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Before Surgery

Pre-operative Evaluation

All patients who are potential candidates for ear surgery should undergo a complete head and neck examination and review of their most recent computerized tomographic images (CT scans) as part of their pre-surgery consultation. 

The patient's physical findings, in particular the ear findings, and the CT scans should be reviewed with the patient. We recommend the use of the patient's actual CT scans and an ear diagram as the best method to describe the indications for surgery and the actual operative procedures. 

Informed Consent

Well-informed patients are better able to participate in their own care.

Patients, or their legal guardian, must consent in writing to the proposed surgical procedures. We recommend that this be performed at the time the patient is considering surgery, and that the consent convey the risks, rewards, alternatives and potential complications.

Pre-testing

All patients should undergo a complete history and physical examination within several weeks of their planned surgery. We recommend that this be performed by the patient's own primary care physician because they know the patient best, are the best able to alter pre-operative medications, and can alert the surgeon to potential problems. Guidelines for pre-operative testing following the recommendations of the American Society of Anesthesiologists and are as follows:

Guidelines for pre-operative testing following the recommendations of the American Society of Anesthesiologists are as follows:

Healthy patients <40 years: CBC, SMA-7

Healthy patients <40 years who smoke: CBC, SMA-7, EKG, Chest x-ray

Healthy patients >40 years: CBC, SMA-7, EKG, Chest x-ray

Pre-operative Medications

As a generalization, patients should avoid all medications, which increase bleeding 10 to 14 days prior to surgery. Aspirin is the most common such drug. Other medications which increase bleeding are:

Analgestic (Pain) Tablets

  • Alka-Seltzer Effervescent
  • Anacin Arthritis Pain Formula
  • Arthritis Strength Bufferin
  • Aspirin ASA Compound Ascriptin
  • Ascriptin A/D
  • Aspergam
  • Athropan Liquid
  • Buffaprin
  • Bufferin
  • Ecotrin
  • Emperin Compound
  • Excedrin 
    Fiorinal, Fiorinal Compound
  • Goody's Headache Powder
  • Measurin
  • Motrin
  • Phenaphen
  • Pyrroxate
  • Vanquish

Cold/Cough Preparations

  • Alka-Seltzer Plus
  • Bayer Children's Cold Tablets
  • Bayer Decongestant
  • Congespirin
  • Contact
  • Coricidin
  • Dristan
  • Sine-Aid
  • Sine-Off
  • St. Joseph Cold Tablets for Children
  • Super Anahist
  • Triaminicin
  • 4-Way Cold Tablets

Sedatives (Sleep) Tablets

  • Cope
  • Dolcin
  • Dolor
  • Duragesic
  • Emagrin
  • Excedrin PM
  • Fizrin Powder

Holistic & Homeopathic Medications

  • As the safety and side effects of these agents is frequently unknown or unclear, they should be discontinued prior to surgery.

 

Patients with a history of stroke or heart valves, often require anti-coagulation therapy and the pre-operative cessation of these medications should be coordinated between the internist and surgeon.

Content provided by the American Academy of Otolaryngology-Head and Neck Surgery www.aao-hns.org

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