Ear Nose & Throat by Lisa Volbrecht

A Discovery top 20 hospital

Patient Guidebook –EAR, NOSE & THROAT SURGERY

JAN 2017

In This Guide •

hearty welcome to you, our valuable guest. We hope that your journey with us will be an extremely positive experience and that you will have a successful recovery.

The purpose of this guide This guide contains useful information that you and/or your child will need to prepare and recover from ear, nose & throat (ENT) surgery. It is designed to be an easy reference guide on what to expect as well as important after care information.

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Everything you need to know about the surgery and Lowveld Hospital What to expect every step of the way Different phases of care after your/your child’s surgery

VERY IMPORTANT!

Keep this guide as a handy reference for at least a few months after your surgery This guide will help you to remember many of the recommendations made by your professional team.

It is crucial that you read this guide as well as the Patient Welcome Pack. Both are equally important.

Otolaryngology [oh-toh-lar-ing-gol-uh-jee]

The medical specialty concerned with diseases of the ear, nose, and throat Ear, nose, and throat surgery is the surgical treatment of diseases, injuries, or deformations of the ears, nose, throat, head, and neck areas. The purpose of surgery to the ears, nose, throat, head, and neck is to treat an abnormality (defect or disease) in these anatomical areas. Most ENT surgeons are referred to as otolaryngologist and the specialty as otolaryngology.

Ear surgery procedures done at the Lowveld Hospital include: •

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Stapedotomy (small opening through the footplate to insert prosthesis) Tympanoplasty (re-construction of the ear drum) Myringotomy (insertion of ear tubes to drain fluid in persons with chronic ear infections).

Nose surgery can include different types of procedures to treat: Sinus problems (sinus surgery) and sinus infections •

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Injuries to the nose

Deformities of the nose and cosmetic surgery of the nose ("rhinoplasty") •

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Nasal allergies (hay fever)

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Tumours of the nose and sinuses.

Other common surgical procedures include correction of a deviated nasal septum ( septoplasty)

• Endoscopic Sinus Surgery

PREPARING FOR THE SURGERY Checklist - Before your surgery: If you are using any medications, ask your doctor what medications you should stop and when you should stop them It’s advisable to stop anti-inflammatory medications at least 2 weeks before the surgery — check with your doctor Ask your doctor if there are any lab tests that should be done Ask your doctor if you should stop smoking (it is advisable) Eat a healthy diet and avoid drinking alcohol a few days prior to your procedure. Ask your surgeon whether you'll be able to go home the day of the surgery or whether you'll need to spend a night in the hospital. Arrange for someone to drive you home after surgery If you develop an illness (cold, sore throat, cough, fever etc) before surgery, please notify your doctor. List of things to bring with on the day of your surgery: 1. Identification (ID book or drivers license) 2. Medical aid card 3. Small bag for medications and paperwork 4. All X-rays and CT scans 5. Medications you are currently taking Download the preadmission form online at www.lowveldhospital.co.za. E-mail (or hand deliver) the completed form to info@lowveldhospital.co.za to ensure a speedy admission!

Examples of medications to stop before the procedure

It’s also recommended to stop all herbal supplements too, like Black cohosh, Dong quai, Echinacea, Ephedra (herbal ecstacy), Feverfew, Fish oils (Omega-3 fatty acids), Garlic, Ginger, Gingko biloba, Ginseng, Goldenseal, Hoodia, Kava, Licorice, St. John’s wort, Valerian root, Vitamin C, Vitamin E, Saw palmetto and Goldenseal. Copyright © Lowveld Hospital 2016. All rights reserved.

THE DAY BEFORE SURGERY You will receive an SMS from Lowveld Hospital before your surgery confirming the time of admission. You will also receive a parking voucher by SMS and email.

Remove nail polish from at least one fingernail and toenail to help the anaesthetist monitor your blood circulation during your procedure.

You may eat normally on the day before your surgery, but do not drink alcohol 2 days prior.

Do not eat or drink anything, including water, after midnight the night before the procedure

Remove all baby bottles from the crib at night & drinking glasses from the bathroom. Inform all family members that the child should not be given anything by mouth 6-8 hours (check with your doctor) before the surgery.

You may bring your child in pyjamas. You may bring formula or special drinking cups for use after surgery. Children may bring a favorite blanket or soft, small toy. If possible, do not bring other children with you the day of surgery.

AFTER ENT SURGERY The aftercare for ENT surgery depends on the procedure, age, concomitant illnesses and overall health of the patient. It is important to always follow the surgeon’s instructions, and postoperative follow-up as part of your aftercare is essential. Medications for pain will be prescribed. Ask your doctor what dose you should take, how frequent you can take it and for how long. Patients stay in the hospital for 3 to 4 hours (for the effects of anesthesia to subside) for same-day surgical procedures (i.e., tonsillectomy), or they may be admitted for a few days for more complicated procedures. Patients will only be discharged after they had something to eat with no ill effects, as well as after passing urine.

THE SURGERY Stapedotomy A small hole is created in the fixed stapes base (or footplace) and a tiny, piston-like prosthesis is inserted.

Tympanoplasty Reconstruction of a perforated tympanic membrane (eardrum) or the small bones of the middle ear. Myringotomy A small incision is made in the eardrum (the tympanic membrane). Ear tubes, tympanostomy tubes or grommets are small tubes open at both ends that are inserted into the incisions in the eardrums during myringotomy. Functional Endoscopic Sinus Surgery Small amounts of bone or other material blocking the sinus openings or growths (polyps) are removed. A thin, lighted tool called an endoscope is inserted through the nose so the doctor can see and remove whatever is blocking the sinuses.

Septoplasty The surgeon makes an incision on one side of your nose to access the septum. Heâ&#x20AC;&#x2122;ll then lift up the mucous membrane, which is the protective covering of the septum. Then, the deviated septum will be moved into the right position. Any barriers, such as extra pieces of bone or cartilage, will be removed. The last step is the repositioning of the mucous membrane.

Tonsillectomy and Adenoidectomy Removal of the small glands on each side of the throat (tonsils) and at the top of the throat behind the nose (adenoids). These operations are usually performed together, and are the most common childhood operations. Copyright ÂŠ Lowveld Hospital 2016. All rights reserved.

AFTER DISCHARGE

Tonsillectomy

AND RECOVERING AT HOME

No aspirin and aspirin -related products for 2 weeks after surgery

Stay in bed on the day of discharge. Try to remain at a constant room temperature. No strenuous activities for 7 – 10 days.

THE MORE YOU CHEW AND SWALLOW, THE SOONER THE PAIN WILL DISAPPEAR. Chewing gum is encouraged. Avoid milk, acidic fruit juices and strongly flavored foods like pineapple, bananas and curry.

For a week to 14 days after the operation, you might have a severely sore throat, ear-ache and/or a slight rise in body temperature. This is normal, so do not be concerned.

Drink pain medication 30 minutes before meals so that the throat will be painfree and eating encouraged

Bleeding may occur – either in the first 24 hours or +-7 days after the operation. This may be dangerous so do not hesitate to contact your doctor immediately!

AFTER DISCHARGE

Adenoidectomy

AND RECOVERING AT HOME

No aspirin and aspirinrelated products for 2 weeks after surgery

Drink lots of fluids such as apple juice, Energade, and water. Avoid acidic drinks/foods, like orange/tomato juice.

You may experience some nasal discharge and bad breath, which is normal. Use alcohol free mouthwash.

Do not blow your nose forcefully for two weeks following removal of your adenoids.

Children may return to school 710 days after a tonsillectomy, and 3 days after an adenoidectomy

You have hypernasal sounding voice after adenoidectomy -this commonly resolves in 1-2 months.

AFTER DISCHARGE

Tympanoplasty

AND RECOVERING AT HOME

No aspirin and aspirin -related products for 2 weeks after surgery

Stay in bed on the day of discharge. Try to remain at a constant room temperature. No strenuous activities for 7 â&#x20AC;&#x201C; 10 days.

Expect some unsteadiness, but if you experience a marked increase in unsteadiness or dizziness, you should contact your doctor

Sneeze with your mouth open. Do not close your mouth & sneeze or pinch your nose & stifle the sneeze, as this may "blow" the patch off the eardrum.

Change the cotton in your ear twice a day. Put antibiotic drops as prescribed by your doctor.

Keep the operated ear dry (except for medications) for as long as your doctor prescribes

AFTER DISCHARGE

Nose surgery

AND RECOVERING AT HOME

No aspirin and aspirin-related products for 2 weeks after surgery

Cough and sneeze with your mouth open

Oozing both from the nostrils and down the back of the throat is to be expected for 1-4 days. Rest in bed with your head elevated on two pillows and try ice on the nose and cheeks

Avoid hot and spicy foods, known to increase nasal blood flow and nasal oozing.

If nose seems dry or sore, place a small amount of water-soluble ointment (k-y jelly) in each nostril. Use saline nasal spray frequently

No strenuous activity, heavy lifting, bending, working or full activity for 2 weeks following surgery

Do not remove any nasal packing. Take your pain medicine 1/2 hour prior to your "removal" appointment at your doctor.

Myringotomy (grommets)

AFTER DISCHARGE AND RECOVERING AT HOME

S t r i c t w a t e r precautions: Keep water out of the ears at all times!

Whenever exposed to water (shower, shampoo, bathing, swimming) use custom made ear-plugs

A clear, grey, brown or bloody liquid may drain from the ear for a day or 2 after the operation. If the discharge persists, please call your doctor.

Avoid activities that will cause increased pressure in the ear, like blowing your nose vigorously, lifting heavy objects, straining at the toilet, bending quickly or lying on the ear that was operated on.

Children school leaving they are

Pulsating, popping or clicking sounds in the ear are common for sev eral days after surgery. Feelings of hollowness or fullness are common.

can go back to the day after the hospital, if feeling well

RISK AND COMPLICATIONS The following complications of ENT surgery have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for patient information only - not to make you overly concerned - but to make you aware and more knowledgeable concerning potential aspects of ENT surgery. Your surgeon will review the risks and bene its of the surgery when obtaining consent for the operation, and will be able to discuss the chance of these complications with respect to an individual's potential risks of surgery at that time.

TONSILLECTOMY/ADENOIDECTOMY − − − −

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Infection Dehydration Bleeding Nausea and vomiting, throat pain, difficulty swallowing, low grade fever, bad breath, ear-aches and fatigue. Reactions to anesthetics. Medication

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to make you sleep during surgery often causes minor, short-term problems, such as headache, nausea, vomiting or muscle soreness. Prolonged pain, and/or impaired healing that could lead to the necessity for hospital admission for fluids and/or pain control

TYMPANOPLASTY −

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− − −

Damage to your facial nerve or the nerve controlling your sense of taste Damage to the bones of your middle ear, causing hearing loss Dizziness lasting up to a month Ringing in the ear (tinnitus) Incomplete healing of the hole in your eardrum causing recurrent ear-

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drum perforation Temporary taste disturbance Moderate or severe hearing loss Cholesteatoma (an abnormal skin growth behind your eardrum)

NOSE/SINUS SURGERY −

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Bleeding Failure to resolve the sinus infections or recurrence of sinus problems and/or polyps. Chronic nasal drainage or excessive dryness or crusting of the nose. Need for further and more aggressive surgery. Damage to the eye and its associated structures. Damage to the skull base with resultant meningitis, brain abscess, or leakage of spinal fluid.

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Permanent numbness of the upper teeth, palate, or face. Nasal obstruction due to failure to control infection or polyps. Prolonged pain, impaired healing, and the need for hospitalization. Failure to restore or worsening of the sense of smell or taste.

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