally only occurs in adults.
 

Septoplasty - Post Op Instructions

A man singing into a mic

Instructions for Patients Undergoing Septoplasty

  • Do not use any aspirin or aspirin products, No Advil, No Aleve, No Ibuprofen, No Motrin or Motrin type products for two weeks before or two weeks after surgery.
  • Do not use any herbal medicines/diet pills for two weeks before and two weeks after surgery.
  • After discharge, strenuous activity is to be avoided. This especially includes bending, lifting, working or full activity until two weeks after surgery.
  • For the first week following surgery, do not blow the nose, but rather sniff secretions into the throat and spit. Avoid smoke and other substances, which might irritate the nose.
  • Use the medications you were given at the time of discharge as directed. These may include an antibiotic to combat infection at the postoperative site and a decongestant to dry nasal secretions. You will also be given a pain reliever.
  • Oozing, both from the nostrils, as well as, down the back of the throat is to be expected for the first day or two. You may have to change your nasal drip pad as often as every 15 minutes or so on the evening of surgery. Oozing will almost always slow down over time. Rest in bed with your head elevated on two pillows and try ice on the nose and cheeks. If the bleeding is especially heavy, call our office.
  • If surgery was performed to alter the outside shape of your nose and you wear glasses, please ask the nurse in our office to show you how to tape them up in order to take the pressure off your nose.
  • Keep head elevated. Sleep on an extra pillow.
  • Change drip pad under nose as needed.
  • Lightly apply ice to the nose as desired, but do not get the dressing (if present) wet.
  • If a portion of your nasal packing comes out, simply and gently replace it back into the nose, or cut the portion of the nasal packing that is dangling, and this normally easily fixes the problem. If you sneeze--sneeze with the mouth open. Do not close mouth and sneeze.
  • Avoid hot and spicy foods. Hot and spicy foods are known to increase nasal blood flow and nasal oozing.
  • If nasal packing is placed at surgery, take your pain medicine 1/2 hour prior to your "removal" appointment time at our office.
  • If your nose seems dry or sore, you can place a small amount of Vaseline in each nostril and sniff. This will coat the lining of the nose and help with the dryness. You can do this in the morning or at night.
  • After your packing is removed, begin using nasal irrigations.

PREPARATION & INSTRUCTIONS FOR NASAL SALINE RINSE

We rely on the mechanical action of the saline water to remove blood clots, crusting and debris to help in the healing process.

Use distilled, filtered or boiled water.
2 teaspoons sea salt
1 teaspoon baking soda (NOT baking powder)
1 quart of water

Use 1/3 of solution for one irrigation 3 times/day
You will need to buy a rubber ear bulb syringe or a squeeze bottle.
(Your local pharmacy carries NeilMed squeeze bottles and premeasured salt/soda sachets.)

INSTRUCTIONS FOR IRRIGATION

  • Please wash your hands and use clean containers.
  • Fill a clean container with the water and the measured sea salt and soda.
  • Shake the container to dissolve the mixture.
  • Standing in front of a sink, bend forward to your comfort level and tilt your head down. Keeping your mouth open, without holding your breath, place the pre-filled bulb or syringe bottle against your nasal passage.
  • Squeeze the bulb/syringe bottle gently until the solution starts to drain from the opposite nasal passage. Some solution may drain from your mouth. DO NOT swallow the solution.
  • Without pinching your nose, blow gently to drain more fluid and remove debris.
  • Repeat #3 thru #5 for the opposite nasal passage. Repeat the process until the solution is used.
  • Discard any remaining solution.
  • Do not perform nasal rinses just before bedtime.

CLEANING OF SUPPLIES

  • After each use, clean the rubber bulb/squeeze bottle. Wash with warm sudsy dish detergent water and rinse with hot water.
  • Place the rubber bulb/squeeze bottle on a clean paper towel until the next rinsing.

When irrigating, lean forward over sink, and use enough force to cleanse the nose and sinuses. We rely on the mechanical action of the water to remove blood clots, crusting and debris to help in the healing process. You should aim toward the back of your head, as well as the top of the back of your head when irrigating your nose. You should irrigate for at least three weeks postoperatively, although some people find that irrigating on a regular basis indefinitely is very helpful in preventing sinus infections.

 

Tympanoplasty - Post Op Instructions

Instructions for Patients Undergoing Tympanoplasty

A woman whispers into a mans ear

DO:

  • Expect some pain in the operated area after surgery. This should be no worse than the pain experienced in the Surgery Center, however. You have been given pain medication and if you experience pain, please use the medications as ordered.
  • Expect some unsteadiness. This is transient and should be gone by the time of your postoperative visit to the doctor's office. It should, however, be no worse than the unsteadiness experienced while in the Surgery Center. If you experience a marked increase in unsteadiness, or dizziness, you should contact the office at once.
  • Expect some swelling of your eyelids on the operated side if a head dressing has been applied. This is normal and secondary to the head dressing and will go away with removal of the dressing, which will be done the first day after the surgery, possibly at home or in the doctor's office.
  • If you must sneeze, sneeze with the mouth open. Do not close the mouth and sneeze or pinch your nose and stifle the sneeze, as this may "blow" the patch off the eardrum.
  • Take antibiotic given to you until it is entirely gone (if an antibiotic has been prescribed to you).
  • There may be some soiling of the bandage--do not be alarmed unless it soaks and dampens the outside!
  • Change the cotton in your ear twice a day. Put antibiotic ointment on the cotton to make a good seal.
  • Keep the operated ear dry, except for medications as prescribed.

Don't:

  • Use any aspirin or aspirin products, No Advil, No Aleve, No Ibuprofen, No Motrin or Motrin type products for two weeks before and two weeks after surgery.
  • Use any herbal medicines/diet pills two weeks before and two weeks after surgery.
  • Expect to hear out of the operated ear right away. Return of hearing may take up to 4 - 8 weeks.
  • Undergo strenuous activity until your first postoperative visit to the doctor's office and the doctor has stated that you may do so.
  • Blow your nose or "snort" in forcefully, or any other Valsalva maneuver, until after checking with the doctor at your first visit postoperatively, this too, could "blow" the patch off the eardrum. If you sneeze -- "sneeze with mouth open".
  • Do not smoke.
 

Sinus Surgery - Post Op Instructions

An elderly couple on the beach

Instructions for Patients Undergoing Sinus Surgery

  • Do not use any aspirin or aspirin products, No Advil, No Aleve, No Ibuprofen, No Motrin or Motrin type products for two weeks before or two weeks after surgery.
  • Do not use any herbal medicines/diet pills for two weeks before and two weeks after surgery.
  • After discharge, strenuous activity is to be avoided. This especially includes bending, lifting, working or full activity until two weeks after surgery.
  • For the first week following surgery, do not blow the nose, but rather sniff secretions into the throat and spit. Avoid smoke and other substances, which might irritate the nose.
  • Use the medications you were given at the time of discharge as directed. These may include an antibiotic to combat infection at the postoperative site and a decongestant to dry nasal secretions. You will also be given a pain reliever.
  • Oozing, both from the nostrils, as well as, down the back of the throat is to be expected for the first day or two. You may have to change your nasal drip pad as often as every 15 minutes or so on the evening of surgery. Oozing will almost always slow down over time. Rest in bed with your head elevated on two pillows and try ice on the nose and cheeks. If the bleeding is especially heavy, call our office.
  • If surgery was performed to alter the outside shape of your nose and you wear glasses, please ask the nurse in our office to show you how to tape them up in order to take the pressure off your nose.
  • Keep head elevated. Sleep on an extra pillow.
  • Change drip pad under nose as needed.
  • Lightly apply ice to the nose as desired, but do not get the dressing (if present) wet.
  • If a portion of your nasal packing comes out, simply and gently replace it back into the nose, or cut the portion of the nasal packing that is dangling, and this normally easily fixes the problem. If you sneeze--sneeze with the mouth open. Do not close mouth and sneeze.
  • Avoid hot and spicy foods. Hot and spicy foods are known to increase nasal blood flow and nasal oozing.
  • If nasal packing is placed at surgery, take your pain medicine 1/2 hour prior to your "removal" appointment time at our office.
  • If your nose seems dry or sore, you can place a small amount of Vaseline in each nostril and sniff. This will coat the lining of the nose and help with the dryness. You can do this in the morning or at night.
  • After your packing is removed, begin using nasal irrigations.

PREPARATION & INSTRUCTIONS FOR NASAL SALINE RINSE

We rely on the mechanical action of the saline water to remove blood clots, crusting and debris to help in the healing process.

Use distilled, filtered or boiled water.
2 teaspoons sea salt
1 teaspoon baking soda (NOT baking powder)
1 quart of water

Use 1/3 of solution for one irrigation 3 times/day
You will need to buy a rubber ear bulb syringe or a squeeze bottle.
(Your local pharmacy carries NeilMed squeeze bottles and premeasured salt/soda sachets.)

INSTRUCTIONS FOR IRRIGATION

  • Please wash your hands and use clean containers.
  • Fill a clean container with the water and the measured sea salt and soda.
  • Shake the container to dissolve the mixture.
  • Standing in front of a sink, bend forward to your comfort level and tilt your head down. Keeping your mouth open, without holding your breath, place the pre-filled bulb or syringe bottle against your nasal passage.
  • Squeeze the bulb/syringe bottle gently until the solution starts to drain from the opposite nasal passage. Some solution may drain from your mouth. DO NOT swallow the solution.
  • Without pinching your nose, blow gently to drain more fluid and remove debris.
  • Repeat #3 thru #5 for the opposite nasal passage. Repeat the process until the solution is used.
  • Discard any remaining solution.
  • Do not perform nasal rinses just before bedtime.

CLEANING OF SUPPLIES

  • After each use, clean the rubber bulb/squeeze bottle. Wash with warm sudsy dish detergent water and rinse with hot water.
  • Place the rubber bulb/squeeze bottle on a clean paper towel until the next rinsing.

When irrigating, lean forward over sink, and use enough force to cleanse the nose and sinuses. We rely on the mechanical action of the water to remove blood clots, crusting and debris to help in the healing process. You should aim toward the back of your head, as well as the top of the back of your head when irrigating your nose. You should irrigate for at least three weeks postoperatively, although some people find that irrigating on a regular basis indefinitely is very helpful in preventing sinus infections.