SURGERY
We have put together information on what you can expect when visiting our clinic. Have a read through and if you still have questions you can note them down to ask us when you come in, or give us a call, our friendly team will be very happy to answer any questions you have.
During your consultation your surgeon will discuss your diagnosis, risks, complications, limitations of surgery and the degree of success or likelihood of failure of surgery. You will be asked to sign a surgery consent form, which is published by the Royal Australasian College of Surgeons. NQ ENT staff will prepare a quotation for your surgery which you will be asked to read and sign. Your surgery will not be booked until a signed quotation is received. Your quotation will include your known gap, which is the amount billed directly to your health fund and your health fund is responsible for paying the invoice. Your quotation may also include a gap fee (out-of-pocket costs) which is payable to NQ ENT by you. Each private health fund has their own fee schedule, so it is essential that you have your private health insurance membership when you come for your appointment. Private Health funds are continuously changing their fee schedules, so it is advisable to contact your health fund before your appointment to know precisely what you are covered for.
Your surgery will not be booked until the gap fee is paid.
NQ ENT uses anaesthetists from Northern Anaesthesia and Perioperative Support Services (NAPSS), Townsville Independent Anaesthetists (TIA) and Townsville Critical Care (TCC) and your surgical quotation will outline the date of your surgery and the anaesthetist. It is your responsibility to contact TIA or TCC and to pay their anaesthetic fee prior to surgery. NQ ENT surgeons only perform surgery at the Mater One Pimlico Campus. You will need to complete your Mater One patient registration form and pay your out-of-pocket fees to the hospital prior to your admission.
Post operative guidelines
The following information will help you know what to expect in the days following surgery and is provided as a guide only. Please carefully read the information before calling the surgery as the answer to your query may already be here. Your surgeon may have provided his personal mobile number, however, if you are worried or if it is an emergency, go to the Townsville University Hospital Emergency Department to be assessed by the Emergency doctors. They will contact your surgeon, if not available, an ENT surgeon is always on call.
*IMPORTANT* The Mater Pimlico Campus does not have an on-call ENT surgeon.
MAJOR EAR SURGERY - Cochlear Implantation/
Myringoplasty/
Tympanomastoidectomy - WOund Care
Head wrap
If you have a head wrap on this will be removed the morning after surgery to inspect the wound. This will be re wrapped by the nursing staff and you will be given some supplies. Generally, the surgical wound will be covered in glue. This will feel crusty if you touch it. When you leave hospital please leave the dressing on for 48 hours. If it falls off re-wrap it. You can take it off after 48 hours and then just wear it at night time to prevent accidental pulling of the ear forward. The dressing should be firm but not so tight as to cause injury.
Packing
You will typically have an ear that is filled with an antimicrobial cream and 1-2 packs in the outer ear. Sometimes this pack will be stitched together with a black string so you can remove it yourself if you live out of town. Once you get home after the head wrap comes off start using the drops prescribed to keep the pack moist. Most of the drops will not penetrate the ear canal. Continue these drops twice a day until you see Dr Anderson. If the packs fall out don’t be concerned just continue the drops.
What should I expect after surgery?
Pain
Usual pain is not severe but with the dressing the ear may throb. Keep your head elevated to minimize swelling. A recliner works well, or adding an extra pillow on your bed is adequate. Usually once the head wrap comes off this settles. Mild pain can be treated with paracetamol and ibuprofen. Occasionally, stronger pain relief may be required. There may be occasional fleeting, stabbing pain in the ear up to one week after surgery. Analgesics will be prescribed, if they are necessary. Let Dr Anderson know if your pain is getting progressively worse.
Swelling
Swelling after any incision is common. Sometimes your ear will protrude as a result.it should subside over a period of several weeks. It may also be noticed that there is some numbness over the top of the ear after the bandages have been removed. This is the result of bruising of the sensory nerves to the ear as a result of the incision. This numbness will gradually subside over a period of several months.
Dizziness
The hearing organ and balance organ are all part of the inner ear system. While unusual some patients may experience this in varying severity after surgery. The vast majority is minor and recovers with resumption of normal activity. While you recover if you are experiencing dizziness it is important that you don’t fall. Take care with steps and in the shower. Its best that if you experience this that a family member or friend stays with you to help you. YOU CANNOT DRIVE IF YOU FEEL DIZZY.
Hearing
Hearing is not assessed until 3 months after surgery. Before this time you will notice crackling and popping in your ear. You will notice your hearing fluctuate during this time, as the dissolvable packing in your middle ear and outer ear clears.
Discharge and smell from the ear.
Your ear will be packed with antibiotic cream that will come out as you use the drops this is normal.
Common Questions
Can I wear my glasses?
You may wear your glasses but they should be taped up so they don’t rest on the incision.
When Can I return to Exercise?
Avoid extreme physical activity, including athletic activities. You may resume light walking three days after surgery. Aerobic exercise, weight training, heavy lifting, and straining may be gradually resumed two weeks after surgery.
When Can I get the ear wet?
Please avoid direct water exposure to the ear canal until you see Dr Anderson. Usually Dr Anderson allows return to unrestricted swimming 4 weeks after surgery. You can use a wet clean towel to clean the external ear canal of crusting and any dried blood. If you have an incision behind the ear this is covered in Glue that may feel crusty. You can wash your hair with care not to get this area wet for 1 week. Be careful not to bend the ear forward.
When can I drive?
You can return to driving once you have not required oxycodone for 24 hours and you have no imbalance and can look left and right quickly without feeling dizzy.
What if I sneeze?
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. If you feel you are getting a cold start using a nasal decongestant for a short period to help this. If you have to sneeze, please do it with your mouth wide open to avoid pressure build up in your ear.
Grommet insertion
Pain relief and diet
The recovery from Adenoidectomy and Grommet insertion is generally brief and well tolerated. Most patients will have no significant discomfort, acting and feeling normal within hours of the procedure. Panadol is usually all that is required for pain relief. Oxycodone will also be provided if needed. Your child can return to a normal diet immediately
Ear Drops
Please use the antibiotic ear drops as given or prescribed 2-3 drops in each operated ear, 2 times a day for 3 days. Keep the ear drop medicine in a cool, dark place until it expires, as it may be used to treat future infections in the unlikely event they occur.
Post-Operative Grommet Drainage
You may commonly see drainage from the ears for several days, and this may be bloody. This is quite normal and should not be alarming unless it persists more than 5 days or is accompanied by increasing pain. Children may commonly pull at or gesture towards their ears for some weeks after the operation. This is generally because they are continuing a learned behaviour from when their ears hurt them, or because they are irritated by the much louder environment they experience when their hearing improves after the operation. In either case, the behaviour will decrease and stop with time. It rarely indicates infection.
Grommets and Swimming
There are often questions regarding water exposure. Note that only a minority of patients will experience complications from water exposure so Dr Anderson does not recommend any special water precautions, unless the patient experiences pain with water exposure or has frequent drainage with water exposure. You should avoid deep diving with grommets and dunking in soapy water.
Physical Activities
After this surgery, children should rest but may play inside for one or two days. After this return to normal activity.
Tonsillectomy
Diet
The more your child drinks, the sooner the pain will subside. Oral intake is encouraged from immediately after surgery. There are no restrictions to food after a tonsillectomy. Water, apple juice, and Gatorade are excellent sources of liquid. Soft foods such as ice cream, yogurt, pudding, apple sauce and sandwiches should also be encouraged. Other soft, easily chewed foods are also excellent. Avoid hot or spicy foods, or foods that are hard and crunchy. Often, chewing gum speeds comfortable eating by reducing the spasm after surgery and can be started any time after surgery.
Physical Activities
After this surgery, children should rest but may play inside after one or two days and may be outside after three or four days, if they feel up to it. Strenuous physical activity following surgery is discouraged for the first 2 weeks. Children may return to school whenever comfortable; 10 days is average, but 14 days is not unusual.
Pain
For the first several days (occasionally up to 10 days) following surgery, pain in the throat is to be expected. Pain will often get worse on days 3 to 5. This can usually be controlled with Liquid paracetamol and oxycodone. Difflam spray is often helpful for local pain control. Avoid medication containing aspirin. Ibuprofen and anti-inflammatory medication provide good pain relief but should be stopped if there is any bleeding. Pain is often worse at night and may prompt the need for additional pain medication. Ear pain, especially with swallowing is also a common occurrence; it is not an ear infection but due to referred pain from the surgery.
Fever
A low-grade fever following surgery may occur and should be treated with Paracetamol. Follow the directions on the bottle. While children have a fever, they should play quietly or remain in bed. If the fever persists (more than two days) or if a higher fever develops, call. Fever may indicate that you have not taken in enough fluids or may have an infection.
Bleeding
Post-operative bleeding is unusual, but it can occur up to two weeks after surgery. For this reason, you must remain within one hour of Townsville. Most bleeding is minor, and you may only see a little coating of blood on the tongue. Most can be treated with observation. Watch for spitting, coughing, or vomiting of blood. If you suspect bleeding following surgery, call immediately if you cannot contact Dr Liebenberg go to The Townsville Hospital Emergency Department.
Nausea and Vomiting
Some patients experience nausea and vomiting after the surgery. This usually occurs within the first 24 hours and resolves on its own after the effects of anaesthesia wear off. Contact Dr Liebenberg if there are signs of dehydration (urination less than 2-3 times a day or crying without tears).
There is a scab in the back of the Throat?
A scab will form where the tonsils and adenoids were removed. These scabs are thick, white, and cause bad breath. This is normal. Most scabs fall off in small pieces five to ten days after surgery.
CAUTERY OF INFERIOR TURBINATES, TURBINOPLASTY OR ADENOIDECTOMY
Pain relief and diet
The recovery from Turbinate Surgery/ Adenoidectomy is generally brief and well tolerated. Most patients will have no significant discomfort, acting and feeling normal within hours of the procedure. Panadol is usually all that is required for pain relief. Ibuprofen can be used after the first 24 hours. Oxycodone will also be provided if needed. Your child can return to a normal diet immediately.
Post-Operative Turbinate surgery swelling
In the days after turbinate surgery it is common to have swelling of the lining of the nasal cavity. This is common and will last approximately one week.
Post-Operative Nasal Bleeding
Nasal bleeding is common after turbinate surgery. It is usually short lived and easy to control with sitting up, gentle pressure and pinching of the soft part of the nose (not over the bridge). You will have a script for Nasolate cream. Normally this is used twice a day for 1 week. If you have some bleeding you can add some more cream between doses.
My child has a funny smell after the Adenoidectomy?
Occasionally your child will have bad breath after the adenoidectomy. This occurs occasionally and for this reason oral antibiotics are given to reduce the smell.
When can I start to blow my nose?
You can blow your nose gently straight away. Due to swelling you may not achieve a great deal but over the course of the week it will gradually improve.
Physical Activities
After this surgery, children should rest but may play inside for one or two days. After this return to normal activity.
MAJOR SINUS SURGERY & SEPTOPLASTY
Bleeding: It is normal to have some bloody discharge for the first 3-5 days after sinus surgery, especially after you irrigate your sinuses. If steady bleeding occurs after surgery, tilt your head forwards slightly and pinch your nose gently. Don’t dab your nose use a nasal bolster.
Pain: You should expect some nasal and sinus pressure and pain for the first several days after surgery. This may feel like a sinus infection or a dull ache in your sinuses. Panadol is often all that is needed for mild post-operative discomfort. If Panadol is not enough to control the pain, you should use the post-operative pain medication prescribed by Dr Liebenberg.
Nasal congestion and discharge: You will have nasal congestion and discharge for at least the first 2 weeks after surgery. Your nasal passage and breathing should return to normal 4 weeks after surgery.
Postoperative visits: Please call the rooms for an appointment to see Dr Liebenberg 2 weeks after surgery. During this visit any residual packing and crusting will be removed.
What to Avoid After Endoscopic Sinus Surgery:
Nose Blowing and Straining: You should avoid straining, heavy lifting (> 10kg) and nose blowing for at least 7 days after surgery. Straining or nose blowing soon after surgery may cause bleeding. You can resume 50% of your regular exercise regimen at 1 week after surgery and your normal routine 2 weeks after surgery.
Aspirin: should be avoided for 2 weeks after surgery, however in certain heart conditions it may be necessary to use after surgery. Ask Dr Liebenberg advice in this regard.
Non-Steroidal Anti-inflammatory (NSAIDs) medications: NSAIDs such as ibuprofen are often used for post-operative pain control. Please discontinue use if persistent and heavy nose bleeding occurs.
Postoperative Care Instructions:
Sinus Irrigations: You will start the sinus irrigations with the sinus rinse kits (Flo Post-Operative Sinus Rinse Kit) the day after surgery. This must be performed at least twice daily. Your doctor or nurse will show you how to perform the irrigations. At first, they will feel strange if you haven’t done them before. Soon, however, they will become quite soothing as they clean out the debris left behind in your sinuses after surgery. You can expect some bloody discharge with the irrigations for the first few days after surgery. These irrigations are critical for success after sinus surgery! Apart from the powdered sachets, medications such as Pulmicort can be added.
When to Call After Surgery:
- Fever after the day of surgery higher than 38 degrees;
- Sudden visual changes or eye swelling, severe headache or neck stiffness;
- Severe diarrhea;
- Steady, brisk nose bleeding that doesn’t get better with the above.
