Walk In Walk Out (WIWO) Unit
Ear, Nose and Throat surgery is carried out on our paediatric day case unit in the Walk In Walk Out (WIWO) Unit. This is a self- contained unit where admission, anaesthesia, surgery, recovery and discharge are carried out in the one area.
You will be asked to arrive on the unit at 07.30 am, where you will meet the nursing team who will be looking after you during your stay.
Once upstairs, you/your child will be asked questions regarding their health and fasting status. We will obtain your child’s weight and observations (heart rate, blood pressure, temperature, respiratory rate) to ensure they are fit for surgery on the day. If your child has no allergies to the “magic cream” (numbing cream), this will be applied to the back of their hands and occasionally the inner elbow area too.
Thereafter, they will be seen by anaesthetists and surgeons who will ask similar questions like the ones asked on admission, all to ensure safety. Once you have been seen by the surgeons/ anaesthetists and consent form has been signed, there may be a small wait until your child goes to theatre. You will be able to accompany your child into the anaesthetic room. Once your child is asleep, you can wait in the waiting area or go off the department to get some fresh air/food.
The operating procedure can take between 1.5 hrs - 4 hrs including anaesthetic and recovery times, which can differ patient to patient which we will advise you of on the day.
What is mastoid/mastoidectomy and why do I need a mastoidectomy?
The mastoid bone is the prominent bone which you can feel at the back of your ear. The bone is filled with tiny air spaces which connect to your middle ear. Occasionally middle ear infections can extend into the mastoid bone (Iyer, 2022) causing mastoiditis (infection of the mastoid) and cholesteatoma formation (build-up of dead skin cells in the middle ear or mastoid bone) (Iyer, 2022). When this occurs, you may get frequent ear infections with foul discharge, hearing loss and balance problems (Iyer, 2022).
The procedure involves a small cut being made behind your ear or sometimes in the front of your ear to remove the cholesteatoma. Having a mastoidectomy may help to reduce or stop the number of ear infections you have, following the procedure.
When to next give your child pain relief
Your child can next have Paracetamol at: (6 hourly thereafter)
Your child can next have Ibuprofen at: (8 hourly thereafter)
Mastoidectomy aftercare
Your child will remain on the WIWO unit for approximately 6-8 hours following their surgery. This is to ensure that the general anaesthetic they have received is wearing off, that they are not vomiting/very dizzy, can eat and drink well, able to pass urine and are pain free. If they require further observation and care, they may be admitted to the children’s unit for an overnight stay.
Pain relief and antibiotics – Your child will be given pain relief in theatre and may receive some more later if they are in pain following surgery. You will be informed prior to discharge when they can next have some more. It is important that your child receives paracetamol/ibuprofen regularly for at least 4-5 days following their mastoidectomy. Your child may also be given a course of antibiotics to take, which will be given to you to take home prior to discharge.
Time off school – Your child will require 2-3 weeks off school to recover from surgery (infection and bleeding risks). A letter will be given to you upon discharge.
Cleaning of the wound – Your child may return from theatre with a head bandage in place which is asked by the surgeons to be kept on until the following day. Once you have removed the bandage, it is normal to see some oozing/slight bleeding from the wound. You are advised to clean the wound daily with a clean baby wipe in a one swipe and discard motion and bathe the wound in petroleum jelly. Avoid having a bath or shower for a few days following surgery to avoid getting water in your ear. It is also advised to avoid swimming or flying for a minimum of 8 weeks.
Feelings and sensations – It is normal to feel dizzy and sick after your mastoidectomy. Moving slowly can help to relieve you of the dizziness you are experiencing, which you will also be advised on during your recovery and prior to discharge. You may also hear some “popping” or “ringing” noises in your ear which is completely normal. Due to pressure build up, it is also advised to sneeze with your mouth open. Occasionally you may have some taste disturbances and facial weakness on the side your operation is on which should get better with time.
Follow-up – You will normally have a follow-up appointment in 3-4 weeks following the surgery to remove the packing in your ear and to see if your wound is healing properly.
If you have any concerns for your child prior to the clinic appointment, please contact the ENT surgeons.
Further reading
ENT UK provide fantastic advice for any questions you may have prior to surgery and any tips for aftercare.
https://www.entuk.org/patients/conditions
If you are worried about your child and need any advice please ring 0161 627 8866
Date of Review: May 2024
Date of Next Review: May 2026
Ref No: PI_WC_1677 (Oldham)