Welcome to Hunterdon ENT

Please prepare for your visit by bringing:

• Your health insurance card
• A list of your questions / concerns
• A copy of any x-rays, CT or MRI scans previously ordered.
• We have access to the films online if you had the study performed at Hunterdon Medical Center or one of the Hunterdon Radiology Associates facilities. If you had it done elsewhere, please bring a CD of the images.
• Bring a copy of your blood work, sleep study, or audiogram when appropriate
• Copies or records from doctors related to your problem
• Completed forms

Post-Operative Care

The recovery period, recommendations and what you can expect following your surgery will vary depending on the surgical procedure performed. Please select from the following list of procedures to find the right post-op treatment information.

Endoscopic Sinus Surgery

1. Activity

Light to moderate activity is recommended. Avoid heavy lifting and straining for the first week after surgery. Nose blowing initially should be gentle and minimal. Forceful nose blowing can lead to nasal bleeding. Elevating the head while resting or sleeping may be helpful.

2. Packing

Your surgeon may place packing and/or plastic splints within your nasal cavity after the surgery. Your surgeon will let you know when these will be removed.

3. Nasal Saline Irrigation

Your physician may recommend mechanically cleaning your nose and sinuses with nasal saline. This can remove blood and mucus from the nose and help with healing after surgery. Nasal saline spray is available over the counter. You can also make a saline solution with the following recipe:

1/2 tsp table salt
12 ounces of water (clean tap or boiled water)
Pinch of baking soda

4. Pain

Some pain after sinus surgery is expected. It is generally of moderate severity. Take the pain medicine as prescribed by your physician.

5. Fever

Low-grade temperature after sinus surgery is common. You should notify our office if your temperature is 101ºF or greater.

6. Bleeding

Some bloody nasal and postnasal drainage after sinus surgery is expected. You will receive information before leaving the surgical facility regarding how much bleeding is expected or normal. Call the office if your bleeding becomes excessive.

7. Nausea/Vomiting

Nausea is fairly common after sinus surgery. Most often it improves significantly the day after surgery. You may be given a prescription medicine to help with nausea. Call the office if you need help managing your nausea or vomiting.

8. Vision Changes

Call the office if you have any decrease in vision or double vision. Some mild blurriness after surgery can be related to eye ointment used at the time of surgery.

9. Clear Nasal Drainage

Call the office if you notice a large amount of clear nasal drainage after surgery, especially if it is one-sided and if it varies with changes in position. Very infrequently, a CSF (spinal fluid) leak may occur. Call your physician if you have any concerns about clear nasal drainage.

Tonsillectomy

1. Diet

We encourage patients to drink fluids and start with soft foods after a tonsillectomy. Good hydration will help healing. Patients can advance to more solid foods as tolerated. Due to diet changes and medications, constipation is not unusual.

2. Activity

Light to moderate activity is recommended. Heavy lifting, straining and contact physical activity should be avoided for at least one week following surgery.

3. Pain

Your physician will prescribe pain medication and will advise you regarding non-prescription pain medicines after surgery. Ear pain can be associated with tonsillectomy and should improve gradually with time and healing. Initially pain may be mild, but can worsen later in the first week. After seven to 10 days, the pain should begin to improve. Adults generally take longer to heal.

4. Bleeding

If you experience blood-tinged saliva or a small amount of bleeding, rinse with cold water or ice water. If bleeding continues and is significant, you should call the office at 908-788-9131 and speak with our nurse during regular business hours. If the bleeding is during non-business hours, call 908-788-9131 and have the answering service page the on-call physician. During non-business hours, you may go directly to the hospital emergency department, if the bleeding is significant.

5. Nausea/Vomiting

Some patients can experience nausea and/or vomiting after surgery. Your physician may prescribe a medicine for nausea. Call the office at 908-788-9131 and speak with our nurse if this is a problem.

6. Healing

The back of the throat often has a white or yellow appearance initially after tonsillectomy. Over a few weeks, a normal pink appearance returns. The white or yellow appearance does not indicate infection.

7. Fever

A low-grade temperature is common after surgery. Please contact our office if the temperature is 102ºF or higher and does not respond to ibuprofen or acetaminophen.

8. Voice

Your voice may sound high-pitched or different initially during the healing phase. With time and healing, the voice quality should gradually return to normal. Children who have undergone a tonsillectomy and adenoidectomy may see a change in voice quality due to improved nasal airflow.

Thyroidectomy

1. Diet

Patients may resume a regular diet without special restrictions. Many patients note a scratchy throat from the endotracheal tube for the first day or two and may prefer soft foods initially.

2. Activity

Light to moderate activity as tolerated is fine. Patients may turn their head from side to side and look up and down without any worry about stitches. Heavy lifting, straining and strenuous exercise should be avoided for at least one week following surgery.

3. Pain

Neck pain and neck stiffness are to be expected. Your physician will prescribe a narcotic pain medication. You may use this as prescribed for severe pain. Do not drive while taking narcotic pain medications. Some patients prefer acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) for milder pain control. Narcotics can cause constipation; stool softeners such as docusate sodium (Colace®) can be helpful for this. Please contact our office nurse at 908-788-9131 if any redness, increased swelling or increased pain develops at the surgery site.

4. Medications

Patients should resume all regular medications after surgery.

Thyroid replacement medication: If the patient had a total thyroidectomy, (s)he will need to take a thyroid hormone pill. Your physician will prescribe a starting dose for this medication. The dosage may need to be adjusted and is usually monitored by your family doctor or endocrinologist.

Calcium: If the patient had a total thyroidectomy, your physician may recommend taking calcium pills such as Tums® for a few weeks. Call the office at 908-788-9131 and speak with our nurse to report symptoms of tingling or numbness of the fingertips or around the mouth. These are signs of hypocalcemia (low calcium in the blood).

5. Nausea/Vomiting

Some patients can experience nausea and/or vomiting after surgery. Your physician may prescribe a medicine for nausea. Call the office at 908-788-9131 and speak with our nurse if this is a problem.

6. Bathing

Patients may shower or bathe normally. It is okay to get water on your incision. If you have stitches, it is okay to get them wet. If you have a plastic bandage over your incision, you may get this wet also.

Myringotomy / Tube Replacement

1. Diet

Advance to a regular diet as tolerated. Some people have nausea associated with anesthesia. This should subside in 12 to 24 hours. If not, please contact our office nurse.

2. Activity

There are no restrictions on activity.

3. Pain

Some patients may experience ear or throat pain after surgery. Pain can usually be controlled with over-the-counter medications such as ibuprofen (Motrin®) or acetaminophen (Tylenol®). If over-the-counter medications do not help, please contact our office nurse.

4. Bathing and Swimming Precautions

Bathe and shower as normal after tube placement. Earplugs should be considered for lake or ocean swimming. When swimming in pool water, earplugs are not needed unless there is discomfort from diving or submersion. Earplugs are available in our office if needed.

5. Medications

Antibiotic eardrops are often prescribed after the procedure. Use them as directed. Oral antibiotics are only occasionally prescribed.

6. Ear Drainage

Drainage from the ears can occur after the procedure. The drainage may have a foul odor or may be bloody. Antibiotic eardrops are often used to treat this. Please call our office nurse if there is still drainage after using all the eardrops.

Adenoidectomy

1. Diet

We encourage patients to drink fluids and start with soft foods. Good hydration will help healing. Patients can advance to more solid foods as tolerated, usually later the same day.

2. Activity

Light to moderate activity is recommended. Heavy lifting, straining and contact physical activity should be avoided for at least one week following surgery.

3. Pain

Patients may use ibuprofen (Advil®, Motrin®) or acetaminophen (Tylenol®) for pain.

4. Nausea/Vomiting

Some patients can experience nausea and/or vomiting after surgery. Your physician may prescribe a medicine for nausea. Call the office at 908-788-9131 and speak with our nurse if this is a problem.

5. Healing

The scab is at the back of the nose and not visible in the throat. It is not unusual to note bad breath due to the scab in the nose. This odor does not indicate an infection.

6. Fever

A low-grade temperature is common after surgery. Please contact our office if the temperature is 102°F or higher and does not respond to ibuprofen or acetaminophen.

7. Voice

Your voice may sound high-pitched or different initially during the healing phase. With time and healing, the voice quality should gradually return to normal. Children who have undergone an adenoidectomy may see a change in voice quality due to improved nasal airflow.

Septoplasty / Turbinate Reduction

1. Diet

Patients may resume a regular diet without special restrictions. Many patients note a scratchy throat from the endotracheal tube for the first day and may prefer soft food initially.

2. Activity

Light to moderate activity is recommended. Avoid heavy lifting and straining for the first week after surgery. Nose blowing initially should be gentle and minimal. Forceful nose blowing can lead to nasal bleeding. Elevating the head while resting or sleeping may be helpful.

3. Packing

Your surgeon may place packing and/or plastic splints within your nasal cavity after the surgery. Your surgeon will let you know when these will be removed.

4. Nasal Saline Irrigation

Your physician may recommend mechanically cleaning your nose and sinuses with nasal saline. This can remove blood and mucus from the nose and help with healing after the surgery. Nasal saline spray is available over the counter. You can also make a saline solution with the following recipe:

1/2 tsp table salt
12 ounces of water (clean tap or boiled water)
Pinch of baking soda

5. Pain

Some pain after nasal surgery is expected. It is generally of moderate severity. Take the pain medicine as prescribed by your physician.

6. Fever

Low-grade temperature after nasal surgery is common. You should notify our office if your temperature is 101ºF or greater.

7. Bleeding

Some bloody nasal and postnasal drainage after nasal surgery is expected. You should expect light bloody drainage for the first 1-2 days. Call the office if your bleeding becomes excessive.

8. Nausea/Vomiting

Nausea may occur after nasal surgery. Most often it improves significantly the day after surgery. You may be given a prescription medicine to help with nausea. Call the office if you need help managing your nausea or vomiting.

9. Nasal Congestion

Severe nasal congestion is to be expected after nasal surgery due to swelling and sometimes due to packing in the nose. You may use decongestant spray or decongestant pills (like Sudafed®) for some relief if tolerated. Please read the packaging insert as decongestants cannot be safely used with certain medical conditions, including high blood pressure and heart disease. Saline spray and elevating the head may also help slightly.

10. Medications

Patients should resume all regular medications after surgery.

Parotidectomy

1. Diet

Patients may resume a regular diet without special restrictions. Many patients note a scratchy throat from the endotracheal tube for the first day or two and may prefer soft foods initially.

2. Activity

Light to moderate activity as tolerated is fine. Patients may turn the head from side to side and look up and down without any worry about stitches. Heavy lifting, straining and strenuous exercise should be avoided for at least one week following surgery.

3. Pain

Neck pain and neck stiffness are to be expected. Your physician will prescribe a narcotic pain medication. You may use this as prescribed for severe pain. Do not drive while taking narcotic pain medications. Some patients prefer acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) for milder pain control. Narcotics can cause constipation; stool softeners such as docusate sodium (Colace®) can be helpful for this. Please contact our office nurse at 908-788-9131 if any redness, increased swelling or increased pain develops at the surgery site.

4. Medications

Patients should resume all regular medications after surgery. Aspirin and/or other blood thinners may be resumed the day after surgery.

5. Nausea/Vomiting

Some patients can experience nausea and/or vomiting after surgery. Your physician may prescribe a medicine for nausea. Call the office at 908-787-9131 and speak with our nurse if this is a problem.

6. Bathing

Patients may shower or bathe normally. It is okay to get water on your incision. If you have stitches, it is okay to get them wet. If you have a plastic bandage over your incision, you may get this wet also.

7. Care of Incision

Apply an antibiotic ointment such as Neosporin® or Bacitracin® to the area twice daily.

8. Drain

Some patients may have a drain in place after surgery. Please follow instructions provided at the hospital for specific care. Drains are usually removed the day after surgery.

Nasal Saline Irrigation

Recipe for hypertonic saline (saltwater) for home irrigation:

Nose should be irrigated 1-3 times per day with a bulb syringe, a large medical syringe or a Neti Pot. Stand over a sink and squirt the saltwater into the nose in such a fashion that you are able to spit some of the saline out of your mouth. This suggests that you are doing an adequate job of irrigating the entire nose. Aim the stream of saline as though you are trying to squirt the back of your head, NOT the top of your head. It is acceptable to breathe the saltwater directly into the nose.

Warm saltwater is preferred as it is much more comfortable. The amount of salt added will depend on your tolerance. However, the more salt that is added the greater the decongestant affect. The bicarbonate is a buffer and will allow the saltwater to be less irritating.

The Benefits of Hypertonic Saline Irrigation Are Threefold

• It is a solvent. It cleans mucus, crusts and other debris from the nasal passages.
• It decongests the nose. Because of the high salt concentration, fluid is pulled out of the membrane. This shrinks the membrane, which improves nasal airflow and opens sinus passages.
• It improves nasal drainage. Studies have shown that saltwater cleansing of the nasal membrane improves ciliary beating so that normal mucus is transported better from the sinuses through the nose
  and into the throat.

If you are also using a nasal steroid such as Flonase®, Nasacort®, etc., you should always cleanse the nose first with the saltwater before utilizing the nasal steroid. The nasal steroid is most effective when sprayed onto clean nasal membranes, and it reaches deeper into the nose after cleansing and decongestion.