Bechara Y. Ghorayeb, MD, PA
Otolaryngology-Head & Neck Surgery                                                              Phone: 713 464 2614
8830 Long Point, Suite 806
Houston, TX 77055                   www.ghorayeb.com
Adenoidectomy
Informed Consent
Removal of adenoids is one of the most frequently performed throat operations. It offers a safe, effective surgical way to resolve breathing obstruction, throat infections and manage recurrent childhood ear disease. Pain following surgery is an unpleasant side effect, but can be reasonably controlled with medication. Similar to the pain experienced with throat infections, it may often also be felt in the ears. There are also some risks associated with removal of adenoids. Although very rare, significant postoperative bleeding may occur. If significant bleeding occurs, it is most often immediate and short lived. Treatment of such bleeding is usually handled as an outpatient, however, sustained bleeding may require treatment in the operating room under general anesthesia. In rare cases, a blood transfusion may be recommended. There are some more persistent side effects sometimes associated with the removal of adenoids. As swallowing is painful after surgery, the patient may not take in sufficient fluids orally. If this cannot be corrected at home, IV fluid replacement may be necessary. Halitosis (bad breath) is common in the immediate postoperative period. Infection is an infrequent occurrence. Anesthetic complications are known to exist, however, they are quite uncommon.


I/We have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of nontreatment, the procedures to be used, and the risks and hazards involved, and I/we have sufficient information to give this informed consent. I/We certify this form has been fully explained to me/us, and I/we understand its contents. I/We understand every effort will be made to provide a positive outcome, but there are no guarantees.


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Patient / Legal Guardian
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Witness

Date:___________________________          Time:___________________________


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