What is septoplasty and what is the evidence for its effectiveness?

Readers I have been “on the sick” this week. Quite shocking really usually I am like Patrick Holford and never have the need to see a doctor. However, for the first time in my life I have been confronted with a document known as the GP note.

The reason I have been taking some time off is that last week I had a bit of minor surgery known as septoplasty. Before I went to see the ENT consultant on 25 June I had never heard of the condition. This week, with a bit of time on my hands, I thought I would do a bit of research. According to Wikipedia, “Septoplastry is a corrective surgical procedure done to straighten to the nasal septum, the partition between the two nasal cavities. (…) When it deviates into one of the cavities, it narrows that cavity and impedes air flow.”

The nasal septum impeding air flow can have a number of consequences. Most importantly off all your breathing is rather irregular and you may have difficulties with exercise. This may mean that you conclude you are not a sporty person and that you give up on exercise which itself may have consequences for your health. A few months ago some one asked me if I smoked, presumably because I get out of breath rather easily. Other problems could include bad snoring and a poor sense of smell both of which I have suffered from. It can also have an effect on the sinuses.

Now for many years I have had problems with concentration and often felt tired even when I had managed to obtain a good night’s sleep. Sometimes the lack of sleep was so bad that I was left with a headache. In short, I was one of those vaguely unwell people looking for something or some one to put him on the path to health and happiness. I spent about £700 on counselling to try to turn myself in to a normal person, but that did not seem to work. Back in January 2004 I had an appointment with the local Patrick Holford representative. He prescribed me with lots of pills and a new diet, both of which were soon discarded.

I then began wonder whether it my destiny to be permanently miserable, apathetic and unsuccessful. After all it would not be possible for Mr Holford and his friends to be successful if there were not lots of people like me around? However, feeling sorry for yourself is never a good idea in the long term especially if it involves comparing yourself negatively to some one like Mr Holford.

You may be asking yourself if there are any alternatives to septoplasty. It appears not: “Nasal drops, sprays or tablets will not relieve an obstruction caused by a bent nasal septum. They may improve nasal breathing a little, but problems return when the treatment stops. Using nasal drops for a long time may actually damage the lining of the nose (muscosa) and make the blockage worse.” http://www.privatehealth.co.uk/private-operations/ear-nose-and-throat/septoplasty/ So that little potion you get from a Chinese herbalist is not actually herbalist is not actually going to help you and make the problem worse. If you remember, going back to my first post, the only bit of original advice the nutritional therapist I saw in 2004 could offer me was to give up citrus fruits! Rather bizarrely, the author of this alternative medicine site: http://www.health-diseases-tips.com/does-septoplasty-work-44699.html says a doctor told him “that septoplasty rarely works”. This contradicts what my ENT consultant and all the anecdotal evidence I found on the internet. (Nonetheless, the site does advise those with sinus problems to let chiropractors put some micro balloons up their noses. I suppose some people like furry handcuffs and plastic whips whilst others go in for chiropractors and mini-balloons: whatever turns you on.)

The anecdotal evidence looks good, but that’s never enough really for those who believe in evidence-based medicine rather than quackery is it? What about the evidence gained from clinical practice, preferably clinical trials. See http://www.emedicine.com/ent/topic128.htm “which states Literature documenting the outcomes of septal surgery is not abundant. Siegal et al and Samad et al have reported patient satisfaction and clinical improvement rates after septoplasty, and both agree that success rates for septoplasty are approximately 70%.” When it comes to obstructive sleep apnea hypopnea syndrome septoplastry can be performed “to straighten a deviated nasal septum (cause of substantial nasal obstruction). This procedure has a very high rate of success in improving the nasal airway if the nasal septal deviation is the major etiology of the nasal obstruction. There are, however, no controlled studies that evaluate the long-term effect of septoplasty on OSAHS.” (See http://www.guideline.gov/summary/summary.aspx?doc_id=10809&nbr=5634&ss=6&xl=999) Also it would appear “nasal septoplasty results in significant improvement in disease-specific quality of life, high patient satisfaction, and decreased medication use.” (See Journal of Otalyngology: Head + Neck Surgery http://linkinghub.elsevier.com/retrieve/pii/S0194599803021673 ) I could go on, but I hope the above goes some way to proving the clinical effectiveness of septoplasty.

I was trying to think about how you could provide a placebo with this type of procedure. The only way I could think of would be to give 50% of patients in a given hospital the anaesthetic, tell them they had had the surgery and then ask them how their breathing was two months later. Presumably you would think it would be worse than those who had actually had the surgery! Still behaving like that would be a bit mean wouldn’t it?

Apparently, about 20% of randomly surveyed adults have problems that could be resolved or relieved by septoplasty. Possibly you are one of them. Many of those individuals will be wasting money consulting various quacks and therapists not realizing that the solution to their problems is very simple. The first thing to do is consult your GP. If necessary she will refer to an ENT consultant who will examine your ears, nose and throat to check what he thinks is causing the problems with your breathing. The waiting list on the NHS is four to five months, though could be a bit longer depending on where you live in the country. The only harmful side effects you may experience are nosebleeds. For the first few days after surgery you will find it difficult to eat and your nose will be blocked up. However, as time goes on your breathing should improve and hopefully will be better than when you went in. I’ll certainly report back. Who knows, as Patrick Holford, puts it the procedure may, “add life to your years.”

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11 Responses to “What is septoplasty and what is the evidence for its effectiveness?”

  1. John Branigan Says:

    I have no sense of smell and am prone to some terrible snoring bouts. Sometimes I wake up like I haven’t slept at all. I shall be down to my GP for BUPA recommendation as soon as I can wake myself up!

  2. dvnutrix Says:

    Th surgery is transformative for many people who had lost track of just how much their sense of smell/taste was impaired or just how uncomfortable it is to mouth-breathe much of the time (dries out the mucosal membranes during sleep – might lead to sore throats and discomfort on waking – lots of snoring etc.).

    Some GPs just don’t seem to hook the nose up and take a look (so to speak) to check for basics like polyps or deviation. But, good for you for having the procedure and I hope that the recovery goes well.

    The only way I could think of would be to give 50% of patients in a given hospital the anaesthetic, tell them they had had the surgery and then ask them how their breathing was two months later.

    Stuff like this has been done with knees. However, you are uniquely well-placed to tell us whether the presence/absence of pain, nosebleeds, swelling etc. might be a give-away as to whether or not you had actually received the surgery.

  3. LeeT Says:

    @ dvn when I told my GP I had a medical insurance the practice chased me up two or three times to ask if I wanted a referral to a consultant. (I did and my delay was just checking the insurers would cover the cost of a consutation.) Presumably the practice gets some kind of commission? Perfectly reasonable given there is some administration involved for them.
    The GP just checked for sign of infection and could not see any. The consultant was able to see what the problem within a few minutes possibly because his equipment was better? There is no reason why if your doctor misses the problem you can’t refer yourself to a consultant. However, it will cost you between £150 and £200 and it is highly unlikely you will be able to claim that back from an insurer without prior approval and a GP referal. Given my nose was bleeding for several days I think that proves I had the surgery.

    @ John Branigan – let’s hope those who know you will be able to see the difference between the new you and your present sleepy state

  4. Anees Says:

    I had septoplastry 2 weeks ago.
    I never had any snoring problems, or loss of smell.
    I just had pronlem playing sports, and my entire nose began to distort.
    just waiting for the swelling to dissapear. everything else is fine.
    be sure that the surgon that carries out the operation is an expert. an in experienced doc will not be able to help you.

  5. LeeT Says:

    Anees

    My understanding is that there are different symptons depending on how serious the problem is.

    Not sure what part of the world you come from I find it unlikely that an operation will be carried out by an inexperienced doctor. The person who carried my surgery was an ENT consultant. Your GP will, I hope, only refer to a local “expert.”

    Hope you are feeling 100% soon.

    Regards

    Lee

  6. Sonia Andreacchi Says:

    I am thinking of having a septoplasty……but am scared of the recovery…and any risks involved..how long does it take to breath through your nose again, smell and look presentable………(swelling to go down) also could you loose your sense of smell permanetly or loose your airways??

  7. Andy Says:

    Hi Lee,

    I was wondering how the septoplasty worked out in the end, and how long it took to heal? Do you think it was worthwhile? I’m thinking of getting it done myself…

    Thanks

    Andy

  8. Hmm.. Says:

    I would think that the placebo effect would have little effect in the case of a deviated septum.

    The level of nasal obstruction, although it varies depending on the conditions from minute to minute in the nose, would remain intact and would one would realize they continue to be afflicted.

    I am thinking about having a septoplasty; however, I have concerns about what the negative side-effects could be from having it. I don’t want nasal valve collapse or any number of other troubles. Still, I cannot reconcile myself to perpetually accepting constant nasal congestion (sometimes one nostril is almost completely blocked and at other times the congestion not too bad).

    Although I very much loathe the present symptoms I don’t want any new problems appearing as a result of the surgery-that would be incredibly depressing. This situation reminds me a bit about the “outrageous fortune” speech in Hamlet…hehe

  9. Deena Says:

    My biggest problem with this deviated septum is nose bleeds.I HAVE BEEN DEALING WITH THIS FOR 1YR. ALSO THE NOSE DRYNESS.My question is does this go away. Is surgery going to fix this. I do not know if there is a easer way to fix this problem other than surgery. HELP PLEASE

  10. Tony Smith Says:

    I have just had a septoplasty operation under the NHS. It was performed by Dr Chandra at William Harvey Hospital, Ashford, Kent and surprisingly, perhaps, I went home the same day. I had to wear gauze or what I called my Miss Piggy mask for about a week while all the blood & mucus came out and I was on cocodomol painkillers & anti-biotics for about a week. I had my operation 2 weeks ago & am now feeling a lot better although my nose is still blocked a lot which is normal, I am told. The main problem was getting to the stage where the NHS offered me the operation which took around 12 months. I had a scan of my nose some 7 months ago, by the way.

  11. T Says:

    I had septoplasty. It was useless. My septum soon recollapsed. I frequent a Chinese doctor, and it is her belief that if one bone is out of alignment, it will affect your entire body. She’s been working on my skull alignment and, in the process, has cured my chronic knee, back and neck pain. My septum has also started to straighten- it’s painful and gradual, but beats an inefficient operation.

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