Rocky Mountain Ear, Nose & Throat

TEL: (303) 795-5587
200 W. County Line Road, Suite 330
Highlands Ranch, CO 80129

Surgery Information

Information about Your Surgery

Here you will find helpful information and for common surgical procedures we perform. If you have any questions about your surgery or after-surgery care, please call us.

Note: This material is provided for informational purposes only. Your particular case may require individualized instructions. When there is a discrepancy, follow the instructions given to you at the time of your surgery.

If you are scheduled for surgery or have had surgery, you should have a follow-up appointment scheduled. In general this should be 1-2 weeks after surgery, but may vary depending on the procedure. If you need a follow-up appointment, call the office (303-795-5587) to schedule one. If there is an emergency, call the office immediately, dial 911, or proceed to the nearest emergency room.

Tonsil and Adenoid Surgery

Nasal and Sinus Surgery

Other


Adenoidectomy without Tonsillectomy

Surgery on the adenoids is indicated most commonly for enlarged and obstructive adenoids, ear infections, and chronic adenoid infection.

This surgery is performed under general anesthesia. The adenoids are removed through the mouth with various instruments to cut and cauterize tissue (stop bleeding). Usually the surgery takes around 15 minutes. Usually patients can go home within an hour or so after surgery.

Some pain may be experienced after surgery, but it is typically mild to moderate, and easily controlled with medications such as Tylenol and Ibuprofen. Sometimes, a prescription pain medication may be needed, but this is infrequent. Also common after surgery is a low-grade (less than 101 F) fever. Some bad breath is common as well as the areas are healing.

General Instructions for After Surgery

  • Diet: Avoid eating if your stomach is unsettled. Nausea is fairly uncommon after general anesthesia. A soft diet for 24 hours is recommended, then a regular diet may be resumed if tolerated. It is very important that you/your child consume adequate amounts of fluids to avoid dehydration.
  • Activity: Avoid strenuous activity for 24 hours. After that, you/your child may resume normal activity as tolerated.
  • Bleeding: Any signs of frank bleeding should be immediately reported to your surgeon. Significant bleeding is rare after adenoidectomy alone.

Tonsillectomy with or without Adenoidectomy

What are the tonsils and adenoids?

Tonsils and adenoids are similar to the lymph nodes (sometimes erroneously called "glands") in the neck, groin, and armpits. Tonsils are two round lumps in the back of the throat. Adenoids are high in the back of the throat behind the nose, and are not normally visible through the mouth. Both tonsils and adenoids "sample" bacteria and viruses that enter the mouth or nose and are part of the immune system. Sometimes, however, they can become more of a liability than an asset.

The most common reasons to remove the tonsils and/or adenoids are:

  • Infection - either recurring infections or a chronic infection that never clears up completely. Examples are tonsillitis, sinus infections, ear infections.
  • Enlargement causing obstruction - e.g. nasal obstruction, mouth-breathing, snoring, sleep apnea, swallowing problems.

Other problems with the tonsils that may require treatment:

  • Abscess around the tonsil (peritonsillar abscess)
  • Cancer or suspected cancer of the tonsil
  • Tonsilloliths (tonsil stones) - collections of white debris within pockets of the tonsils that is foul-smelling and can cause bad breath and chronic irritation.
  • Surgery is indicated when the above problems are excessive and/or not easily managed with medications.

Tonsillectomy (removing the tonsils) and Adenoidectomy (reducing/removing the adenoids)

This surgery is performed under general anesthesia. There are many ways to remove tonsils, but typically an instrument that both cuts tissue and cauterizes (stops bleeding) is utilized. The tonsils are removed through the mouth by using an instrument the hold the mouth open and keep the tongue out of the way. You should let your doctor know if you/your child has any loose teeth, as these can potentially be dislodged by this instrument. Most commonly, no stitches are placed. The "raw" areas where the tonsils used to be will form a white/gray coating/scab during the healing process and will heal on their own. The adenoids are removed through the mouth as well with similar instruments. Usually the surgery takes around 20 minutes. Usually patients can go home the same day. In some situations, admission to the hospital overnight may be indicated.

Pain is common as the areas in the throat are healing, and usually requires prescription pain medication. It is common for this pain to radiate to or be felt in the ears. Typically, pain peaks around day 4-7, then starts to get better. By two weeks, pain level is usually much better. Also common after surgery is a low-grade (less than 101 F) fever. Some bad breath is common as well as the areas are healing.

General Instructions for After Surgery

  • Diet: Avoid eating if your stomach is unsettled. Nausea is fairly uncommon after general anesthesia. A soft diet for 7-10 days is recommended. It is very important that you/your child consume adequate amounts of fluids to avoid dehydration.
  • AVOID: Acidic or carbonated beverages, hot foods/liquids, hard/sharp foods, mouthwash/gargling, red-colored foods/liquids (can lead to confusion about bleeding).
  • Activity: Avoid strenuous activity for 7-10 days.
  • Bleeding: Any signs of frank bleeding should be immediately reported to your surgeon, and you should proceed to the nearest emergency room.

Septoplasty (Correcting a Deviated Nasal Septum)

Deviated Nasal Septum

A common abnormality inside the nose is a bent or deviated septum. The nasal septum is the wall that divides your nose in half. It serves to help streamline airflow through the nose. The structure of your septum is part cartilage, part bone. Kinks, prominent areas, or bends in the septum can cause blockage or turbulent airflow, causing you to feel like one or both sides of your nose is blocked much of the time. This can also contribute to nose bleeds because the turbulent airflow dries out the nose. It can also be a site of obstruction that contributes to snoring. Often, because this is a structural problem, medications (nasal sprays, allergy medications) do not provide enough relief in symptoms.

Septoplasty (surgery to correct a deviated septum)

Septoplasty is most commonly performed under general anesthesia, and usually takes around 30 minutes to perform. It is an outpatient procedure, meaning you should go home the same day. It is performed through a small incision placed just inside the nose on one side. The bent portions of cartilage and bone can then be removed and/or reshaped with the goal of making the septum straight and positioning it properly in the midline (middle) of your nose. There should not be any change in the external appearance of your nose. Likewise, there should not be any external swelling or bruising after the surgery. You will most likely have a plastic splint inside each side of your nose after surgery, and these will be removed easily in the office around 1 week after surgery. You should expect mild to moderate pain after surgery, which may require prescription pain medications. Also, there will be significant nasal congestion during the initial healing phase, especially until the plastic splints are removed.

General Instructions for After Surgery

  • Diet: Avoid eating if your stomach is unsettled. Nausea may occur after general anesthesia, and appetite usually returns within 24-48 hours. When you feel up to it, start with liquids and increase as you can tolerate. You may resume a regular diet when your stomach allows it.
  • Activity: Avoid strenuous activity for 2 weeks. Keeping your head elevated for the first 3 days can help with discomfort due to swelling and help decrease bleeding. Avoid blowing your nose for 5 days after surgery.
  • Moisturization: At the minimum, use a saline mist/spray 4 times a day for 2 weeks after surgery. If you can tolerate it, use gentle saline rinse after 24 hours to help flush out clots, crust, etc. A humidifier at your bedside at night can help as well.
  • You may use a topical decongestant such as Afrin or Neosynephrine, or an oral decongestant such as Sudafed, as needed for congestion after surgery. This can be used for up to 3 days.

Turbinate Reduction Surgery

Enlarged Turbinates (Turbinate Hypertrophy)

The nasal turbinates are projections of tissue inside the nose that serve to moisturize and warm the air as we breathe. They swell in response to many things, such as irritants or allergies, or temporarily with a viral infection (a cold). If they are causing obstruction of the nose, this may be improved with allergy medications or nasal sprays. If these measures fail, a conservative surgery to reduce the size of the turbinates can help.

Turbinate Reduction Surgery

Over-aggressive reduction or removal of the turbinates is not recommended, especially in the dry climate here in Colorado. A minimally invasive reduction in the turbinate size can help many patients with nasal obstruction. There are many techniques to do this, such as using energy delivered through a needle-like instrument to deliver gentle heat to the tissue under the surface of the turbinates, thereby causing some contraction of the tissue as it heals. Another technique uses an instrument that actually removes some of the tissue under the surface. While it takes a few weeks to get the full benefit from this procedure, recovery from the operation is very quick. Typically some minor oozing for a day or so after surgery and some minor crusting can be expected. Most often, no packing is left in the nose. This procedure may be performed along with other nasal surgery.

General Instructions for After Surgery

  • Diet: Avoid eating if your stomach is unsettled. Nausea may occur after general anesthesia, and appetite usually returns within 24-48 hours. When you feel up to it, start with liquids and increase as you can tolerate. You may resume a regular diet when your stomach allows it.
  • Activity: Avoid strenuous activity for 1 week. Keeping your head elevated for the first 3 days can help with discomfort due to swelling and help decrease bleeding. Avoid blowing your nose for 3-5 days after surgery.
  • Moisturization: At the minimum, use a saline mist/spray 4 times a day for 2 weeks after surgery. If you can tolerate it, use gentle saline rinse after 24 hours to help flush out clots, crust, etc. A humidifier at your bedside at night can help as well.
  • You may use a topical decongestant such as Afrin or Neosynephrine, or an oral decongestant such as Sudafed, as needed for congestion after surgery. This can be used for up to 3 days.

Functional Endoscopic Sinus Surgery (FESS)

Blocked Sinus Passages

Blockage of any of the drainage pathways in the sinuses can cause frequent or chronic sinus infections. Sometimes these can be treated with medications alone (antibiotics, nasal sprays, allergy medications). When medications do not provide the needed relief, surgery may be indicated to open up blocked sinuses. Which sinuses to open depends on symptoms as well as findings on CT scan. In certain cases, patients are candidates for a minimally invasive technique called Balloon Sinus Dilation, which can be performed without general anesthesia in the office. Other times, more traditional sinus surgery in the operating room may be needed.

Functional Endoscopic Sinus Surgery (FESS)

FESS is usually performed under general anesthesia. Small endoscopes are inserted into the nose to visualize the sinus passages. Various small cutting instruments are used to selectively remove tissue and thin bone fragments to make the natural drainage pathways of the affected sinuses larger. In some cases, an Image Guidance system may be used, which precisely localizes the surgical instrument on the patient's CT scan in real time. Once the sinuses are open, any significant polyps are removed, and the sinuses are cleaned out. Some absorbable packing material may be left inside the sinus cavity after surgery to help with bleeding and the healing process. With current techniques, it is rare to require any packing that needs to be removed (although this was common many years ago). There will be some minor oozing after surgery, but significant bleeding is not common. There may be some crusting that builds up in the sinus cavity as healing occurs, and this may require one or two "cleanings" in the office in the weeks after surgery. The more you can do to keep your nose moist (saline spray, saline rinses) after surgery, the less cleaning will need to be done.

General Instructions for After Surgery

  • Diet: Avoid eating if your stomach is unsettled. Nausea may occur after general anesthesia, and appetite usually returns within 24-48 hours. When you feel up to it, start with liquids and increase as you can tolerate. You may resume a regular diet when your stomach allows it.
  • Activity: Avoid strenuous activity for 2 weeks. Keeping your head elevated for the first 3 days can help with discomfort due to swelling and help decrease bleeding. Avoid blowing your nose for 5 days after surgery.
  • Moisturization: At the minimum, use a saline mist/spray 4 times a day for 2 weeks after surgery. If you can tolerate it, use gentle saline rinse after 24 hours to help flush out clots, crust, etc. A humidifier at your bedside at night can help as well.
  • You may use a topical decongestant such as Afrin or Neosynephrine, or an oral decongestant such as Sudafed, as needed for congestion after surgery. This can be used for up to 3 days.

In-Office Balloon Sinus Dilation

Balloon Sinus Dilation

Balloon sinus dilation is most commonly performed in the office with local anesthesia. The procedure involves placing a device through the opening of your nose, which is then gently guided into the opening of the affected sinus(es). A balloon is inflated in the natural opening of the sinus to remodel the surrounding tissue to widen the drainage pathway. For more information about this new technology, see the Balloon Sinus Dilation page under Patient Information.

What to Expect During the Procedure

The procedure generally consists of two phases:

Application of local anesthesia

(usually takes around 15-30 minutes)

When you first arrive for your procedure, expect the nurse to spray some medicine in your nose. This starts the numbing process. It also contains a decongestant to open up your nose and make access to the sinuses easier. It is common for your throat to feel a little numb as you swallow some of this medicine. Next, your physician will use a small endoscope to look inside your nose. Small sponges called "cottonoids" soaked in the same numbing medicine and decongestant will then be placed inside your nose. These will be left in place for a few minutes. Then, your physician will likely inject additional numbing medicine at strategic points inside your nose. Occasionally this step is not needed. This medicine contains adrenaline, which helps to constrict blood vessels and minimize bleeding. Because of this, you will likely feel like your heart is racing. Don't worry, this effect wears off quickly. Because of the cotton pieces that were placed in your nose, the injections should not cause much pain.

Dilation Procedure

(times vary, but usually around 30 minutes)

First, a small tool may be inserted into your nose to seek the natural opening to your sinus. This will also make sure you are sufficiently numb. The XprESS device will then be inserted into your nose and directed into your sinus. After confirming correct placement, the balloon will be positioned and inflated for a few seconds, then deflated. The inflation will likely be repeated a few times. As the tissue is remodeled, you will likely feel a fair amount of pressure, which may be mildly uncomfortable, but this will pass quickly. Also, you may hear some popping and crunching sounds. This is the thin bone around your sinus opening being remodeled, and is a completely normal part of the procedure. Your physician may then "flush" out your sinus with saline. This may collect in the back of your throat, and it is perfectly fine to swallow this solution - it is harmless. The above procedure will be repeated for each sinus that is being dilated.

What to Expect After the Procedure

  • Most patients can return to normal activity within 1-2 days, many within 24 hours.
  • Even if you feel up to it, avoid strenuous activity or heavy lifting for 48 hours.
  • Minor nose bleeding is common in the first few days after the procedure. You can use over-the-counter Afrin (oxymetazoline) for up to 3 days to help with any oozing or nasal congestion.
  • Avoid blowing your nose for 48 hours after the procedure. If you sneeze, do so through your mouth instead of your nose. If you accidentally blow your nose or sneeze during this period, you may get some air in your cheek or face, which will cause it to appear puffy. This should dissipate within a day or two. Call your physician with any concerns.
  • You may sniff inwards through your nose as much as you want.
  • Sleep with your head elevated for 2 days. This will help with any swelling and discomfort.
  • Rinse your nose with saline 2-3 times per day.
  • Pain is typically mild after the procedure, and can be controlled with Tylenol and Ibuprofen. Sometimes, prescription pain medication may be required.
  • You may resume a regular diet after the procedure.

Ear Tubes

Ear Infections

Ear infections (acute otitis media) are extremely common in children. By the age of five, nearly every child has had at least one ear infection. Most ear infections either resolve on their own (especially if viral) or are effectively treated with antibiotics (bacterial). But sometimes ear infections become especially frequent, or the fluid persists in the ear and becomes chronic, lasting for weeks. In these cases, other problems such as hearing loss, speech problems, or behavior problems can result, and insertion of ear tubes may be considered. Sometimes, a hearing test and tympanogram can help with the diagnosis of fluid in the middle ears.

What are ear tubes?

Ear tubes are tiny cylinders placed through the eardrum to allow air into the middle ear. The underlying problem in most of these ear disorders is dysfunction of the Eustachian tubes, which connect the middle ear space (behind the eardrum) to the nasopharynx (back of the nose). Normally, the Eustachian tubes should allow the pressure in the middle ear to equalize with the pressure in the external environment. Placement of ear tubes bypasses the problematic Eustachian tubes and allows ventilation of the middle ear. The tubes typically stay in place for 9 months and will fall out by themselves.

What are the benefits of ear tubes?

Insertion of ear tubes may:

  • Significantly reduce the frequency of ear injections
  • Restore hearing loss caused by middle ear fluid
  • Improve speech problems and balance problems
  • Improve behavior and sleep problems caused by repeated ear infections

Ear Tube Surgery (Myringotomy with tube placement)

Children: Brief general anesthesia (3-5 minutes), usually by gas administered through a mask, is needed. Typically there is no need for an IV, unless other procedures are also being performed. The recovery is very quick and most children are on their way home in less than 30 minutes.

Adults: Often tubes may be placed under local anesthetic (small amount applied to the eardrum) in the office.

Using a microscope, a tiny incision is made in the eardrum, any fluid is suctioned out, and the tube is placed. Some eardrops may be applied to help keep the tube from clogging, and often these will be continued for a few days after surgery. There is usually minimal pain after surgery. Children may be fussy for the first day or so. There may be minimal blood or blood-tinged fluid in the ears.

General Instructions for After Surgery

  • Diet: Normal diet as tolerated.
  • Pain is usually minimal, however, Tylenol or ibuprofen should be adequate.
  • Activity: May resume normal activity as tolerated.
  • Water Precautions: Generally, no special precautions are needed during normal bathing or even getting in a swimming pool. You should use ear plugs when swimming in untreated (e.g. lake) water, or if you plan to submerge your head completely underwater. Some children may develop drainage (infection) from the tube even with minor water exposures, and if this occurs, stricter water precautions may be recommended.

Face or Neck Incisions

Skin Incisions

Skin incisions are required for many of the surgeries we perform. For the best strength and cosmetic appearance, these are typically closed in layers, meaning there are one or more layers of absorbable stitches placed under the skin. Sometimes, the final layer may also be absorbable stitches, while other times, you may have stitches that need to be taken out. This is usually done around 5-7 days after surgery, but specific instructions should be given to you the day of surgery.

Care for your incision

Keep the incision dry for the first 24 hours, unless otherwise instructed. After this, you may get the incision wet in the shower, but avoid submerging the incision or allowing direct spray from the shower. Gently pat the incision dry. Apply a layer of antibiotic (e.g. Bacitracin) ointment 2-3 times per day for the first week. You may cover the incision with a clean bandage if desired, but this is not required. Monitor for signs of infection: increasing redness, warmth, swelling, pain, or drainage. Infections typically do not develop immediately, but take a few days to show signs. Notify your surgeon promptly should any of these signs appear. Avoid any trauma to or stretching of the incision.

The healing process

The majority of healing occurs over the first 6 weeks after surgery, but the scar continues to mature over several months. The final appearance will be improved if you minimize sun exposure to the area. Use sunscreen (after 2 weeks from surgery) and protective clothing/hats whenever possible.

Drains

Sometimes a drain may be left in place after surgery, to prevent blood and fluid from building up under the skin. You should receive instructions on taking care of the drain and emptying it on the day of surgery. Empty and record the drainage amount every 12 hours. Typically, the drain is ready to be removed when output is less than around 30 milliliters in a 24 hour period. You may be given a pre-scheduled appointment for removal, or you may be asked to call when the output reaches a low enough level. The drain is held in place by a stitch placed through the skin. You should keep the tubing protected from accidentally catching it on anything, especially while sleeping.


Middle Ear and/or Mastoid Surgery

Chronic Ear Disease

Chronic ear disease (chronic otitis media) most commonly results from longstanding Eustachian tube dysfunction or hole in the eardrum that allows contamination of the middle ear space with bacteria, leading to recurrent or chronic drainage and infection. This may be associated with varying degrees of hearing loss, either due to the size of the hole in the eardrum, scarring, or due to destruction/erosion of the delicate bones of hearing. Surgery is recommended most commonly for one or more of these reasons:

  • Hearing loss
  • Persistent or recurrent drainage
  • Inability or unwillingness to keep water out of affected ear

Sometimes, there may also be abnormal growth of skin into the middle ear (space behind the eardrum) and/or mastoid (air-filled bone behind the ear), which is called cholesteatoma. When cholesteatoma is present the ear is considered “unsafe,” and surgery is generally recommended. Left unchecked, cholesteatoma will likely continue to grow and cause increasing problems with hearing loss, drainage, potential balance problems, and even devastating problems like a brain abscess or meningitis.

What happens during surgery?

Surgery is performed under general anesthesia. For certain cases, only a small incision inside the ear canal and a small incision behind the ear may be needed. For many cases, a slightly larger incision behind the ear is used. A piece of fascia (muscle sheath tissue) from one of your chewing muscles may be harvested to repair the eardrum. In certain cases, the bone behind your ear may need to be drilled down (a mastoidectomy) to improve exposure. If there is erosion of one or more of your bones of hearing, these may be replaced with a synthetic prosthesis. In cases with significant disease present, this reconstruction of the hearing bones may require a second surgery several months later.

General Instructions for After Surgery

1. If you have a large, white dressing covering your ear, remove it on the first day after surgery. The dressing with the gauze inside is meant to collect any bloody discharge from the ear. The cotton ball in your ear should be changed twice daily until the drainage stops. There will be a discharge from the ear that can persist up to 10 days following surgery. If this discharge increases in amount or starts to develop an odor, please contact your surgeon.

2. A dry wash cloth should be pressed firmly against the head covering the ear to keep the incision & ear dry while showering. Do not shampoo for 1 week.

3. It is important that water be kept out of the ear until it is healed. This is accomplished by putting a plug of cotton covered lightly with Vaseline in the ear while shampooing or showering.

4. Some bloody or watery drainage from the incision behind the ear may occur for the first 10 days following surgery. Leave steri-strips over the incision behind the ear to collect any discharge. If the wound becomes red and swollen, please contact your surgeon as this may be a sign of infection. Do not blow your nose for three weeks following surgery. Any accumulated secretions in the nose should be expectorated through the mouth to avoid infecting the ear. If you do sneeze or cough, open your mouth wide during the episode to relieve the pressure through the nose. A “full” sensation in the ear with occasional popping sounds may be noticed during the healing process and this will resolve over time.

5. No airline travel should be undertaken for the first 6 weeks.

6. It may take 6-8 weeks following your surgery before you will notice a difference in your hearing.

7. No swimming, aerobic exercises, or contact sports until approved by your surgeon.

8. Notify your surgeon if you develop a cold or become ill in the first two weeks following surgery.

9. First postoperative appointment: Approximately 7-10 days after surgery. Some packing material may be removed from your ear canal. Further follow-up and instructions will be determined at that time.


Laryngoscopy

What is laryngoscopy?

Direct laryngoscopy is a procedure that allows close examination of the throat and voice box. It also allows procedures such as biopsies, vocal cord injections, or excision of lesions. You may have had a "flexible laryngoscopy" in the office. While this allows a good first look at the throat and voice box, it is very limited in terms of performing procedures. Direct laryngoscopy is performed under general anesthesia so that your gag and cough reflexes can be deactivated. It involves placing a hollow, rigid metal tube (called a laryngoscope) through your mouth and into your throat, which allows a "direct" look at your voice box. Often a camera and video monitor will be used to get an even closure look and document pictures. With certain procedures that require precise and delicate technique to excise lesions from the voice box, a microscope is typically used, along with very tiny instruments or a laser.

Examples of conditions that may require this procedure are:

  • Leukoplakia (white patch) or lesion of the vocal cords or throat
  • Suspected cancer of the throat or voice box
  • Polyps, cysts, nodules, or other benign problems with the vocal cords
  • Paralyzed vocal cord
  • Airway narrowing or stricture

Sometimes esophagoscopy (looking down the esophagus) or bronchoscopy (looking in the air passages to the lungs) may be performed as well.

General Instructions for After Surgery

  • Depending on the procedure, you may or may not be placed on "voice rest." If voice rest is recommended, do not speak or whisper for 24 hours. After 24 hours but for the next 7 days, speak only in a soft, normal voice, and do NOT whisper. Avoid excessive throat clearing and coughing as much as possible.
  • You may cough or spit up some blood-tinged mucous for a couple of days, but you should not have frank bleeding. If you do, this should be reported to your surgeon.
  • It is common to have some soreness of your mouth, jaw, tongue, and throat after surgery. Your tongue may feel a little numb for a few days. This is due to pressure from the laryngoscope. Minor cuts and bruises inside the mouth occasionally occur from placing the laryngoscope, and these will heal quickly on their own.
  • It is common to have a hoarse or raspy voice for a few days to a week or two, depending on the procedure, due to some swelling and the healing process.
  • Activity: You may resume normal activity as tolerated. Generally you will feel tired or run-down for a couple of days after anesthesia, so do not push it.
  • Diet: Avoid eating or drinking if your stomach is unsettled. Some nausea is common in the first day or so after anesthesia. When you feel up to it, start with liquids and progress to your normal diet as you tolerate. It is best to avoid spicy or acidic foods/beverages for a couple of weeks, as this may irritate any healing areas and be painful. Make sure to stay well-hydrated.