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«NORTH COUNTY EAR, NOSE AND THROAT – HEAD AND NECK SURGERY Pediatric and Adult 2023 West Vista Way, Suite J Vista, California 92083 (760) 726-2440 ...»

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Julie A. Berry, M.D.

Patient Name __________________________________ Date of Birth _________________

Tonsillectomy and Uvulopalatopharyngoplasty (UPPP) Please initial that you understand the risks, sign the last page, and bring both pages with you to give to me on the day of surgery.

______(initial) Bleeding - This is the number one risk of tonsillectomy. Adults have a 3-4 % chance of a severe enough episode of bleeding in the first 10 days that requires a return trip to the operating room to control the bleeding. (The UPPP portion of the procedure carries only minimal risk of bleeding.) Streaks of blood or old dark blood with vomiting are common. Streaks of blood when crusts break away are also common. Steady teaspoonfuls of blood require you to go to the nearest emergency room or to call 911 if severe.

The dietary and exercise precautions are in place because of the risk of bleeding. You should also be careful with any other activity that may increase blood pressure such as bending over to tie shoes or straining with a bowel movement.

______(initial) Infection - This is very rare. Antibiotics are given after surgery, although this is more to help with pain control.

It is normal for a whitish/grayish, moist, thick layer to develop over the incision/suture line.

This is not infection! This is the "scab" which eventually comes off on its own.

______(initial) Pain - Discussed above. Deep ear pain is almost universal and often sets in five to seven days after surgery, even after throat pain has subsided. This is because the throat and the ear nerves travel similar pathways to the brain. You can be fairly certain it is not an ear infection. It may hurt to yawn for a month or longer.

The tongue may be swollen, painful, or numb because of the retractor. It may have indentations or tingling sensations. This is normal.

The act of swallowing itself will be uncomfortable even with the pain medication.

______(initial) Difficulty swallowing and speaking - This to be expected and subsides as pain and swelling subsides. Some patients have stitches which may cause irritation but eventually dissolve on their own. After two weeks I can remove any that remain if they are truly bothersome. It can take 4 to 6 weeks to adjust to the new swallowing process (since the throat muscles have been tightened outward).

______(initial) "Velopharyngeal insufficiency" - It is common for liquids to come out of the nose during swallowing and for the voice to stay nasally for several weeks after surgery. This is due to swelling in the back of the nose. However, if there is excess scarring in the soft tissues preventing the muscles from pulling the "palate" up and backwards, the palate would not be able to block off the nose during swallowing as it normally should. I instruct all patients that they will always have some problem if they drink too fast or tip the head very far back or very far forward to drink (i.e. it may be hard to drink the milk from the bottom of the cereal bowl or to take big gulps from a soda can). Very rarely this could require speech/swallow therapy if it remained bothersome for over a year.

______(initial) Aspiration pneumonia - This is very rare and easily treated. Difficulty swallowing after surgery may result in liquids going down the windpipe instead of the esophagus and cause a lung infection. Alternatively, if you had an active throat infection at the time of surgery, the bacteria might get seeded in the lungs as the breathing tube is placed. This requires stronger antibiotics and possible re-admission to the hospital.

______(initial) Pulmonary edema - About 5% of patients with moderate or severe sleep apnea may suddenly develop fluid on the lungs and require extra observation. This is due to the sudden relief of chronic blockage and is also called "postobstructive" pulmonary edema.

______(initial) Failure of surgery to improve the symptoms.

I understand the above risks and wish to proceed with surgery.

____________________________________ ______________________

Patient Signature Date

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