When I told my primary care doctor that, he said rather firmly that many, many people had deviated septums and it was not a big deal. That surgery was not necessary and that I should take nasal inhalers that cleared my nasal passages - since I was a snorer at night. Is it a lifestyle surgery, or something that I should get done? I realize it depends on the severity of my deviation, but curious what some of the risks may be if I do undergo surgery. Do most people get the surgery done? I am a snorer at night. I am of normal weight. I don't take any medications other than nexium.
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I was told by an ENT that I had a deviated septum and should get surgery to correct it.
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20 UpVoted this answer
Airflow in the nasal airway is a complex process with multiple factors, both anatomic and molectular. Collapse of the cartilage of the nose, trauma to the nasal bone, enlargement of the turbinates (bony structures in the nose thought to be related to hydration and airflow), as well as enlarged adenoids can all be anatomic reasons for the feeling of nasal obstruction. Additionally, individuals with allergies or chronic sinus infections can have swelling of the soft tissue in the nose that can cause problems with airflow.
It is true that many individuals have devlations of the nasal septum, which can either be congenital (born with it) or acquired (usually from trauma). These deviations can often be large enough to cause obstruction, but also are very often asymptomatic regargless of severity.
A formal evaluation by an ENT to address the anatomic components of your nasal airway would be best before considering surgery. And yes, often times simple conservative measures such as sinus rinse nasal irrigations, inhaled nasal steroids, and avoidance of allergens can improve the nasal airflow enough that your symptoms will improve without surgery.
Additionally, the rest of the upper airway should also be assessed. Some adults may persist to have large adenoids and tonsils - all other factors being normal, removing these structures may help with snoring and sleep apnea. Also, sometimes the walls of our upper airways can be weak and collapse on their own, and surgical repair for this is complex and usually not helpful. Other issues such as a small jaw, a low hanging palate, and of course obesity can also contribute to snoring and sleep apnea.
The best thing to do when struggling with these issues is to have a good comprehensive exam of the upper airway to identify a potential source for the snoring, which can often be multifactorial. To determine if this is snoring versus obstructive sleep apnea (stopping breathing at night) - a formal sleep study may be indicated.
Hope this answers your questions.
It is true that many individuals have devlations of the nasal septum, which can either be congenital (born with it) or acquired (usually from trauma). These deviations can often be large enough to cause obstruction, but also are very often asymptomatic regargless of severity.
A formal evaluation by an ENT to address the anatomic components of your nasal airway would be best before considering surgery. And yes, often times simple conservative measures such as sinus rinse nasal irrigations, inhaled nasal steroids, and avoidance of allergens can improve the nasal airflow enough that your symptoms will improve without surgery.
Additionally, the rest of the upper airway should also be assessed. Some adults may persist to have large adenoids and tonsils - all other factors being normal, removing these structures may help with snoring and sleep apnea. Also, sometimes the walls of our upper airways can be weak and collapse on their own, and surgical repair for this is complex and usually not helpful. Other issues such as a small jaw, a low hanging palate, and of course obesity can also contribute to snoring and sleep apnea.
The best thing to do when struggling with these issues is to have a good comprehensive exam of the upper airway to identify a potential source for the snoring, which can often be multifactorial. To determine if this is snoring versus obstructive sleep apnea (stopping breathing at night) - a formal sleep study may be indicated.
Hope this answers your questions.
19 UpVoted this answer
You are correct that it does depend on the severity of the deviation. Most people do not undergo surgery if the severity does not interfere with life. However, if the snoring is so loud that it wakes you, or you develop sleep apnea, then you may consider surgery. If you are the type of person who takes more personal responsibility and if you want more self-care approaches, nasya oils (used in Ayurveda) are EXCELLENT at clearing obstructions that tend to develop with deviated septae, and there are nasal yoga practices, to be learned from a good yoga therapist www.iayt.org), that slowly but surely shift the deviated septum over months back toward center. But you have to be very tuned in to your body to learn how to do these yoga practices. Good Luck!
16 UpVoted this answer
First, the "you don't need the surgery" comments ought to be tempered by a frank discussion of the risks, benefits, and alternatives--by a professional who deals with the problem on a daily basis, not "dabbling" in opinions and assumptions. Second,comments like these are less than professional and demonstrate less about good medicine and more about rote parochialism of the PCP (i.e. "my" patient). While septoplasty can be a procedure which is often "overcalled" to cure everything from snoring (it doesn't) or sleep apnea (again, it doesn't) here the PCP has far less information than a trained specialist. Finally, the doctor advising his patients to indefinitely take nasal inhalers to "clear nasal passages" blocked due to a deviated nasal septum is simply nonsense and is actually iatrogenic (i.e. an adverse outcome due to a physician) medicine and a serious risk management issue for the PCP. A sinus infection as a result of the deviated septum (they do happen!) followed by morbidity of say, a brain abscess, would make validity of such "medical advice" suspect. And I believe anyone can surmise what would follow.....
12 UpVoted this answer
It is hard to say which doctor is right without a physical exam. Most people do have some degree of septal deviation. The firmness of the response
from the PCP might be a bias against surgery, mainly because he or she might not do the surgery, so they don't really understand whether or not surgery is indicated.
Sometimes the difficulty in breathing is due to turbinate hypertrophy, and not a septal problem at all. Other causes of breathing problems can be a long nose, so the angle of entry of air is an awkward one, or a previous nasal fracture which has displaced the septum out of the vomerine groove.
PCPs generally don't do surgery, and ENTs do. We tend to recommend what we specialize in. So the deciding factor for you--surgery or not--should be the degree to which this bothers you.
Do you mouth breathe a lot? Can you exercise and still breathe comfortably through your nose? Do you have a hard time getting air through your nose, even if you don't have a cold? If so, surgery may permenently help you.
If you live in a cool, dry climate, you may get what we call "Colorado nose". The inferior turbinates are a complex of bone, blood vessels, and a mucosal lining that are loacted on the outer sides of the nasal passages. Their function is to warm and moisten air. So--in a cold, dry climate--they are always working. Turbinate hypertrophy--in which the turbinates get bigger because they are working so hard--is common in this area, and physical obstruction of the airway can occur becuase of it. In my experience. fixing the turbinate problem is much more helpful for people with nasal breathing problems than correction of a septal deviation, unless the deviation is severe.
I am a surgeon, and tend to see medication as a temporary solution rather than a permanent "fix". People can get addicted to nasal inhalers, because there is rebound swelling when you stop using it. i would recommend getting a second opinion from a different ENT or plastic surgeon who is skilled in this area. A direct exam of the septum and turbinates, plus a detailed history, which help guide their recommendations, and your decision regarding surgery.
Risks of surgery include bleeding, infection, and a less than perfect outcome. Noses are inherently asymmetrical, and perfect evennes is impossible to achieve. Improvement, not perfect correction of symptoms is a realistic goal.
Hope this helps
from the PCP might be a bias against surgery, mainly because he or she might not do the surgery, so they don't really understand whether or not surgery is indicated.
Sometimes the difficulty in breathing is due to turbinate hypertrophy, and not a septal problem at all. Other causes of breathing problems can be a long nose, so the angle of entry of air is an awkward one, or a previous nasal fracture which has displaced the septum out of the vomerine groove.
PCPs generally don't do surgery, and ENTs do. We tend to recommend what we specialize in. So the deciding factor for you--surgery or not--should be the degree to which this bothers you.
Do you mouth breathe a lot? Can you exercise and still breathe comfortably through your nose? Do you have a hard time getting air through your nose, even if you don't have a cold? If so, surgery may permenently help you.
If you live in a cool, dry climate, you may get what we call "Colorado nose". The inferior turbinates are a complex of bone, blood vessels, and a mucosal lining that are loacted on the outer sides of the nasal passages. Their function is to warm and moisten air. So--in a cold, dry climate--they are always working. Turbinate hypertrophy--in which the turbinates get bigger because they are working so hard--is common in this area, and physical obstruction of the airway can occur becuase of it. In my experience. fixing the turbinate problem is much more helpful for people with nasal breathing problems than correction of a septal deviation, unless the deviation is severe.
I am a surgeon, and tend to see medication as a temporary solution rather than a permanent "fix". People can get addicted to nasal inhalers, because there is rebound swelling when you stop using it. i would recommend getting a second opinion from a different ENT or plastic surgeon who is skilled in this area. A direct exam of the septum and turbinates, plus a detailed history, which help guide their recommendations, and your decision regarding surgery.
Risks of surgery include bleeding, infection, and a less than perfect outcome. Noses are inherently asymmetrical, and perfect evennes is impossible to achieve. Improvement, not perfect correction of symptoms is a realistic goal.
Hope this helps
6 UpVoted this answer
Nasal surgery is definitely a "quality of life" procedure. You will live a long and healthy life with or without the procedure. However, for some people, nasal obstruction causes much distress. In those cases, nasal surgery to improve breathing can make a big difference in their life. Nasal steroid sprays can be helpful but in people who have significant anatomic reasons for their breathing issues (deviated septum, inadequate support for their breathing passages or enlarged turbinates) steroid sprays alone are not enough.
The most important question is whether nasal obstruction causes you any significant problems. If not, you don't need surgery. If it is a problem, then surgery is an option. I hope this answer is helpful.
The most important question is whether nasal obstruction causes you any significant problems. If not, you don't need surgery. If it is a problem, then surgery is an option. I hope this answer is helpful.
3 UpVoted this answer
If your nasal septal deviation is causing symptoms such as blockage of one side of your nasal passage when you try to breathe through that side while holding the other nostril closed, recurrent bouts of sinusitis and post nasal drip, and any sign of nasal obstruction these may be indications for surgery. My recommendation would be that you follow the advice of an ENT specialist who is experienced in treating nasal septal deviation and not the advice of a general practitioner who does not have expertise in this area.
3 UpVoted this answer
Thanks for the question - Its difficult to determine the degree of clinical correlation between your presumed deviated septum and described symptoms. You would require a full history and examination for a more accurate determination. Having said that, many people do have deviated septum's and go through life unaffected - I would argue that most people with deviated septum's do not have surgical correction and do just fine. Conversely, requiring long-term medications to clear your airway is not ideal either and I, for one, would want to know the etiology of my airway issues. I would recommend you consult with another expert (ENT) for a second opinion, ask a lot of questions including the risks and benefits of undergoing surgery. Best of luck, gv
2 UpVoted this answer
Maybe you should get a second opinion from another ENT or plastic surgeon.
The risks from septoplasty are similar to those from other operations on the face: postoperative pain with some bleeding, swelling, bruising, or discoloration. A few patients may have allergic reactions to the anesthetics. The operation in itself, however, is relatively low-risk in that it does not involve major blood vessels or vital organs. Infection is unlikely if proper surgical technique is observed. One of the extremely rare but serious complications of septoplasty is cerebrospinal fluid leak. This complication can be treated with proper nasal packing, bed rest, and antibiotic use. Follow-up surgery may be necessary if the nasal obstruction relapses.
The risks from septoplasty are similar to those from other operations on the face: postoperative pain with some bleeding, swelling, bruising, or discoloration. A few patients may have allergic reactions to the anesthetics. The operation in itself, however, is relatively low-risk in that it does not involve major blood vessels or vital organs. Infection is unlikely if proper surgical technique is observed. One of the extremely rare but serious complications of septoplasty is cerebrospinal fluid leak. This complication can be treated with proper nasal packing, bed rest, and antibiotic use. Follow-up surgery may be necessary if the nasal obstruction relapses.
