POSTOPERATIVE INSTRUCTIONS
FOR NASAL AND SINUS SURGERY
(Septoplasty, Septoplasty and turbinectomy, endoscopic sinus surgery)
Diet
Patients who have received general anesthesia may experience some nausea and occasionally, vomiting. It is therefore preferable to eat a bland light meal or a liquid diet on the first day after the surgery. Regular diet may be resumed the next day.
Wound care and other information
1. Elevate the head at all times. Sit in a recliner or use two or three pillows when sleeping. Head elevation reduces bleeding and swelling.
2. Take the pain killers with some food or a piece of toast. This reduces nausea.
3. You may take a shower with lukewarm (not hot) water. Make sure you have someone with you in the house in case you feel drowsy or fainty from taking pain killers.
4. Do not remove packing or splints if present. You may have to breathe from your mouth if the splints get occluded with mucous or clots. This may cause a dry mouth. It is therefore very important to drink a lot and maintain adequate hydration.
5. Bleeding is expected for two to three days after surgery. Just change the drip pad as needed and keep the nostril clean. Clean the dried blood and secretions from the nostrils with hydrogen peroxide 3% and Q-tips dipped in hydrogen peroxide, followed by application of an over-the-counter topical antibiotic (Bacitarin or Neosporin) three times a day.
Care after removal of packs or splints
1. Do not blow your nose for at least one week from the day of surgery. Avoid heavy lifting or straining. These activities will increase the likelihood of nasal bleeding.
2. If you have to sneeze, please do it with your mouth open. This prevents excessive pressure build-up and bleeding from the nose.
3. Do not take Aspirin or products containing acetyl salicylic acid. Aspirin prevents clotting and increases the bleeding.
4. After the removal of the nasal splints or packs, use saline spray (Ocean Spray, Ayr, NaSal, Sea Mist, generic normal saline) 6 to 8 times daily to keep the mucosa moist and to help loosen the crusts. Also, use the SinusRinse Bottle (http://www.neilmed.com/usa/index.php) twice a day.
5. Avid lifting or exercising in order to decrease the risk of bleeding due to a rise in blood pressure. If excessive bleeding occurs, rest, elevate the head of the bed and put ice compresses on the face and neck. Any concerns?, do not hesitate to contact our office.
Medications
An antibiotic is usually prescribed following the surgery. You may also receive a prescription for painkillers in the form of codeine or hydrocodone. These products cause somnolence, drowsiness and constipation. Occasionally, Phenergan suppositories may be necessary for nausea or vomiting.
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office
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MYRINGOTOMY AND INSERTION OF PE TUBES
Post-op Instructions
Diet
Children or adults who have received general anesthesia may experience some nausea and occasionally, vomiting. It is therefore preferable to eat a bland light meal or a liquid diet on the first day after the surgery.
Keep ears dry
1. Keep the ears dry. Do not allow water to enter the ear after surgery. Plug the ears with a cotton ball and vaseline petroleum jelly when showering or washing the hair.
2. It is better not to swim or dive. Although ear plugs and swim molds are available, they are not fool-proof. These are available in all drugstores. Custom swim molds may be purchased in our office.
3. If accidentally, the head is submerged in water or water enters the ear during a shower, use the antibiotic eardrops that were prescribed immediately after the surgery.
Medications
Eardrops are usually prescribed for 3 days after the surgery (Cortisporin Otic Suspension or any other antibiotic eardrops, 3 drops 3 times a day, for 3 days). Do not refrigerate eardrops. Hold bottle in your hand for a few minutes to bring the eardrops to body temperature. Cold eardrops cause a brief but unpleasant vertigo.
Following the insertion of PE tubes, there isn’t much pain. Tylenol should suffice to control any discomfort.
Please note the following:
If you have ear drops from your pediatrician used for pain such as Auralgan, Tympagesic, or Americaine, please throw them away. These drops will burn the middle ear tissue while the tubes are in place.
The patient may experience a certain amount of pulsation, popping, clicking, and other sounds in the ear. A feeling of fullness or occasional sharp pain are not unusual in the early postopertive period. Tylenol should be sufficient for any discomfort.
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office
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Post-Op Instructions for Ear Surgery
(Mastoidectomy, Tympanoplasty)
Diet
In the immediate post-operative period, the patient may experience some vertigo, nausea or vomiting. It is therefore preferable to stick to a liquid diet or a light bland meal. A regular diet may be resumed the day after surgery. It is not unusual to experience some earache on mastication and possibly, some difficulty in fully opening the mouth.
Wound Care
The operated ear is usually packed and full of blood. It will feel clogged and you may hear crackling sounds. On the side of the operated ear, the temple and the region around the orbit (eye) may become a little swollen
If you have a dressing wrapped around the head or sutured behind the ear, please keep that dressing dry and avoid water at any cost. In general, such a dressing is removed a couple of days after the surgery. If you have a cotton ball in the ear, change it when it gets soaked and replace it with a clean cotton ball. It is not necessary to use a band aid or adhesive tape to hold the cotton ball. Use a little antibiotic ointment to make the cotton ball stick.
1. Do not allow any water to enter the operated ear. Protect the ear when showering or washing the hair with a cotton ball coated with Vaseline. It is a good idea to have someone help you with washing the scalp to avoid water. When finished washing, remove the coated cotton, wipe the ear with a soft paper tissue and place a clean, dry cotton ball. A little antibiotic ointment may help the cotton ball stick and stay in place. A shower cap provides extra protection.
2. Thick, dark or bloody ear drainage is expected during the first week after surgery. You may clean the crusting from the outer part of the ear with peroxide and Q-tips. Replace the cotton ball in the ear with a clean, dry piece when the current one is soiled. Occasionally, you may see brown or dark red pieces of packing (Gelfoam) extruding from the ear canal. Do not attempt to replace them or to remove the remaining pieces that are still in the ear canal.
3. Do not blow your nose for at least two weeks from the day of surgery. Blowing can build excessive pressure in the operated ear and displace the reconstructed or grafted eardrum.
4. If you have to sneeze, please do it with your mouth wide open to avoid pressure build up in your ear.
5. When sleeping, try to sleep on the unoperated ear.
Medications
Antibiotics are usually prescribed, please take them as directed until they are all gone. You may take pain medication as needed. Pain medications cause drowsiness, somnolence, nausea and constipation. Please refrain from driving, operating machinery or making important decisions when taking painkillers.
Follow-up
If you have a wrap-around dressing or a dressing sutured behind the ear, please make an appointment in 2 to 3 days to have it removed.
Contact our office and report any:
Excessive headache, severe attacks of dizziness or vertigo or intractable vomiting
Temperature above 102 degrees
Facial paralysis ( Inability to close the eye and crooked smile like in Bell’s Palsy)
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office
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Tonsillectomy and Adenoidectomy (T&A)
Post-op Instructions
Diet
First day
Avoid hot and highly seasoned foods
Encourage intake by frequently offering milk, ice cream, water, fruit juices, jello, broth, etc.
Second day
Drink several glasses of water. Add soft foods as desired (jello, chocolate pudding, mashed potato, pureed vegetables, cottage cheese, etc)
Third to tenth day
Soften any food you like with a blender + lots of water to make it liquid-like.
Medications
An antibiotic is usually prescribed for seven to ten days following the surgery. The patient also receives a prescription for pain killers in the form of codeine or hydrocodone. These products cause somnolence, drowsiness and constipation. Occasionally, if the patient vomits, phenergan suppositories may be necessary.
General instructions
*Children should be kept indoors and relatively quiet for the first 3 days
*Frequent coughing and clearing the throat should be avoided
*Objectionable mouth odor is commonly observed and is relieved by abundant fluid intake
*A white or gray membrane on the sides of the throat is normal and should disappear in 1 to 2 weeks
*Earache is expected. It is not an ear infection, it is referred from the throat.
*Occasionally, a transient neck stiffness may occur in children following adenoidetomy.
*Patient may return to school or work 1 week after discharge. Please note that painkillers cause drowsiness. Patients who take painkillers should not operate machinery, drive or make important decisions.
*Do not use aspirin or ibuprofen for 2 weeks; it increases the possibility of bleeding
*Avoid drinking orange juice, grapefruit juice, and tomato juice for 1 week after the operation, they make the throat burn
*Avoid exercise or lifting so that not to elevate your blood pressure which may cause bleeding.
Fever
Most children experience a low grade temperature. This is caused by dehydration. Encourage fluid intake and if needed, use Tylenol (NOT ASPIRIN or ADVIL or MOTRIN). If the temperature remains above 102.2 (39.0 Celsius) and does not respond to Tylenol, or if the child refuses to drink, then IV fluids are required. Please call our office or the closest emergency room.
Bleeding
The danger of serious bleeding is over after you leave the hospital. In about 2% of patients there is some bleeding after 6 or 8 days. If this happens to you, do not become excited, for this bleeding is usually slight and stops spontaneously. Remain quiet, lie down, and spit the blood out gently. Gargle the throat gently with ice water + hydrogen peroxide (50:50) and stay quiet. If the bleeding does not stop promptly, call your doctor. If the doctor is not available and bleeding continues, go to the nearest emergency room.
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office
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Laser-Assisted Uvulo-Palato-Plasty (LAUP)
Radio Frequency (RF) Uvulo-Palato-Plasty
Diet (similar to T&A instructions)
First day
Avoid hot and highly seasoned foods (jalapenos, pepper, salsa etc.)
Maintain adequate hydration by frequent intake of milk, ice cream, water, tea, apple juice, jello, broth, etc.
Second day
Drink several glasses of water (lukewarm water is less irritating than cold)
Add soft foods as desired (jello, chocolate pudding, mashed potato, pureed vegetables, mashed boiled eggs, cottage cheese, etc)
Third to fifth day
Gradually resume normal diet but avoid hot foods, spicy or highly seasoned foods, potato chips, nuts, dry toast, pop corn and crackers until 1 to 2 weeks after surgery
Medications
An antibiotic is usually prescribed for seven to ten days following the surgery. The patient also receives a prescription for painkillers in the form of codeine or hydrocodone. These products cause somnolence, drowsiness and constipation. Occasionally, Phenergan suppositories may be necessary for nausea or vomiting. A local anesthetic spray (Benzocaine) may be used topically to anesthetize the throat and relieve the pain.
General instructions
*Frequent coughing and clearing the throat should be avoided
*Objectionable mouth odor may be noted and is relieved by abundant fluid intake
*A white or gray membrane on the surgical site is normal and should disappear in 1 to 2 weeks
*Patients who have undergone UPPP under general anesthesia will notice sutures in the soft palate. These do not need removal, they are absorbable sutures.
*Earache or a slight fever is expected and may be disregarded unless condition worsens
*Patient may return to work the day after surgery, however, one should not drive, operate machinery or make major decisions if taking painkillers
*Do not use aspirin for 2 weeks; it increases the possibility of bleeding
*Avoid drinking orange juice, grapefruit juice, and tomato juice for 1 week after the operation,they make the throat burn
Bleeding
The danger of serious bleeding is over after you leave the office or hospital. In a small percentage of patients, bleeding may occur after 6 to 8 days. If this happens to you, do not become excited, for this bleeding usually stops spontaneously. Remain quiet, lie down, and spit the blood out gently. Gargle the throat gently with ice water and remain quiet. If the bleeding des not stop promptly, call your doctor. If the doctor is not available and bleeding continues, go to the nearest emergency room.
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office
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DIRECT LARYNGOSCOPY
WITH BIOPSY, REMOVAL OF POLYPS, NODULES OR STRIPPING, WITH OR WITHOUT LASER
Postoperative instructions
Please do not smoke
Diet
You may experience some sore throat or a sore tongue from the operation. This is due to the pressure that the metal laryngoscope exerts on the tissues. Because some patients suffer from nausea or occasionally vomit after general anesthesia, it is always a good idea to eat a light meal or just liquids after the operation. You may resume your normal diet the next day. Please drink plenty of fluids. Dehydration is extremely harmful to the vocal cords.
Voice rest
1. Please observe relative voice rest for at least seven days. This gives the raw tissue in the larynx a chance to begin to heal. Occasionally, if the surgery has been extensive, you might be requested to observe absolute voice rest.
2. Hoarseness may last up to 2 to 3 weeks. During this time, tissue swelling will gradually decrease and the lining of the vocal cords will regenerate.
3. If you must speak, please do so in a normal tone of voice. This creates less trauma to the vocal cords than whispering or shouting.
4. Avoid excessive coughing or throat clearing. These are two of the most damaging things you can do to the vocal cords, especially during the healing process.
Medications
Usually, antibiotics and pain medications are not needed for this procedure. If antibiotics or painkillers are prescribed, please take them as directed.
Follow-up
It usually takes 24 to 48 hours for the laboratory to process the biopsy and give us a result, however, occasionally, it takes longer. We know that you are waiting impatiently for the results. We will do our best to obtain the pathology report as soon as possible and we will call you to inform you of the result.
You will be informed if further therapy is required. Occasionally, procedures are staged so that abnormal scar tissue will not form.
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office
______________________________________________________________________________________
DIRECT LARYNGOSCOPY
WITH BIOPSY, REMOVAL OF POLYPS, NODULES OR STRIPPING, WITH OR WITHOUT LASER
Postoperative instructions
Please do not smoke
Diet
You may experience some sore throat or a sore tongue from the operation. This is due to the pressure that the metal laryngoscope exerts on the tissues. Because some patients suffer from nausea or occasionally vomit after general anesthesia, it is always a good idea to eat a light meal or just liquids after the operation. You may resume your normal diet the next day. Please drink plenty of fluids. Dehydration is extremely harmful to the vocal cords.
Voice rest
1. Please observe relative voice rest for at least seven days. This gives the raw tissue in the larynx a chance to begin to heal. Occasionally, if the surgery has been extensive, you might be requested to observe absolute voice rest.
2. Hoarseness may last up to 2 to 3 weeks. During this time, tissue swelling will gradually decrease and the lining of the vocal cords will regenerate.
3. If you must speak, please do so in a normal tone of voice. This creates less trauma to the vocal cords than whispering or shouting.
4. Avoid excessive coughing or throat clearing. These are two of the most damaging things you can do to the vocal cords, especially during the healing process.
Medications
Usually, antibiotics and pain medications are not needed for this procedure. If antibiotics or painkillers are prescribed, please take them as directed.
Follow-up
It usually takes 24 to 48 hours for the laboratory to process the biopsy and give us a result, however, occasionally, it takes longer. We know that you are waiting impatiently for the results. We will do our best to obtain the pathology report as soon as possible and we will call you to inform you of the result.
You will be informed if further therapy is required. Occasionally, procedures are staged so that abnormal scar tissue will not form.
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office
______________________________________________________________________________________
Post-Op Instructions for Neck Operations
Parotidectomy, thyroidectomy, parathyroidectomy, MIRP,
excision of submandibular gland, carotid body tumors, vagus nerve stimulation,
branchial cleft cysts, thyroglossal duct cysts, lymph nodes…
Diet
Patients who have received general anesthesia may experience nausea and occasionally, vomiting. It is therefore preferable to eat a bland light meal or a liquid diet on the first day after the surgery. Regular diet may be resumed the next day. Also, pain pills may cause nausea if taken on an empty stomach. It is preferable to take those pills with a piece of toast or some food.
Activity and Wound Care
Elevate the head as much as possible. Sit in a recliner or use two or three pillows when sleeping. Head elevation reduces bruising and swelling. Occasionally, you may notice that the bruises or swelling have migrated to other places (usually lower regions). You may have a dressing or your wound may be exposed.
Wounds sealed with Dermabond acrylic coating:
Your wound may be sealed with a coat of clear Nylon-like compound called Tegaderm. This protects the wound and allows you to take a shower without covering it. Do not apply antibiotic ointment over this acrylic coat; it will peal off by itself in 10 – 15 days.
For exposed wounds:
If your wound is not sealed with clean Tegaderm, keep the exposed wound dry. Avoid showers. You may take a bath with lukewarm (not hot) water. If accidentally, water reaches the wound, dry it immediately with a clean towel. Make sure you have someone with you in the house in case you feel drowsy or fainty from taking pain killers. Clean the wound once a day. This is best done with a cotton swab dipped in 3% hydrogen peroxide. If you have not received a prescription for antibiotic ointment, use over-the-counter triple antibiotic. Apply a scanty amount on the suture line. At times, you may not see the sutures because they have been placed inside the wound. On other occasions, there may be metallic staples instead of sutures. Occasionally, a thin film of clear adhesive is placed over the wound to protect it and allow you to take a shower.
Wounds with dressings or drains:
In rare instances, you may have a dressing or a drain. Unless specifically instructed, do not remove them. Avoid showers and keep the dressing dry. Some dressings may be sutured to the skin. Do not attempt to remove them. Drainage is expected for two to three days after surgery. Just kink the drain tubing, before detaching the bulb and emptying it. By kinking the tubing, you prevent air and old drainage from being sucked back into the wound.
Medications
An antibiotic is usually prescribed for seven to ten days following the surgery. You may also receive a prescription for painkillers in the form of codeine or hydrocodone. These products cause somnolence, drowsiness and constipation. Occasionally, Phenergan suppositories may be necessary for nausea or vomiting.
Follow-up
Please return to follow up to be seen in the office as per the appointment that was given to you
PHONE: 410- 554 4455 at our Union Memorial Hospital office, 433-444 4848 at our Good Samaritan Hospital office, 410-554 NOSE (6673) at our Lutherville Office