Archive for the ‘Evidence Based Medicine’ Category

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

September 5, 2008

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.”