Microsoft Word - ENTA Post-op Instructions

ENT & Allergy Associates , LLP ! 777 N. Broadway, Sleepy Hollow, NY 10591 ! 914-829-5650

Septoplasty & Turbinate Reduction Post-Operative Instructions

Summary: The Do’s and Do Not’s

Do:

• DO use over the counter AFRIN (oxymetazoline) topical decongestant nasal spray (3 sprays in each

nostril twice daily) for the first 2-3 days after surgery to help with the expected bleeding.

• DO take the pain medication prescribed: _______________ every _____ hours as needed for pain. You

can take extra-strength Tylenol IN PLACE OF the narcotic prescribed if the pain is not too severe and it

is sufficient to control your pain.

• DO take the antibiotics prescribed: ______________ - _____ times a day for ______ weeks/days. While

taking antibiotics, it is recommended that you take over the counter pro-biotic lactobacillus acidophilus

pills or eat yogurt daily to replace the “good bacteria” in your digestive system.

• DO make sure you have a follow-up appointment __________________________.

Call 914-829-5650 to make or confirm your appointment with your surgeon.

• DO start your irrigations WHEN BLEEDING SUBSIDES. These irrigations should be performed at

least three times a day. It is preferable to rinse even more often if you can. The nasal rinses are essential to

the healing process. Please see the last page of this packet for irrigation instructions.

• DO cough and/or sneeze with your mouth open to decrease pressure on the nose.

• DO eat a regular diet. A soft diet may be easier to tolerate if you have a sore throat after surgery.

• DO consider taking pain medication before your first post-operative appointment, especially if you have

needed to take the pain medication often prior to this visit. Do bring a family member with you.

Do Not:

• DO NOT perform any heavy lifting (nothing greater than 10-15 lbs), bending over, stooping, or straining

until cleared by your surgeon to do so.

• DO NOT blow your nose or pick at your nose until cleared by your surgeon to do so.

• DO NOT take any medications which increase risk of bleeding. This includes aspirin and aspirin-like

products (Advil, Motrin, Excedrin, Alleve, Celebrex, Naproxyn, etc.).

• DO NOT fly without your doctor’s clearance for at least 14-21 days after surgery.

• DO NOT drink alcohol, drive, or handle heavy machinery while taking narcotic pain medication.

Questions/concerns and Emergencies

If you have any questions or concerns, please do not hesitate to contact our office at 914-829-5650 at any time.

There is always a physician “On Call” for emergencies outside of normal business hours.

The following signs or symptoms should be reported to the physician/nurse:

a. Persistent fever over 102 degrees Fahrenheit

b. Persistent bleeding with more that ½ cup of bright red blood within 30 minutes or causing choking

c. Severe pain unrelieved by prescribed medication

d. Changes in vision (i.e. double-vision, visual loss)

e. Mental changes (i.e. confusion, slurred speech

f. Neck Stiffness or deep head pain

g. Continued Nausea or vomiting

If you experience difficulty breathing, shortness of breath, or severe bleeding, call 911 or go to the nearest

emergency room immediately.

ENT & Allergy Associates , LLP ! 777 N. Broadway, Sleepy Hollow, NY 10591 ! 914-829-5650

Septoplasty & Turbinate Reduction Post-Operative Instructions

1. Nasal sprays/Irrigations:

a. You should use over the counter Afrin (oxymetazoline) topical decongestant nasal spray (3 sprays

in each nostril twice daily) for the first 2-3 days after surgery to help with the expected bleeding. If

you experience nasal congestion, you can continue to use the spray as needed for 4-5 days total to

provide temporary relief until you can see your doctor for your scheduled endoscopic nasal

debridement (cleaning) as described below.

b. When bleeding subsides, you should start using nasal saline irrigations. There are a number of over

the counter sinus rinse (not spray) products available, including the NeilMed sinus rinse kit. These

products are available at most pharmacies without prescription. Please read the directions carefully

and use distilled water (or boiled water that has cooled to room temperature) and the salt packets

that come inside of the box; irrigate at least 3 times per day. A feeling of fullness in the ears or

“being underwater” is not uncommon, and could be due to normal post-operative inflammation

in the nose or nasal irrigation that is too forceful. If you experience ear fullness or pain with the

irrigations, be sure to use less forceful irrigation technique. Please refer to the “Nasal Saline Irrigation

Instructions” at the end of this packet for more information.

2. Nasal splints: You may have special nasal splints in your nose following surgery; if so, these splints will

be removed at the first post-operative visit. The splints may make breathing through your nose difficult,

although the splints used typically have a breathing channel to prevent this. A humidifier or vaporizer can

be used in the bedroom to prevent increased throat pain due to mouth-breathing while sleeping.

3. Steam treatments: Frequent hot showers and/or carefully breathing in steam can help soften and clear

the mucous and clots that typically build up within the nasal cavities after surgery.

4. Bleeding: Slight to moderate trickling of blood with or without mucous in the back of your throat or on

your drip pad/gauze taped under your nose is normal and to be expected. You should change your drip

pad periodically throughout the day as needed. This may be necessary for the first 3-5 days after surgery.

You may discontinue using the drip pad once you have no further drainage. In case of heavy nasal bleeding,

use 3 generous squirts of Afrin into each nasal cavity, apply ice to the bridge of the nose, and pinch the

nose just above the tip and hold for 20-30 minutes; if heavy bleeding continues, you should contact the

office at 914-829-5650 (ENT & Allergy Associates). If you experience severe bleeding, please call 911

or go to the closest emergency room immediately.

5. Nasal crusting: You may experience some crusting around the nostrils at the front part of the nose,

causing some discomfort and/or nasal congestion. You may gently clean the hair-baring area of the nose

daily, as needed, using a Q-tip dipped in hydrogen peroxide or warm soapy water. Keep your fingers out

of your nose. Do not probe any deeper into your nose. Do not pull at the splints or the suture(s) holding

them in place if you have splints.

6. Tooth numbness/tenderness: There may be some tingling, tenderness or numbness in your upper teeth,

palate and gums. This is not unusual, especially if you have had a septoplasty; this is temporary in the vast

majority of cases.

7. Nasal congestion/Decreased sense of smell: You can expect to have a stuffy nose until the nasal splints

are removed, with some intermittent congestion for the remainder of the healing period depending on a

number of factors. Sense of smell will also likely be diminished during this time, and sense of taste will be

affected as well.

ENT & Allergy Associates , LLP ! 777 N. Broadway, Sleepy Hollow, NY 10591 ! 914-829-5650

8. Pain: Postoperative pain is not uncommon and may last for up to 3-4 weeks postoperatively. It is not

uncommon to have fluctuating levels of pain for the first week or so, after which the pain usually begins

to diminish. Narcotic pain medication (Percocet, Vicodin, Tylenol with codeine, etc.) will be prescribed for

you to take in the event you experience any significant post-operative pain in the vast majority of cases.

You can take extra-strength Tylenol in place of the narcotic prescribed if the pain is not too severe, AND

in order to avoid the occasional side-effects of narcotics, including nausea, constipation, or grogginess. Do

not drink alcohol, drive, or handle heavy machinery while taking narcotics.

9. Stool softener/Hydration: While using prescription narcotic pain medication, take an over the counter

mild laxative or stool softener such as Dulcolax, Miralax, or Colace to prevent constipation. Avoid straining

with bowel movements. It is also important to stay well hydrated after surgery. Drink plenty of fluids

throughout the day.

10. Medications: Obtain all medications and nasal sprays prescribed and use as directed.

a. Antibiotics are often used in the initial post-op period to prevent infection while the nose is

healing. While taking antibiotics, it is generally recommended that you take over the counter pro-

biotic lactobacillus acidophilus pills or eat yogurt daily to replace the “good bacteria” in your

digestive system.

b. Any medications which thin the blood should be avoided. These include aspirin and

aspirin-like products (Advil, Motrin, Excedrin, Alleve, Celebrex, Naproxyn, etc.). If you are on

Coumadin, or another blood thinner, check with your physician regarding when you should restart

this medication.

c. If you have high blood pressure, it is important that your blood pressure is well controlled.

Likewise, if you have diabetes, it is important that you keep your blood sugars under control. If

you have concerns about either of these levels, please contact your primary care physician for

further recommendations.

11. Nose blowing: Do not blow your nose under any circumstance until you are cleared to do so by your

doctor.

12. Head elevation: Sleep with 2-3 extra pillows, elevating your head slightly. You do not need to sleep sitting

up in a chair but you may do so if you find this more comfortable.

13. Throat discomfort: Throat discomfort is extremely common after endotracheal intubation (having a

breathing tube in the throat) during general anesthesia. This should resolve on its own within 1-2 weeks.

Throat lozenges tend to soothe the discomfort until it passes. A soft diet helps as well.

14. Diet: There are no dietary restrictions, but alcohol consumption is not recommended. If you have a sore

throat, you might find a soft diet easier to tolerate until your throat discomfort improves.

15. Tobacco: Tobacco use is discouraged as nicotine decreases blood flow to the healing nasal tissues and can

actually compromise wound healing decreasing the success rate of nasal surgery.

16. Activity: Please refrain from all heavy lifting (lift nothing more than 10-15 lbs), bending over or stooping

to lift, and vigorous exercising until cleared by your doctor (usually a 1-2 weeks after your first post-

operative visit. Rest and do not overexert yourself.

17.

Cough/Sneeze: Cough and sneeze with your mouth open to decrease pressure on the nose.

18. Travel: You should avoid airplane travel for 14-21 days following nasal surgery; the cabin pressure changes

may cause swelling/pain within the sinuses. Check with your physician prior to flying after nasal surgery.

19. Fatigue: Generalized fatigue or light-headedness may be experienced after surgery. This is may be due to

the general anesthetics used during the surgery, use of narcotic pain medication, or mild temporary anemia

due to expected blood loss during surgery. Do not get up quickly out of bed the first few days after surgery.

Foods heavy in iron, or iron supplements, are suggested if higher than normal blood loss results in slight,

but temporary, anemia. Patients with more extensive surgical procedures (revisions, polyps, etc.) generally

will have more blood loss than other patients. However, very rarely will blood transfusions be necessary.

Drink plenty of fluids to maintain hydration (6-8 glasses daily at a minimum). Avoid alcohol or caffeine the

first week after surgery. Persistent vomiting or fainting should be reported to your physician.

20. Migraines: If you suffer from migraine headaches, the trauma of the surgery may trigger secondary

migraine headaches, requiring additional attention by an appropriate Neurologist. Migraine medication may

be indicated to alleviate these symptoms and should be used only after discussion with the prescribing

ENT & Allergy Associates , LLP ! 777 N. Broadway, Sleepy Hollow, NY 10591 ! 914-829-5650

physician. Migraine medication should not be taken at the same time as a narcotic pain medication unless

otherwise instructed by your physician.

Post-operative Visits

Please schedule your first post-operative visit in 7-10 days. Call 914-829-5650 (ENT & Allergy Associates) and

specify that you are scheduling a post-operative nasal debridement visit. During this visit, you will have your

nasal splints removed if present, and you will have your first endoscopic debridement.

Endoscopic debridement

of the nasal cavities is a procedure, during which your nasal cavities are cleaned by

removing dried blood, mucus, and early scar tissue in order to promote healing, minimize the chance of

secondary bacterial infections, and relieve congestion and/or headaches. During the healing period, blood and

normal mucous secreted by the mucous glands in the nose sticks to raw areas, become hardened by air, and

then turn into crusts. The crusts then become a focus of bacterial growth and possible infection when allowed

to sit long enough in the nose. Persistent crusting is the single most common reason for persistent symptoms

of nasal obstruction, congestion, foul smell, and headaches, postoperatively. Therefore, saline irrigations

combined with periodic debridements are absolutely necessary.

After your surgery, you will have a series of visits during which you will have this procedure performed in the

office, beginning with the first one typically within 7-10 days, followed by a number of subsequent debridements

at various intervals. This is only necessary until your nasal cavities are totally healed with functional mucosal

lining. On the average, significant crusting requiring endoscopic debridement will generally last about 2 months

after surgery, and patients typically have 2-4 total debridements during this time period. A variable degree of

postoperative crusting is dependent on the degree of surgery and tissue removal. More debridements may be

necessary in more advanced cases of irreversible mucosal damage from chronic infections (revision surgeries,

polyp cases, etc.). Also, a prior history of chemotherapy or radiation therapy may prolong the healing period

resulting in increased levels of crusting. Significant crusting can last as long as 3-6 months or even longer in

some of these cases.

Instructions/expectations for debridement visits:

Please make sure that you have eaten something and you are well hydrated prior to arriving for your

debridement visits to prevent low blood sugar and possible fainting; it is suggested that you take one or two

narcotics pills about one hour prior to your first debridement appointment (do not take pain medication on an

empty stomach and do not take more than you have regularly taken leading up to the debridement), when your

nasal cavities are still swollen and tender. This will decrease the discomfort of the procedure. However, you will

need a ride to and from the first post-operative appointment if you take narcotic pain medication.

Topical anesthetic spray will also be used in the office prior to all debridements to minimize discomfort. The

medical assistant may spray your nasal cavities prior to the doctor seeing you in the examination room for the

procedure. After the first visit/debridement, the discomfort levels during this procedure decrease as the

immediate postoperative swelling and inflammation begin to dissipate.

It is normal to have some light bleeding and pink or dark red drainage after your initial debridement for a few

hours to several days. You may have to temporarily wear a drip pad (as you did right after surgery) to protect

your clothing. Severe bleeding is rare and needs to be reported to your physician and possibly treated in a nearby

emergency room.

After a debridement visit, you may be asked to start topical antibiotics (in spray form or mixed in your

irrigations), nasal steroid sprays or irrigations, allergy treatments, or a combination of these treatments. You

may also be placed on culture-directed oral antibiotics, depending on how your nasal cavities are healing.

ENT & Allergy Associates , LLP ! 777 N. Broadway, Sleepy Hollow, NY 10591 ! 914-829-5650

Questions/concerns and Emergencies

If you have any questions or concerns, please do not hesitate to contact our office at 914-829-5650 at any time.

There is always a physician “On Call” for emergencies outside of normal business hours.

The following signs or symptoms should be reported to the physician/nurse:

h. Persistent fever over 102 degrees Fahrenheit

i. Persistent bleeding with more that ½ cup of bright red blood within 30 minutes or causing choking

j. Severe pain unrelieved by prescribed medication

k. Changes in vision (i.e. double-vision, visual loss)

l. Mental changes (i.e. confusion, slurred speech

m. Neck Stiffness or deep head pain

n. Continued Nausea or vomiting

If you experience difficulty breathing, shortness of breath, or severe bleeding, call 911 or go to the

nearest emergency room immediately.

Over the counter medication and supplies to purchase at your pharmacy while

filling your prescription medication:

1. Afrin (oxymetazoline) topical decongestant nasal spray – to be used for 2-3 days then as needed for 4-

5 days total (Item 1a above)

2. NeilMed sinus rinse kit (Bottle and salt packets) – to be used starting two days after your surgery (Item

1b as above

3. Throat Lozenges – for sore throat (Item 13 above)

4. Stool softener such as Dulcolax, Miralax, or Colace to prevent constipation with narcotic use (Item 9

above)

5. Tylenol (Acetaminophen) – use for mild pain instead of the prescribed narcotics (Item 8 above)

6. Humidifier – to prevent dry mouth and throat during sleep (Item 2 above)

7. Gauze and tape for drip pad replacements – (Item 4 above)

ENT & Allergy Associates , LLP ! 777 N. Broadway, Sleepy Hollow, NY 10591 ! 914-829-5650

Nasal Saline Irrigations

Preparation:

Add approximately 1 cup (8 oz) of distilled or boiled tap water to a NeilMed® Sinus Rinse or equivalent

irrigation bottle. Warm this water to just above room temperature. Now add the contents of a

NeilMed® Sinus Rinse packet (follow packet instructions). Alternatively, you may refer to the recipe

below to make your own mixture.

Irrigation:

While leaning forward with your head over a sink, irrigate one nostril with half of the bottle (4

oz) while aiming the squeeze bottle diagonally (away from the septum in the middle of the nose). Then

irrigate the opposite nostril. It’s sometimes helpful to use the right hand to irrigate the left nostril and

vice versa. If done correctly, the saline solution will cleanse your nasal cavity/open sinuses and exit out

of the opposite nostril and/or mouth. To prevent the solution from passing into your mouth and throat,

its best to focus on making a “k” sound to close off your palate while you irrigate.

For a video demonstration, go to http://www.neilmed.com/usa/directions-videos.php

Recipe to make your own saline sinus irrigation solution:

1 gallon boiled or distilled H2O (must be sterilized)

4 teaspoons canning/pickling/kosher salt (non-iodized)

4 teaspoons baking soda

Store it in the refrigerator and warm 1 cup (8 oz) to just above room temperature prior to each use.