Adult patient 10 days after nasal polypectomy and uvula trimming presenting with severe throat pain—what are the likely causes and recommended evaluation and management?

Severe Throat Pain 10 Days Post-Nasal Polypectomy and Uvula Trimming

This patient requires immediate direct visualization by the operating surgeon to rule out infection, dehiscence, or uvular necrosis—severe throat pain at 10 days post-operatively is abnormal and demands urgent evaluation.

Expected Post-Operative Pain Timeline

The clinical concern here is that pain should be resolving, not severe at 10 days post-operatively:

• Pain after endoscopic sinus surgery typically peaks within the first 3 days and resolves over a 1-week period 1
• Uvulopalatoplasty procedures demonstrate minimal postoperative pain in nearly all published studies, with transient discomfort resolving within days 1
• Severe pain persisting or worsening at 10 days suggests a complication rather than normal post-operative recovery 1

Differential Diagnosis and Required Workup

Immediate Examination Required

The surgeon must perform direct visualization with nasal endoscopy and oropharyngeal examination looking for:

Infection/Abscess:

• Purulent drainage, erythema, or fluctuance in the surgical bed 1
• Fever, odynophagia, or trismus suggesting deep space infection
• Secondary atrophic changes with purulent secretions requiring topical or systemic antibiotics 1

Uvular Complications:

• Mucosal erosion, ulceration, or necrosis of the uvula 1
• Severe palatal damage including palatal fistula or uvula loss/sloughing—reported as moderate complications after uvular procedures 1
• Exposed cartilage or bone suggesting tissue breakdown

Wound Dehiscence:

• Separation of surgical sites with exposed raw surfaces
• Bleeding or crusting beyond expected post-operative changes 1

Velopharyngeal Issues:

• Transient nasal regurgitation occurs in 4% of uvulopalatal procedures but should not cause severe throat pain 1
• Nasopharyngeal stenosis (rare but serious) 1

Management Algorithm

Step 1: Urgent Surgical Re-Evaluation

• Same-day or next-day appointment with the operating surgeon for direct visualization 1
• Do not manage this remotely or delay evaluation—tissue complications require direct inspection

Step 2: If Infection Confirmed

• Initiate oral antibiotics covering typical upper respiratory pathogens (amoxicillin-clavulanate or fluoroquinolone) 1
• Consider topical antibiotics if purulent nasal secretions present 1
• Culture any purulent drainage to guide antibiotic selection

Step 3: Pain Management Adjustment

• The patient may require short-term opioid analgesia if severe pain is confirmed as inflammatory rather than infectious 1
• NSAIDs can decrease pain without increasing bleeding risk after endoscopic sinus surgery 1
• Acetaminophen alone is often insufficient for severe post-operative pain 1

Step 4: Supportive Measures

• High-volume saline irrigations to improve mucociliary clearance and resolution of crusting 1
• Avoid decongestants which are not recommended for chronic use 2
• Maintain hydration and soft diet to minimize mechanical irritation

Critical Red Flags Requiring Emergency Evaluation

Refer to emergency department immediately if any of the following are present:

• Airway compromise (stridor, difficulty breathing, inability to swallow secretions)
• Severe bleeding from surgical sites
• Orbital symptoms (diplopia, vision changes, periorbital swelling) suggesting intracranial extension 2
• Neurological symptoms (severe headache, altered mental status, neck stiffness)
• Sepsis indicators (high fever, hypotension, tachycardia)

Common Pitfalls to Avoid

• Never assume pain at 10 days is "normal healing"—this timeline is too late for typical post-operative pain 1
• Never prescribe antibiotics empirically without visualization—you may miss a surgical complication requiring intervention
• Never delay evaluation for "a few more days"—uvular necrosis and deep space infections can progress rapidly 1
• Never restart oral corticosteroids without ruling out infection—steroids can worsen infectious complications 1

Post-Evaluation Long-Term Management

Once acute complications are excluded or treated, ensure the patient continues:

• Twice-daily intranasal corticosteroids indefinitely to prevent polyp recurrence 3, 2
• Regular nasal saline irrigations for mucociliary clearance 1
• Follow-up between 3-12 months post-operatively for nasal endoscopy to assess healing and recurrence 3
• Evaluation for aspirin-exacerbated respiratory disease if not already performed, as this may benefit from aspirin desensitization to reduce recurrence 3, 2