Post-Op Instructions

Post-Op Tonsillectomy & Adenoidectomy Instructions

Your child’s adenoid region will heal over a three-week period. Most of the healing is accomplished within the first 7 days.

Pain and Discomfort
It is normal for your child to have bad breath or neck discomfort after surgery. They may experience moderate discomfort or pain in the first 24–48 hours. Generally, the pain is worse at night. This should be controlled with the pain medication prescribed for them (Tylenol with Codeine or Lortab Elixir).

Once the discomfort or pain improves, your child may find that plain Tylenol is sufficient during the day. You should not to give them plain Tylenol within four hours of Lortab or Tylenol with Codeine as these narcotic prescription drugs already contain Tylenol.

In the post-operative period, your child may experience ear pain. Generally, this is referred pain and will resolve as the area heals. Your child may experience some nasal congestion, neck pain or stiffness and headaches in the first week after adenoidectomy.

Nausea
Nausea is quite common after surgery and may be associated with several factors including the anesthetic medication or the pain medication (Codeine or Lortab). Nausea and vomiting generally resolve after the first 12–24 hours.

Here are some tips to help you deal with your child’s nausea:

  1. Avoid giving your child narcotic pain medications on a completely empty stomach.
  2. If nausea or vomiting occurs shortly after a dose of Codeine or Lortab, try giving your child plain Tylenol until the nausea improves.
  3. Some children report small sips of ginger ale or a cola drink helps relieve their nausea. Small portions of bananas, applesauce, moistened graham crackers or soda crackers may be helpful prior to taking medications.
  4. Your child should avoid acidic products such as orange juice.

Fever
A low-grade fever is common, especially in children after anesthesia. This fever typically occurs in the late afternoon or evening and may reach 100°F. Fevers usually improve with prescription pain reliever or Tylenol. For temperatures higher than 100°F, please contact your child’s surgeon or the on-call physician.

Bleeding from the Nose
There is a risk of bleeding during the first three weeks after surgery. The risk is generally highest in the first 24 hours and 7-10 days after surgery when the eschar or scab begins to fall off.

Your child may experience drainage of old, bloody mucus from the nose. Red blood is generally new and you should contact your child’s surgeon if this occurs. Old blood from the nose is generally brown and of less concerning. This should resolve after the first 24 hours.

Bleeding from the Mouth
You should contact your child’s surgeon immediately if your child experiences any bleeding from the mouth or your notice a red or purple clot in their mouth or throat. If you are unable to contact your child’s surgeon immediately then you should call 911 or proceed to the nearest emergency room.

Diet
As a rule, your child should begin with clear liquids such as ice chips or water then advance in color and texture until a soft diet is tolerated. Although fluid intake is important, most patients receive enough intravenous fluid during the operation to last them the first 24 hours following the procedure. If your child is unable to drink after the 24 hours, you should contact their surgeon. Bad breath is common for the first two weeks.

Tips for maintaining fluid intake:

  • Begin with sips of water or ice chips or your child’s favorite juice.
  • Gatorade is an excellent fluid source and may also be frozen in cubes or ice chips.
  • Classic favorites such as popsicles, smoothie, ice cream, frozen yogurt, yogurt, ice cream shakes and other frozen drinks are usually tolerated well.
  • Once your child tolerates liquids then their diet may be advanced. Avoid hot (temperature) liquids or foods. After the first 18 hours, lukewarm foods are allowed. Some suggestions include: lukewarm soup, pasta, eggs or other soft foods.
  • A soft diet is generally helpful for the first week.
  • Do not let your child eat sharp foods such as chips.
  • Your child may brush the front of their teeth but they should not brush the back, as this may promote bleeding.
  • Do not allow your child to run or walk with any objects such as straws in their mouth.

Activity
No strenuous or athletic activity is allowed during the first two and a half weeks after surgery. This includes any activity which may cause a significant elevation in the heart rate or blood pressure. Your child should not participate in gym or PE (physical education) classes during this time.

Travel
During this three-week post-operative period, any travel outside of a 30-minute radius from Santa Barbara is not recommended.

Gargling
Your child should rinse their mouth with cool water or mouthwash.

Medications
Your child should take any medications (pain medications or antibiotics) as directed.

Follow-up Appointment
A follow-up appointment will be made by the nurse and is usually scheduled one week after surgery

Emergencies
If you have any questions or concerns, contact Dr. McCaffery or Dr. Merrin through the main office number at (805) 964-6926. If your child’s doctor is unavailable, an on-call doctor will be listed on the office message.

If you are unable to contact the doctor and there is an emergency, you should call 911 or proceed to the nearest emergency room.

Post-Op Ventilation Tube Surgery Instructions

A ventilation tube was placed in your child’s eardrum. You cannot see the tube.

Ear Drainage
It is normal to have a small amount of bloody or milky drainage from your child’s ear canal. This will persist as long as your child uses the ear drops given to them after surgery. Drainage usually stops within 24 hours of the last use of the ear drops. If desired, you may place a small piece of a cotton ball in each of your child’s ear bowls to catch any drainage.

Occasionally, children will continue to experience drainage from their ears several days after the drops are discontinued. If this occurs, you should call the office for an appointment.

Fever
It is normal for your child to have a low-grade fever up to 100°F in the first 24 hours following anesthesia. If your child is eating well and acting normal, then the fever may be relieved with Tylenol (acetaminophen). You should contact your child’s doctor if they have a fever above 100°F or if the fever lasts for more than 24 hours after surgery.

Bathing/Ear Plugs
It is usually best for your child to avoid getting large amounts of water in their ears. A few drops of clear shower water will not cause any harm. If your child tends to go underwater in the tub or stands in the shower stream, you may wish to use a silicon plug (available in most drug stores) or a third of a cotton ball covered in Vaseline as a sealant.

Custom plugs may be made to fit your child’s ear if they swim frequently or are taking lessons.

Travel
While travel within 24 hours of anesthesia is not recommended, there are no specific restrictions. In fact, your child will be more comfortable with elevation changes or airplane flights once the tubes are in place.

Medications

  • Cortisporin Otic Suspension: three drops in each ear, three times a day for three days.
  • Ciprodex: four drops in each ear, two times a day for three days.
  • Plain Tylenol may be used according to the manufacturer’s instructions.

Follow-up Appointment
Please call the office to arrange for your child’s follow-up appointment one to two weeks after their tube placement. If your child experienced hearing loss, a follow-up audiogram may be performed. Keep in mind that young children usually test more accurately with the audiologist in the early mornings.

In rare cases, children with ear tubes may develop ear drainage weeks or months after the initial placement. This is usually associated with a new upper respiratory infection or cold. You should call Dr. McCaffery’s or Dr. Merrin’s office for further instructions. For most, a medication will be prescribed over the phone followed by an office appointment two to three weeks later.

Emergencies
You may contact your surgeon or the on-call doctor at the office number (805) 964-6926.
If Dr. McCaffery, Dr. Merrin or the on-call doctor is unable to be reached, you should call 911 or proceed to the nearest emergency room.

Post-Op Instructions after Sinus/Nasal Surgery

Your nasal passage and/or sinuses will heal over a six-week period. Most healing is accomplished within the first seven to ten days. You should expect to have some stuffiness or nasal congestion.

Pain/Discomfort
You may use plain Tylenol or your prescribed pain medication. You should not take plain Tylenol (acetaminophen) within four hours of taking Tylenol with Codeine, Vicodin, Percocet, Darvocet, or Lortab as these narcotic prescription drugs already contain Tylenol.

Antibiotics and Steroids
Take any antibiotics or steroids as directed. These may be a continuation of the same medications you were on before surgery.

Nasal Drainage
It is normal to have some blood-tinged mucus drain from your nose after surgery, especially in the first 24 hours. Change the nasal dressing as needed to protect your clothing. You should contact your doctor if the dressing is saturated with blood more frequently than every two hours.

Additional Instructions
Keep your head elevated on three to four pillows for the first 36 hours after your operation. Avoid heavy lifting, coughing, athletics or other strenuous activity. Dr McCaffery recommends his patients begin using nasal saline spray two days after surgery, two squirts in each nostril four to six times each day. Dr. Merrin recommends that his patients start using saline irrigation three times a day after surgery.

You will be given specific instructions by your doctor after surgery.

Follow-up Appointment
Your doctor will usually see you one week after your surgery. A specific day with be given to you by the surgical nurse before you leave. If you have nasal packing, it will be removed at this time.

Emergencies
If you have a fever above 100°F, persistent nausea, vomiting or visual changes, contact your doctor immediately. If you have any questions or concerns, contact your doctor through the office number (805) 964-6926.

If Dr. McCaffery, Dr. Merrin or the on-call doctor is unable to be reached, you should call 911 or proceed to the nearest emergency room.