Recovering After Surgery

What to Expect After Surgery

VENTILATING TUBES/GROMMETS

What should I expect after surgery?
Patients generally recover quickly following insertion of ventilating tubes (grommets) and pain is rarely an issue, however, there may be an unusual sensation in the ear due to the pressure difference.  It is also common for there to be a discharge from the ear for 24 to 48 hours following surgery.  This can simply be the grommets doing their job and does not require any further intervention and will usually settle on its own.

Will there be any pain post surgery?
Grommets are a surgical procedure performed under general anaesthetic, therefore, discomfort, lethargy and perhaps a feeling of being unwell may be experienced for up to 48 hours following surgery. The feeling of pressure or noise is all part of the ears adjusting to the grommets. If there is sharp, unbearable pain and or persistent discharge beyond a week you should call our rooms for follow up.

My ears are discharging with pus and blood. Is this normal?
It is normal to see a small amount of discharge with a mixture of dried blood from the grommets for the first day or two following surgery.  Should the discharge persist or stop then reoccur several days after surgery you should call our rooms for follow up.

My ears feel blocked. Is this normal?
It is normal to experience an unusual pressure sensation in the ears following your surgery.  The ears are becoming accustomed to the new pressure changes and this will usually resolve over the next two weeks after surgery.

What should I do if I have an earache?
If you experience earache after surgery it should resolve itself within a day or two and be managed with over the counter pain medication e.g. paracetamol.  If the pain becomes unmanageable or there is persistent discharge from the ear, you should call our rooms for follow up.

Swimming, bathing and ear plugs after grommets.
We do not recommend any swimming or submerging the ears in water for the first two weeks following surgery.  After two weeks you should wear ear plugs when swimming or submerging the ears in water to prevent water reaching the inner ear.  No protection is needed during baths and showers as long as the ears are not submerged under water.

When can I start getting back to school, sport and work?
Most patients resume their usual activities within two days following their ventilating tube insertion.

When can I fly? Are there any precautions I should take?
You can fly 24 hours following the general anaesthetic.  There should be no problems with pressure equalisation as the ventilating tubes will act as a pressure equalisation valve. However, you may like to use EarPlanes® which are designed to help relieve inflight discomfort.

TONSILLECTOMY & ADENOTONSILLECTOMY

What should I expect after surgery?
Recovery from surgery is different for everyone, however, one thing for sure is recovery from having your tonsils out is very painful and will most likely take two to three weeks for full recovery.  Immediately after surgery and the following day is usually fairly tolerable. It’s when the healing starts that the level of pain and discomfort increases. The toughest time is between day four and day eight.  During that period the pain level will increase considerably and that’s quite normal. Furthermore, it will be extremely painful and difficult to swallow and pain management most likely less effective.  From about day eight onwards the pain usually starts to reduce and you will recover more rapidly, however, expect some pain on yawning or stretching of the jaw for at least a few weeks after this.

How painful will this procedure really be?
Pain thresholds are very individual and vary considerably; however, most people will experience a severe degree of pain following a tonsillectomy (or adenotonsillectomy).  Before surgery it is difficult to imagine or anticipated the level of pain and discomfort therefore, after surgery the pain experienced can be interpreted as a complication or something wrong, in most cases the healing is progressing normally. What is important is to take pain relief medication regularly and continue to eat and drink as much as possible.

How can I manage the pain?
When you leave hospital you will be sent home with some pain relief medication.
It is important to take this regularly, at least every four to six hours. Taking the pain medication about 20 minutes before eating will help with swallowing. Eating and drinking are essential to a healthy recovery. As time passes the level of pain medication can be reduced to maintain comfort.  If there is persistent pain despite regular pain medication, a local anaesthetic spray such as Diflam Forte Spray can be used, available (without prescription) at your local pharmacy. Chewing gum, sucking a lolly pop and drinking fizzy/carbonated drinks can help with keeping the throat moist and in turn reduce pain.

My breath is very smelly in fact really bad.
Yes it is common to have bad breath for a few weeks after surgery.  This is due to accumulation of bacteria within a sluthy build up.  Sluth is material that collects at the area where the tonsils have been taken from and is quite normal.  By eating and drinking as much as possible, particularly rough foods, the build up of sluth will be reduced and so to the unpleasant bad breath.

My ears are really sore and I have an earache.
Quite commonly pain is referred to the ears and predominately noticed in children tugging, pulling and complaining of sore ears.  This is due to both areas having a common nerve supply.  It is not unusual for the ear ache to be more severe than the throat pain.  Usually, this does not indicate any problem with the ear itself, it is known as referred pain. There is no immediate solution other than the pain relief regime and this will resolve with the healing process.

If I’m vomiting what should I do?
If vomiting persists it is important to try and maintain as much fluid as possible.  The vomiting may well be related to the anaesthetic and should settle down within twenty four hours.  Nausea and vomiting may also be a side effect of the pain medication, therefore, see your GP for alternative pain medication. If the vomiting persists and you are unable to maintain fluid intake you will need to present at the hospital emergency department to be assessed for possible re admission and hydration.

I’ve noticed some bleeding?
The main risk of adenotonsillectomy is bleeding. Bleeds can vary and stop and start over the first few days of recovery and usually involve only small amounts of blood.  Bleeding usually settles down by itself and sucking on some ice will help.  If bleeding persists, with excessive amounts of blood for periods of time you should present at the emergency department for evaluation.

How long before I start feeling better?
As mentioned days four to eight are the hardest days and you should anticipate experiencing high levels of pain. After about eight to ten days the pain will begin to ease and recovery will start to improve.  Typically things have healed up completely by fourteen days after surgery.

When can I start getting back to school, sport and work?
As a guide we advise two weeks off school or work following an adenotonsillectomy.  Sporting activity should be avoided during this recovery period as this may increase the risk of bleeding.  Usually after two to three weeks patients can ease back into their usually activities.

When can I fly and are there any precautions I should take?
We do not recommend flying for the first two weeks after surgery due to the risk of bleeding.  At your post operative visit you can get clearance.  Should there be a specific reason why you need to fly during the first two weeks after surgery discuss this with your surgeon before confirming your surgery.

What can I eat and drink?
Eating and drinking is recommended as soon as the anaesthetic has worn off.  We encourage as normal diet as possible.  The rougher the food, the less sluth collects in the back of the throat.  This will lead to a faster and less painful recovery.  It is important to try and maintain a high food and fluid intake if possible as this reduces the risk of bleeding.  There are no restrictions with the type of food that can be eaten, however, hot spicy foods should be avoided. Chewing gum, sucking a lolly pop and drinking fizzy/carbonated drinks can help with keeping the throat moist and in turn reduce pain.
A good idea is to prepare in advance and stock up with foods that you/patient enjoy. Consider a variety of foods and some favourite foods to encourage eating and drinking especially with the younger patients.

I’m really having trouble getting my child to eat or drink?
It’s very common for children to resist eating and drinking after tonsillectomy surgery. You can help them by preparing small amounts of food they can nibble on throughout the day. Anything is better than nothing. It may be necessary to entice them to eat and drink by preparing more of their favourite food.  Rejecting food and not eating for a couple of days (resulting in weight loss) is not unusual.  However, it is important to maintain fluid intake, otherwise this may lead to dehydration and increases the risk of bleeding.  Sucking on small amounts of crushed ice, room temperature fizzy drinks, lolly pops, honey on a spoon are helpful for soothing the throat area. Pain management is an important step, try giving the medication about fifteen minutes before eating to make swallowing easier.  If your child is resisting pain medication you may need to use some creative strategies to get them to take it. Most important don’t be distressed by their rejection; you will need to keep persisting with your most persuasive techniques for at least the first 10 days post surgery.

Typical symptoms after surgery?
Fever: It is quite common for patients to have a slight fever after surgery.  This does not indicate an infection and is usually associated with the anaesthetic and the removal of the tonsils.

Pain: Generally patients don’t anticipate the level of pain they will experience after tonsillectomy surgery and become concerned that something is wrong. In most cases recovery is on track. As well as extreme discomfort when swallowing, expect to feel generally unwell and lethargic.  Not being able to maintain a normal diet, reduced physical activity and the surgery procedure all contribute to a general feeling of being unwell and lethargy.  Be kind to yourself, rest as much as possible, keep up the pain management routine and maintain food and fluid intake.

Should I be taking antibiotics?
Antibiotics are not given routinely following tonsillectomy.  If there are signs of infection at the time of surgery, you may be discharged home on oral antibiotics.  This decision will be made by your doctor after assessment.

NASAL SURGERY

What should I expect after having nasal surgery?
The most common symptoms include the feeling of a blocked nose, discomfort, and difficulty in breathing through your nose. This is due to congestion and narrowing of the nasal passage reducing air flow (post surgery). There may also be some discharge from the nose and pain in the tip of the nose and this will persist for some weeks after surgery.  You could also experience some bloody discharge from the nose for a few days possibly up to a week after surgery. There will also be a large amount of debris which will be flushed out with the regular nasal douching and you may experience this for a couple of weeks post surgery. If you are having a procedure involving the external aspect of the nose you may be required to wear a splint for the first week following your surgery.  There may also be some sutures inserted under the nose if an open approach is used for the nasal surgery.

How much pain will I be in after surgery?
We all have different pain thresholds and patients should expect to experience some discomfort or pain during the recovery. Often there is some tenderness at the nasal tip, and congestion making it difficult to breathe.  Some patients may experience mild headaches, however, nasal douching, rest and gentle non strenuous activity including taking pain relief medication as required is the best remedy.

When can I blow my nose?
Avoid blowing the nose, and instead use FLO nasal wash to clean and flush the nasal passages.  A nasal wash will be more effective at clearing the congestion within the nose rather than blowing following the operation. The feeling of congestion/blocked nose comes from some internal swelling post your surgery, therefore, blowing the nose will not be helpful.

When can I take the bandage/nasal bolster off?
The bolster is used to collect any blood or mucous that may be dripping from the nose.  When the nose stops dripping you don’t need to use the bolster any more.  It is not essential to wear the bolster, however, this prevents any discharge from seeping on to your face or clothes.  If you have had an external procedure to the nose you may be required to wear a splint.  This is usually kept on for one week following the surgery.

When I left hospital I was given some ointment, what should I do with it?
You may be given ointment following surgery (Chlorsig, labelled eye ointment).  This ointment is for your nose not your eyes.  Apply it twice daily, after your morning and evening nasal wash (douche). Place a small amount on your little finger and gentle rub the inside of the nasal passage. Use the ointment until you run out or your post operative review.

I have an earache/headache/bruising. Is this normal?
It is quite common following nasal surgery for patients to feel blocked in the ears.  This is due to the eustachian tube being blocked.  Also the lining of the nose is often very swollen following the surgery and may block the drainage of your sinuses.  This will give the sensation of facial pressure above, below and between the eyes.  This pressure symptom should be relieved with regular nasal wash.  If you have had a procedure to the external aspect of the nose, it is quite common to have some bruising.  This bruising will usually subside after a couple of weeks.

My eyes hurt. Is this normal?
It is unusual to have eye pain following nasal surgery.  If your vision is affected or there is persistent pain despite pain relief you should seek medical advise.

What should I do if my nose starts bleeding?
It is quite common for the nose to bleed for the first twelve to twenty four hours following surgery.  Regular nasal washes should help to alleviate the bleeding.  If continuous bleeding persists or increases despite regular washes please seek medical advice.  In the short term it is important to pinch the nostrils as low down possible and lean forward to prevent the blood from being swallowed.  Also sucking on ice or applying ice to the back of the head may help ease the bleeding.

When should I start using FLO (nasal wash) and how often?
FLO is an integral part of recovery following nasal surgery.  It should be used the day after surgery and be used at least three to five times a day until your first post operative review.  The more regularly the nose is flushed the quicker it will heal and the less congested the nose will feel.

Can I take decongestants and cold and flu medication?
If the nose is very congested despite regular douching with FLO it is possible to use decongestants.  However, these should only be used for three or four days at a time and not as a substitute to nasal washing.  If there is persistent congestion despite this regimen, please contact your surgeon.

I bumped my nose. Should I be worried?
Generally the structural integrity of the nose is stable following nasal surgery.  If you have had a procedure to the external part of the nose (broken nose) the bones may be still quite mobile and it is important to wear the splint for the first week after surgery.  If there has been significant trauma to the nose and the alignment looks to have changed contact your surgeon as soon as possible.

When can I start getting back to school, sport and work?
It should be possible to get back to work and school one week following your surgery.  It is however recommended that you not perform any major physical exertion for at least two weeks following surgery.  This may lead to increased risk of bleeding from the nose.

When can I fly and are there any precautions I should take?

It is not recommended to fly within four weeks following your surgery.  This is due to the congestion within the nose which may make it difficult to equalise pressure in the sinuses and the ears during take off and landing.  If it is necessary to fly immediately discuss this with your surgeon at the time of booking surgery. You may need to use ear plugs such as Earplanes to equalise pressure and regular nasal decongestant prior to the flight.  It is also important to ensure that you are chewing on take off and landing to improve eustachian tube function following nasal surgery.

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