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Hospital Discharge Info

Physiotherapy

Facial Nerve Information

Ophthalmology

Nutrition

General Queries

Medication Information

Follow-Up Procedures:

The CT scan, MRI scan or audiologic testing may be required as follow up procedures. Be sure to inform the physician's secretary if you are allergic to contrast dye (Omnipaque 300), as a prescription for medication will have to be ordered to be taken before the scan.

Call your physician if you experience any of the following problems:

  • drainage from your nose, ear or incision
  • severe and/or continuous headaches
  • neck stiffness
  • fever above 38 Celsius (100.4 Fahrenheit)
  • increased problems with balance
  • change in facial nerve movement or sensation redness, irritation or injury to your eye
  • exceptional fatigue
  • soreness in your legs or calves
  • swallowing problems

Physiotherapy

Balance Retraining Exercises

The main complaint of many post-operative patients is fatigue. Others experience symptoms such as dizziness, light-headedness, unsteadiness and/or disequilibrium.

It is important to realize that balance improves slowly over time - in fact it may take two to six months and sometimes up to a year for full recovery. Depth perception and focusing mechanisms may be impaired initially and cause disequilibrium.

The following rehabilitation program is offered only as a guide, because individuals vary considerably. For a more personalized program, be sure to contact your physiotherapist.

The purpose of balance retraining exercises is to force the patient to develop strategies for performing activities in their daily life.

When performing these exercises, take extra precautions to ensure that you do not fall, ie., hold onto a chair or other support. Initially you should do these with a partner. Perform each exercise twice a day as tolerated.

  • Standing with feet as close together as possible, turn your head to the right and to the left horizontally while looking ahead at a visual target. These are small head movements - it is not necessary to move your head as far as it can go. Do this for one minute without stopping, then try again with your feet even closer together.
  • On a flat surface, rock back and forth about the ankle without bending at the hip, for thirty seconds. Repeat the exercise for another thirty seconds with your eyes closed.
  • On a compressible surface (like carpets or pillows) attempt again to rock back and forth about the ankle without bending at the hip.
  • In a corner, practice standing on one foot. Attempt this first with eyes open for thirty seconds, then with eyes closed. Remember to switch feet and repeat the same exercise.
  • Practice turning your head while walking. Begin by walking close to a wall.
  • Practice turning around when you walk. Begin with large circles, then smaller ones. Make sure you turn in both directions.

References: This is based on the works of Susan J. Herdman, Ph.D., P.T., F. Fallenbaum, P.T., SMBD-Jewish General Hospital, Department of Physiotherapy

Walking

It is an essential part of your recovery, assisting with circulation and helping in the prevention of phlebitis.

In the first few weeks after your surgery, increase the distance daily. You may find that you are still occasionally dizzy when walking. If so, attempt the following: Remember not to look down at the floor. Keep eyes level and fixed on a visual target.

Remember to slow down before turning corners.

If there are many distractions while you are walking, it may be best to stop before looking over your shoulder.

Other Sports Activities

Light sports such as badminton, darts, Tai chi, basketball, swimming are suggested to improve coordination. It is important to note that one should not swim alone. Difficulty in ascertaining which way is up once submerged is of vital importance to understand.

Fatigue

Fatigue is not unusual after acoustic neuroma surgery. It is important to 'listen to your body'.

Plan your day's activities and allow for rest periods.

Allow yourself a good night's sleep.

Activity

Driving and Air Travel: It is suggested that driving not be conducted until you are assessed by your physician or surgeon at your follow-up appointment (4-6 weeks after surgery). The patient should check with the surgeon about when it is safe to travel by air.

Lifting And Moving: No heavy lifting (over 10lb.) or strenuous activity, such as vacuuming, carrying groceries and lifting children until assessed at your doctor's appointment.

Sex: no restrictions

Returning to Work: To be assessed and discussed at follow-up visit with your physician. Each person and occupation are different. Special documents concerning sick leave insurance, etc., should be given to the physician's secretary.

Bathing

You can shower or take a bath, but it is suggested when you first get home that you should have assistance close by, in case of loss of balance and fatigue.

Use of a tub rubber mat is helpful.

The shower and bath should not be too long, too hot or too cold.

You may shampoo once the incision is healed and the sutures have been removed. A gentle shampoo with no perfume, such as a baby shampoo is recommended. Take care to avoid shampoo getting into your eyes.

Mouth care

If you have facial nerve problems, eg., weakness on one side and problems chewing or decreased feeling, it is especially important to have good oral hygiene.

Brush your teeth and rinse your mouth after eating and remove food particles. Floss your teeth after each meal. See your dentist regularly and inform her/him of your surgery. Be careful not to bite your affected cheek or lip. Use of a 'Waterpic' may be helpful.

Facial Nerve Information

Facial paralysis can result from injury to the facial nerve. One of the most difficult challenges facing the surgeon is the complete removal of the tumor without damaging the facial nerve. Depending on the size, shape and location of the tumor, facial nerve damage may be unavoidable in some cases.

When there is facial paralysis after surgery, there are typically two stages of recovery:

Up to 3-6 months

In the early stage, facial movement may be weak or there may be no facial movement at all. The face may droop at rest and you may find that the face tends to pull to the normal side without your control.

The eye may be unable to blink normally or completely close and tearing may be decreased. You will have to take special care of your eye at this time.

Nerve healing and regeneration takes place at varying degrees. Nerve regeneration is a slow process and it may take up to a year to realize significant recovery. There is nothing that can be done at this time to improve the rate and amount of recovery. The facial nerve needs time to heal.

Facial exercises, are not appropriate during this stage since the nerve needs ample time to heal (like a broken bone in a cast has to heal). At this time, exercises performed with maximum effort will have little effect and may be harmful later as they can reinforce abnormal movement patterns.

Electrical stimulation at this time is not appropriate in the treatment of facial paralysis since it reinforces abnormal movement patterns and can be harmful to the progress of the healing process of the nerve.

It is important to schedule regular appointments with your physician to monitor your health and to note any changes to your face. Regular follow-up will ensure that if facial rehabilitation is appropriate, it will be started at the optimal time (Stage 2).

Shortly after surgery a facial retraining therapist can give you some preventative exercises, monitor you and assess when you are ready for active retraining (contact your physician or ANAC for the facial retraining therapist in your area).

After 6 months
As nerve recovery takes place, small facial movements begin with some function naturally following. Generally this occurs somewhere between 3 and 12 months after surgery (unless there has been a nerve graft in which case the recovery period will be longer). You will begin to use these new movements whenyou speak, eat and make facial expressions. This may be the time to begin a rehabilitation program with a therapist (physio/occupational/speech) who has been specifically trained in facial neuromuscular retraining.

Speech Therapy may be helpful if you are experiencing any difficulty in pronouncing specific sounds or managing food.

As recovery continues, you may notice involuntary movements in areas of your face. This is referred to as 'synkinesis'. Facial retraining techniques will help to improve this condition.

What is facial retraining?

Facial retraining or muscle re-education is a problem solving, individualized approach used to produce symmetrical movements and control undesired movements of the face. Since treatment is based on individual function, a therapist can help you develop a personalized exercise program to give you the greatest benefit.

Techniques include a detailed facial evaluation, specific retraining strategies (ie. strengthening exercises or relaxation exercises), sensory feedback and an individualized home based exercise program.

Moist heat placed on the face and/or gentle massage will help to relax your facial muscles and prepare it for exercise. When exercises are done, the movements should be as symmetrical as possible using a mirror in a quiet area. Exercises should not be done when you are tired or upset. You may find that alcohol, nicotine, caffeine, cold weather and stress may make your face feel tighter.

Ophthalmology

Eye Problems and Care

If there is a disturbance of the facial nerve, extra precautions are required for eye care. Blinking or closing the eye may be impaired. It is imperative to protect the cornea from drying out and to prevent dirt and other irritants from getting into the eye.

During the day the eye is usually well protected by blinking but during sleep the eyelid may not close completely and the cornea may become dry and damaged.

Wash your hands before touching your eye.

Keep your eye moist with products recommended by your ophthalmologist. Appropriate products include Isoptotears, Cellufresh, Aquasite, Eyestil, etc. It may be necessary to try several brands before finding the product that is the most comfortable. For sensitive eyes, choose those marked 'without preservatives'. During the night, use an ointment which is more viscous and gives longer protection, ie. Lacrilube or Duralube. For daytime use, be aware ointment causes blurring of vision.

Avoid bright lights or wind when possible.

Wear protective and/or sun glasses with side shields. If symptoms are severe, goggles make excellent moisture chambers. Normal eyeglasses may provide some protection against windy, dusty conditions and other threats that come near to the eye.

Avoid water-proof eye make-up, ie. mascara, it may chip and enter the eye.

If you have some eyelid closure, blink your eyes completely, 10 times per minute, especially when reading, watching television or using the computer.

Close your eyes for one minute every 15 minutes when reading or watching television.

Avoid fans blowing near the face, especially car vents and air conditioners.

A humidifier in the home may be helpful.

Consider having your eyes tested by ophthalmologist in case new glasses are needed.

Eyedrop Application

Ask for a teaching session regarding eyedrop application before you are discharged from the hospital.

It may be easier for the first few times to have another person apply the eyedrops or ointment.

Wash your hands with soap and water and dry with a clean towel.

Tilt your head back and look up. Gently pull the lower eyelid downwards to form a small pocket for the eyedrops.

Gently squeeze the container to place one or more drops in your eye, as recommended by your physician.

Close your eye gently for one minute. Move your eyeball from side to side to allow the liquid to circulate.

Wipe the excess liquid off your lid with a clean tissue.

Do not allow the tip of the container to touch your eye or lid.

Eye Ointment Application

As above, but place your index finger on your cheekbone and gently pull the skin down to expose the sac on the eye.

Squeeze a thin ribbon of ointment along the sac starting at the inner corner near the nose. Turn the tube to detach the ointment. Close your eye for one-two minutes. Wipe the excess ointment with a clean tissue. Do not allow the tip of the container to touch your eye or lid.

References:

EYE CARE AFTER ACOUSTIC NEUROMA SURGERY, Robert E. Levine, ANA, Carlisle PA
ACOUSTIC NEUROMA DISCHARGE INFORMATION, Sunnybrook Health Science Centre, North York, ON

Nutrition

Cranial nerves may have been affected by the tumor and the surgery. This could affect your eating ability or enjoyment.

Taste Disturbance, Mouth Dryness or Excessive Salivation

There may be some change in taste and the amount of saliva secretion. This can affect your appetite.
Rinse your mouth before and after eating
Try cold foods, and foods at room temperature
Try marinating meat in soya sauce, sweet juices, Italian Salad dressing or wine
Be inventive, try different seasonings and combinations of foods

Dry Mouth/Difficulty Swallowing

Suck on frozen fruit juices, cracked ice or hard candies (sugarless)
Eat soft, moist foods
Assess fluid intake and consistency with physician. It may be necessary to take thicker fluids to avoid aspiration (choking).
Dunk or soak foods in liquid
Avoid rough, coarse or dry foods
Chewing gum (sugarless) may help with a dry mouth

Difficulty Chewing

Foods cut in small, bite size pieces allow for easier chewing
Milk and milk products are easy to chew and digest
Meat should be tender, ground or thinly sliced
Canned fruit and vegetables, juices are suggested
Pasta, rice and soft crusted bread are easy to chew and easy to digest
The use of a food processor or blender may help in preparing food
Several nutritional supplements are available in drug stores. If you are having difficulty in consuming enough protein and energy producing foods, they may be of benefit.

General Queries

Swallowing, Throat and Voice Problems

Surgery for acoustic neuroma may affect the nerves that control the throat, swallowing and voice. Consultation with a Speech Therapist may assist in evaluating problems. This should be reviewed and followed with your physician.

Elimination

Voiding: It is important to remember that you had a catheter in the bladder during your hospitalization. If you have any discomfort such as burning or frequency on voiding, please inform your physician.

Bowel: Many people become constipated during their hospitalization due to medication, change in eating habits, lack of exercise, etc. It is important to return to normal habits of elimination. Natural products such as bran, prunes, prune juice etc. are of benefit.

It is very important to understand that you are not to strain when going to the bathroom as this will cause an increase in the pressure in your head. If you have any difficulty in moving your bowels please inform you physician. A 'stool softener' may be prescribed.

Incision

The sutures usually remain for approximately 10 days. The incision should remain dry until the sutures are removed, and then shampooing is allowed. There may be a change in sensation around the incision, such as numbness, therefore it is important to brush or comb gently. Report to your doctor any discharge or redness at the incision site.

After the incision is well healed, non-perfumed creams may alleviate itching and dryness.

Headaches

Headaches may be troublesome for some. The causes vary from tension, incisional, holding the head in a certain position (muscle) and pre-existing conditions, ie. migraines.

Assessment by the Physiotherapist may be helpful.

Cool cloths, ice packs or warm cloths have been found to be soothing to some. Adequate rest and a stress-free environment have also been helpful. Your physician may also prescribe pain and/or anti-inflammatory medication. If the headaches persist or change in severity, inform your physician.

Immunity

The immune system may be depleted from the surgery and stress leaving you susceptible to flus, colds, etc.

Psychological Coping

For some, adjustment to a new self after acoustic neuroma removal is challenging. In addition to the changes in hearing, the appearance now may be altered and other impairments present. Return to the former level of activity may lag.

It is important to concentrate on your strengths rather than on your weaknesses, give yourself the time to recuperate, know all your options, know that you are not alone. Support from family, friends, medical personnel and the Acoustic Neuroma Association of Canada will assist in strengthening your coping skills and allow time for healing.

A diary of recovery with photographs can record and demonstrate improvement otherwise not acknowledged or remembered.

Feel free to call on others, they are there for you. Each recovery is different, so do not feel you are not doing well. Give yourself time. You will get the confidence once more in understanding the messages your body is sending.

For further information and local contacts, call 1-800-561-ANAC (2622)

Medication Information

It is always wise to be knowledgeable about the uses and side effects of any medications you are taking. If you have unanswered questions, keep in mind that your neighborhood pharmacist is a valuable member of the health care team.

Brain tumors cause abnormalities in the normal tissue surrounding them. This is called 'tumor associated edema' or 'brain swelling'. Drugs from the 'corticosteroids' (or 'steroids') class are often prescribed to counteract this problem. They work by decreasing the flow of fluid across the abnormal blood vessels of the tumor, and this in turn reduces swelling (edema) in the normal tissue. The most common drugs used are Decadron