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Acoustic Neuroma Center Discharge Instructions Barrow Neurosurgical Associates (602) 406-3181 (Drs. Porter, & Spetzler) Arizona Otologic Associates (602) 279-5444 (Drs. Daspit & Weisskopf) Arizona Ear Center (602) 307-9919 (Dr. Syms) Recovery Although specific instructions will be provided to you at the time of hospital discharge this document is intended to give you general guidelines and prepare you for recovery. Follow-up with your physicians An appointment should be scheduled with the neurosurgeon or neurotologist ten to fourteen days after the surgery to remove sutures, evaluate the surgical site and assess your recovery. Before the appointment, write down any questions you may have to ensure that all of your concerns are addressed. Special accommodations can be made for patients traveling from out of state. Write down any instructions that your physician gives you such as the need for an annual check-up, future x-rays, or other time-sensitive tests. Activity Patients recover at various rates from neurosurgical procedures and are encouraged to honor their physical and emotional limitations. Resume normal daily activities after six weeks with a few exceptions. □ □ □ □ □ □ Avoid direct firm pressure on the incision for at least 4 weeks and do not lift greater than 5 lbs for 4 weeks. No swimming, diving, water sports, playing in lake or stream water for 3 months until cleared by your surgeon. Do not blow your nose until such a time as your physician has indicated that your ear is healed. Any accumulated secretions in the nose may be drawn back into the throat and expectorated if desired. This is particularly important if you develop a cold. Do not "pop" your ears by holding your nose and blowing air through the eustachian tube into the ear. If it is necessary to sneeze, do so with your mouth open. Do not take any unnecessary chance of catching cold. Avoid undue exposure or fatigue. Should you catch a cold, treat it in your usual way, reporting to us if you should develop ear symptoms. Do not drive until you are able to quickly turn your head over your right and left should without dizziness or difficulty. Air travel is permissible two days following surgery and is preferred to automobile or train travel for trips of over 200 miles. When changing altitude you should remain awake, and chew gum to stimulate swallowing. Ask your surgeon for additional specific limitations any activities involving great physical exertion. Exercise gradually with activities such as walking rather than aggressive gym activities. Driving is not recommended until the patient has complete awareness of their surroundings and has total control over their motor skills. Showering is appropriate upon release by the surgical team. Maggie Varland RN, BSB Neuroscience Program Coordinator Barrow Acoustic Neuroma Center Revised 2/2007 Page 1 of 3 Medication Prescriptions for pain control and other medications are provided at discharge. You may not feel that it is necessary to have these prescriptions filled right away, but it is important that your medications be available if the need arises. Discuss the possible interactions between various medications that you are taking with your physicians. Avoid drinking alcohol, driving, and operating heavy machinery while taking medication for pain. Social Services The hospital's case management department and social workers are available to help you identify needs that you may have after discharge from the hospital. These needs may range from renting wheelchairs to arranging home health care and outpatient therapies. Please ask to speak to one of these individuals before the day of discharge. Remember to take all of your belongings with you and to tell your friends and family that you have been discharged from the hospital. Infection Report signs and symptoms of infection to the surgeon immediately if any of the following occur: sudden increase in swelling at the surgical site after the swelling had begun to subside, fever or chills, colored drainage from incision, or a temp. >101 without other signs of illness. Pink skin is indicative of the healing process where as reddened areas may be a sign of infection. Keep fingernails trimmed short to decrease risk of incision irritation and infection from scratching as healing occurs. Diet Frequent small meals (4 – 6 per day) are suggested with a moderate amount of protein in each to assist in healing process. Avoid straining hard for bowel movements for 3 months. Use stool softeners immediately after surgery and include plenty of fluids and fiber in diet. Contact your primary care physician to help manage constipation problems. Wound care Avoid peroxide for incisions closed with absorbable sutures, as it will cause too rapid of breakdown of suture. Clean with soap and running water. Keep incision free of dried blood, crusting or scabbing to decrease risk of infection and minimize the scar. Begin daily hair washing with mild shampoo and conditioner (to ease the tangles) when cleared by surgical team. Use caution when the combing hair. Vigorous rubbing can disrupt the sutures. If a nylon suture is used for the skin closure the surgeon will remove them during the postoperative visit to the clinic after hospital discharge (within ten to fourteen days following surgery). Normal Healing Process You may anticipate a certain amount of pulsation, popping, clicking and other sounds in your ear, as well as a feeling of fullness. Occasionally sharp shooting pains are not unusual. At times it may feel as if there is liquid in the ear. Shooting pains in and around the ear are not uncommon. Pain above the ear when chewing is also common. Unsteadiness is expected following inner ear surgery but should gradually decrease during the first month. Maggie Varland RN, BSB Neuroscience Program Coordinator Barrow Acoustic Neuroma Center Revised 2/2007 Page 2 of 3 The following is a list of general symptoms, which are normal and may take months to disappear completely: Lightheadedness Imbalance Fullness in the ear Headaches Facial weakness Ringing in your ear Dizziness When to call your physician Feelings of depression are temporary and common following any surgical procedure. Please contact your physician if you have any lingering concerns about this. The following symptoms warrant a call to your surgeon: Discharge from the incision after five days Persistent ear pain nor relieved by aspirin or Tylenol Symptoms of a CSF (cerebro-spinal fluid) leak including: Watery discharge from the nose, ear or incision, especially when bending over Salty taste in the back of your throat Symptoms of meningitis such as: Fever Stiff neck (extreme) Headache (extreme) Photophobia Incapacitating unsteadiness Signs of infection (noted above) are thought to be present Sutures come apart Confusion Nausea/vomiting If you have any questions Patients with the Auditory Brainstem Implant (ABI): Unusual sensations not previously experienced in any part of your body New muscle twitching in any part of your body Maggie Varland RN, BSB Neuroscience Program Coordinator Barrow Acoustic Neuroma Center Revised 2/2007 Page 3 of 3