Related Archives - Deviated Septum Surgery

Septoplasty and Turbinate Reduction Surgery: Your Quick Guide

December 8, 2020 by Marc Leave a Comment

Turbinate reduction (also known as turbinoplasty) is a procedure that is commonly done along with septoplasty. In this article we answer common questions about having septoplasty and turbinate reduction surgery done at the same time.

Table Of Contents

What is Septoplasty and Turbinate Reduction Surgery?

Benefits of Septoplasty Turbinate Reduction Surgery

What to Expect After Septoplasty and Turbinate Reduction Surgery?

Septoplasty and Turbinate Reduction Complications

Septoplasty and turbinate reduction before and after pictures

Septoplasty and turbinate reduction video

Frequently Asked Questions – Septoplasty and Turbinate Reduction Surgery

What is Septoplasty and Turbinate Reduction Surgery?

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Septoplasty is a surgical procedure performed to straighten the deviated nasal septum and turbinate reduction surgery is done to reduce the size of the enlarged turbinates (bony structures lined with mucosa) present on the lateral (side) wall of the nose. In many individuals, deviation in the septum is present along with overgrowth of the turbinates, causing nasal obstruction and narrowing of the airway. In such cases, the two surgeries are performed in conjunction to relieve nasal obstruction and restore the nasal airflow.¹Kim, D. H., Park, H. Y., Kim, H. S., Kang, S. O., Park, J. S., Han, N. S., & Kim, H. J. (2008). Effect of Septoplasty on Inferior Turbinate Hypertrophy. Archives of Otolaryngology–Head & Neck Surgery, 134(4), 419.

Benefits of Septoplasty Turbinate Reduction Surgery

Benefits of septoplasty and turbinate reduction surgery are:²Han JK, Stringer SP, Rosenfeld RM, Archer SM, Baker DP, Brown SM, et al. Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngology–Head and Neck Surgery. 2015 Nov;153(5):708-20.³Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015 Mar;53(1):59-65. doi: 10.4193/Rhin12.059. PMID: 25756080.

Septoplasty in combination with turbinate surgery treats the nasal blockage and maintains the nasal airflow.
It helps treat conditions such as chronic rhinosinusitis (inflammation of nose and sinuses), sleep apnea, and epistaxis (bleeding from the nose).
It reduces the prospects of revision surgery.
It is a cost-effective procedure.

What to Expect After Septoplasty and Turbinate Reduction Surgery?

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In this section we cover what you can expect when recovering from septoplasty and turbinate reduction surgery, along with recovery tips:

Septoplasty and turbinate reduction recovery – What to expect ?

The following symptoms can be experienced by the patient after the surgery:⁴Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Braz J Otorhinolaryngol. 2013 Aug;79(4):471-4. English, Portuguese⁵Bielamowicz, S., Hawrych, A., & Gupta, A. (1999). Endoscopic inferior turbinate reduction: A new technique. The Laryngoscope, 109(6),

Feeling of congestion due to placement of nasal packing or splints in nostrils.
Disturbance in sleep and headaches for 1-2 weeks due to nasal packing.
Mild bleeding from the nose.
Mild to moderate pain for 2-3 days.
Swelling and discoloration of the nose and adjacent areas for 2-3 days post-surgery.
Excessive accumulation of mucus (crusting) for a few weeks.

Septoplasty and turbinate reduction – Recovery time

Research suggests that recovery after septoplasty and turbinate reduction surgery was achieved in 22-43 days. Swelling subsides within 1-2 weeks after the surgery following which patient can resume work. Complete recovery from symptoms due to nasal obstruction is observed after 1 year of the surgery. However, significant improvement can be observed even after 3 months of the surgery.⁶Dąbrowska-Bień J, Skarżyński PH, Gwizdalska I, Łazęcka K, Skarżyński H. Complications in septoplasty based on a large group of 5639 patients. Eur Arch Otorhinolaryngol. 2018 Jul;275(7):1789-1794.⁷Alotaibi A, Almutlaq BA, Ahmed HG. Time for Recovery of Symptoms after Septoplasty.

Septoplasty and turbinate reduction - Recovery tips

Below are recovery tips to fasten the healing after the surgery:⁸Dąbrowska-Bień J, Skarżyński PH, Gwizdalska I, Łazęcka K, Skarżyński H. Complications in septoplasty based on a large group of 5639 patients. Eur Arch Otorhinolaryngol. 2018 Jul;275(7):1789-1794.⁹Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Apply cold pack or ice over the operated site on the nose and adjacent areas intermittently for 20 minutes for 2-3 days.
Take medicines as prescribed by the doctor.
Flush the nose with saline irrigation 4-6 times daily for 1-2 weeks to keep the nose clean and moist, and to minimize crusting (accumulation of mucus).
Apply antibiotic ointment (mupirocin) using Q-tips to clean the nose.
Sleep or rest with the head elevated using pillows to reduce pressure on the nose.
Avoid blowing of nose for at least a week after the surgery.
Avoid smoking, drinking alcohol, or visiting crowded places for a few days.
Visit doctors as recommended.

Septoplasty and Turbinate Reduction Complications

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Here are some of the common complications/side effects of septoplasty and turbinate reduction surgery, and a brief description of each:

Pain after septoplasty and turbinate reduction

Mild to moderate pain is experienced by the patient post-surgery. The patient may experience pain and discomfort during retrieval of nasal splints (placed to support the nose), 1 week after the surgery. However, following post-surgery instructions such as the use of pain killer medication, applying a cold pack over the operated site, and sleeping with the head elevated using pillows can aid in better pain control.¹⁰Scheithauer MO. Surgery of the turbinates and "empty nose" syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc03.¹¹Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Congestion after septoplasty and turbinate reduction

Nasal congestion is common after septoplasty and turbinate reduction surgery for the initial 1-2 weeks. It could be due to the presence of swelling at the operated site or placement of nasal packing or splints after the surgery to support the nose. Sometimes patients with persistent nasal obstruction or nasal congestion may require revision surgery.¹²Joshi RR, Riley CA, Kacker A. Complication Rates Following Septoplasty With Inferior Turbinate Reduction. Ochsner Journal. 2019 Dec 21;19(4):353-6.

Swelling after septoplasty and turbinate reduction

Mild to moderate swelling will occur for 3-4 days after the surgery and subside gradually. It may be accompanied by bruising or discoloration of the skin. However, the use of medications and placement of a cold pack or ice intermittently for 20 minutes for the first 48 hours after the surgery can fasten the recovery.¹³Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Sinus infection after septoplasty and turbinate reduction

The presence of nasal obstruction for a long duration can result in sinus infections, affecting the quality of life. The presence of deviated nasal septum and enlarged turbinates may affect the drainage of mucus and cause clogging (due to increase accumulation of mucus) of sinuses leading to sinus infections. So, this surgery reduces the incidence of sinus infections besides improving the nasal airflow. Overall, it is considered to be a safe and effective procedure.¹⁴Joshi RR, Riley CA, Kacker A. Complication Rates Following Septoplasty With Inferior Turbinate Reduction. Ochsner Journal. 2019 Dec 21;19(4):353-6.

Headache after septoplasty and turbinate reduction

The incidence of headaches is reported to be less after septoplasty and turbinate reduction surgery. The contact between the mucosa (inner skin) of deviated nasal septum and enlarged turbinates acts as a stimulus to produce pain, leading to headaches. So, performing septoplasty and turbinate reduction surgery eliminates these mucosal contacts, reducing the incidence of headaches. Research suggests that there is a significant improvement in the severity of headaches within 3 months after the surgery.¹⁵Lakshmanan, S., Singh, U., Zaffrullah, N. S., & Manimaran, V. (2020). Clinical Outcome Following Endoscopic Septoturbinal Surgeries for Rhinogenic Contact Point Headache: A Retrospective Analysis. Indian Journal of Otolaryngology and Head & Neck Surgery.

However, patients may complain of postoperative headaches for a week due to the presence of nasal packing.

Bleeding after septoplasty and turbinate reduction

Mild oozing of blood after surgery is common. Excessive bleeding after the septoplasty and turbinate reduction surgery is reported in ~6% to 13.4% of patients. The presence of this complication could be due to several reasons such as septal incision (cut on septum), technique opted to perform the surgery, lack of use of nasal packing, and surgeon-related differences. In case of severe bleeding contact your doctor immediately.¹⁶Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Septoplasty and turbinate reduction before and after pictures

Here are good pictures of how some people have looked before and after their septoplasty and turbinate reduction procedures:

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Septoplasty and turbinate reduction video

Here are good videos that show the steps of the septoplasty and turbinate reduction procedures:

Frequently Asked Questions – Septoplasty and Turbinate Reduction Surgery

Here are answers to the most commonly asked questions related to septoplasty and turbinate reduction surgery:

How long does a septoplasty and turbinate reduction take?

Research suggests that average room time (time during which patient is present in the operating room) was reported to be ~110 minutes and average surgical time (time taken to perform surgery) was ~77 minutes.¹⁷Quinn, N. A., Alt, J. A., Ashby, S., & Orlandi, R. R. (2018). Time, Resident Involvement, and Supply Drive Cost Variability in Septoplasty with Turbinate Reduction. Otolaryngology–Head and Neck Surgery, 159(2), 310–314.

Cost of septoplasty and turbinate reduction in the USA

The total cost for septoplasty and turbinate reduction surgery ranges from $852 to $10,559. The cost may vary depending on the technique opted, complexity of the case, surgeon’s expertise, and operating room’s fees. The additional cost incurred ranges from $400 to $5,081.¹⁸ Thomas, A., Alt, J., Gale, C., Vijayakumar, S., Padia, R., Peters, M., … Meier, J. D. (2016). Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction. International Forum of Allergy & Rhinology, 6(10), 1069–1074

Septoplasty and turbinectomy – what is the difference between turbinate reduction surgery and turbinectomy?

Turbinal reduction surgery or turbinoplasty includes partial removal of the bone and the mucosa (skin) covering the turbinates. Meanwhile, turbinectomy involves the removal of the entire turbinates (entire bone and skin). This is associated with more crusting (increased accumulation of mucus) and delayed healing when compared to turbinoplasty.¹⁹Bhandarkar ND, Smith TL. Outcomes of surgery for inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg. 2010 Feb;18(1):49-53.

Sources:

1
Kim, D. H., Park, H. Y., Kim, H. S., Kang, S. O., Park, J. S., Han, N. S., & Kim, H. J. (2008). Effect of Septoplasty on Inferior Turbinate Hypertrophy. Archives of Otolaryngology–Head & Neck Surgery, 134(4), 419.
2
Han JK, Stringer SP, Rosenfeld RM, Archer SM, Baker DP, Brown SM, et al. Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngology–Head and Neck Surgery. 2015 Nov;153(5):708-20.
3
Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015 Mar;53(1):59-65. doi: 10.4193/Rhin12.059. PMID: 25756080.
4
Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Braz J Otorhinolaryngol. 2013 Aug;79(4):471-4. English, Portuguese
5
Bielamowicz, S., Hawrych, A., & Gupta, A. (1999). Endoscopic inferior turbinate reduction: A new technique. The Laryngoscope, 109(6),
6
Dąbrowska-Bień J, Skarżyński PH, Gwizdalska I, Łazęcka K, Skarżyński H. Complications in septoplasty based on a large group of 5639 patients. Eur Arch Otorhinolaryngol. 2018 Jul;275(7):1789-1794.
7
Alotaibi A, Almutlaq BA, Ahmed HG. Time for Recovery of Symptoms after Septoplasty.
8
Simpson JC. Postoperative Care of The Patient After Nasal Surgery
9
Scheithauer MO. Surgery of the turbinates and "empty nose" syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc03.
10
Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.
11
Joshi RR, Riley CA, Kacker A. Complication Rates Following Septoplasty With Inferior Turbinate Reduction. Ochsner Journal. 2019 Dec 21;19(4):353-6.
12
Lakshmanan, S., Singh, U., Zaffrullah, N. S., & Manimaran, V. (2020). Clinical Outcome Following Endoscopic Septoturbinal Surgeries for Rhinogenic Contact Point Headache: A Retrospective Analysis. Indian Journal of Otolaryngology and Head & Neck Surgery.
13
Quinn, N. A., Alt, J. A., Ashby, S., & Orlandi, R. R. (2018). Time, Resident Involvement, and Supply Drive Cost Variability in Septoplasty with Turbinate Reduction. Otolaryngology–Head and Neck Surgery, 159(2), 310–314.
14
Thomas, A., Alt, J., Gale, C., Vijayakumar, S., Padia, R., Peters, M., … Meier, J. D. (2016). Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction. International Forum of Allergy & Rhinology, 6(10), 1069–1074
15
Bhandarkar ND, Smith TL. Outcomes of surgery for inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg. 2010 Feb;18(1):49-53.

Septoplasty Recovery: Complete Guide to Deviated Septum Surgery Recovery

Septoplasty Recovery: Complete Guide to Deviated Septum Surgery Recovery

Is Deviated Septum Surgery Painful? How to Manage Pain After Septoplasty Surgery

Is Deviated Septum Surgery Painful? How to Manage Pain After Septoplasty Surgery

Septoplasty and Rhinoplasty Surgery: Answers to Common Questions

Septoplasty and Rhinoplasty Surgery: Answers to Common Questions

Deviated Septum Surgery Success Rate: A Look at the Evidence

Deviated Septum Surgery Success Rate: A Look at the Evidence

Is Fixing a Deviated Septum Worth It? A Look at the Pros & Cons

Is Fixing a Deviated Septum Worth It? A Look at the Pros & Cons

Buteyko Breathing for a Deviated Septum: What You Need to Know

October 29, 2020 by Marc Leave a Comment

One interesting home treatment for a deviated septum is the Buteyko breathing method.

The Buteyko method was first introduced by Professor Konstantin Buteyko, a Russian physiologist. He believed that decreased carbon dioxide levels in the body affect the energy producing process in the cells and disturb the homeostasis (stable internal state) within the body causing diseases.

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Practicing these breathing exercises can raise the levels of carbon dioxide, curing several chronic diseases. This approach is quite popular in treating asthma and is found to be helpful in conditions such as diabetes, psychological disorders, immune and metabolic disorders, reproductive disorders, and sleep apnea.¹Courtney R. Strengths, weaknesses, and possibilities of the Buteyko breathing method. Biofeedback. 2008 Jul 1;36(2):59-63.

The main Buteyko exercises include the following:²Buteyko Clinic, Nose Unblocking Exercises, Exercises to Combat Asthma,Mar 25, 2014.

1
Exercise to unblock nose.
2
Normalizing breathing volume:

By blocking nostrils using fingers,
By keeping hands on side of the face, or
By keeping hands on chest and stomach.

3
Diaphragm breathing while walking.
4
Holding breath while walking (to create light to strong hunger for air).
5
Breathing exercises for severe asthma, anxiety, and panic attacks.
6
Breathing exercises for children and teenagers.
7
Multiple, short breath holds.
8
Relaxation.

The presence of deviated septum blocks the nose and obstructs breathing. The Buteyko breathing technique unblocks the nose and can be performed in the following steps:³Courtney R. Buteyko breathing method. Recognizing and Treating Breathing Disorders E-Book. 2014 Jan 1:241.

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Step 1

It begins with control pause (CP) which involves gentle inhaling and exhaling through the nose, followed by holding the breath. The breath should be held until the individual develops a desire or hunger to breathe.

Step 2

In this, the individual relaxes and breathes slowly for 3-5 minutes. It is also known as slow breathing.

Step 3

This step begins with gentle inhalation and exhalation through the nose followed by holding the breath to the maximum extent. It is known as maximum pause.

Steps 2 and 3 are repeated five times and can be performed for 20-40 minutes.

It is believed that hyperventilation (unseen excessive breathing) leads to a deficiency of carbon dioxide in the blood. This phenomenon lowers oxygen levels in the tissues and causes several chronic disorders.Breath-holding exercises increase the levels of carbon dioxide (hypercapnia) in the body and cure these disorders.⁴Courtney R. Strengths, weaknesses, and possibilities of the Buteyko breathing method. Biofeedback. 2008 Jul 1;36(2):59-63. In individuals with deviated septum, these exercises unblock the nose and ease breathing.

Buteyko Breathing Exercises in 3 Minutes by Patrick McKeown

When to Ask for Help After Deviated Septum Surgery

When to Ask for Help After Deviated Septum Surgery

Deviated Septum Surgery: Success Rates & Things to Consider

Deviated Septum Surgery: Success Rates & Things to Consider

Types of Deviated Septum Surgery: Complete Guide to Septoplasty, Turbinate Reduction, Rhinoplasty & More

Types of Deviated Septum Surgery: Complete Guide to Septoplasty, Turbinate Reduction, Rhinoplasty & More

Deviated Septum Diet: Healthy Foods to Reduce Breathing Problems (and Foods to Avoid)

Deviated Septum Diet: Healthy Foods to Reduce Breathing Problems (and Foods to Avoid)

Deviated Septum Symptoms: Do You Know These 7 Signs?

Deviated Septum Symptoms: Do You Know These 7 Signs?

Turbinate Reduction (Turbinoplasty) for a Deviated Septum: Plain English Guide for Patients

October 28, 2020 by Marc Leave a Comment

In this plain English guide to turbinate reduction surgery for a deviated septum, we cover everything you need to know about this surgical procedure:

What is turbinoplasty surgery?
What happens during turbinoplasty surgery?
What should I expect after turbinoplasty surgery?
What are the risks of turbinoplasty surgery?
What are the pros & cons of turbinoplasty surgery?

And much more. Let’s get started:

Table Of Contents

What is Turbinate Reduction Surgery?

Turbinate Reduction Surgery Procedure Steps

Effectiveness of Turbinate Reduction Surgery

What to Expect After Turbinate Reduction Surgery?

Turbinate Reduction Surgery Recovery

Precautions After Turbinate Reduction Surgery

Turbinate Reduction Pain After Surgery

Turbinate Reduction Surgery Side Effects

Pros and Cons of Turbinate Reduction Surgery

Turbinate Reduction Surgery Pictures

Turbinate Reduction Surgery Videos

Frequently Asked Questions – Turbinate Reduction Surgery

What is Turbinate Reduction Surgery?

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Turbinate reduction surgery is a procedure to reduce the size of swollen turbinates to clear the nasal airway.

Turbinates are small bony projections present on the lateral (side) walls of the nose and covered by mucous membrane. They help in humidification, filtration, and regulation of the airflow in the nose. Presence of allergies, deviated nasal septum, or infection can cause swelling of the turbinates, causing nasal obstruction and altering the airway flow.¹Jackson, L. E., & Koch, J. R. (1999). Controversies in the Management of Inferior Turbinate Hypertrophy: A Comprehensive Review. Plastic and Reconstructive Surgery, 103(1), 300–312.

Turbinate Reduction Surgery Procedure Steps

The steps that are followed during a turbinate reduction surgery procedure in the following²Galetti, G., Dallari, S., & Galetti, R. (1991). Turbinoplasty: Personal Technique and Long-Term Results. ORL, 53(2), 111–115.

step 1

Local anesthesia is injected into the nose to numb the nose.

step 2

Using a blade, a vertical incision is marked on the frontal aspect of mucosa (inner skin) of the turbinates, which are present on the lateral (side) wall of the nose.

step 3

This is followed by removal of the swollen part of the tissue covering the turbinates.

step 4

The complete turbinal bone (or part of the turbinal bone) is removed or reshaped.

step 5

Temporary nasal packs may be given.

Effectiveness of Turbinate Reduction Surgery

Studies show that ~88% of individuals report significant improvement in the nasal airway obstruction after turbinate reduction surgery.

Within 3 months of the surgery, improvement is observed in symptoms such as reduced sense of smell, facial pain, itching of nose, sneezing, and nasal discharge.³Hamerschmidt R, Hamerschmidt R, Moreira AT, Tenório SB, Timi JR. Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis. Brazilian Journal of Otorhinolaryngology. 2016 Apr;82(2):131-9.

What to Expect After Turbinate Reduction Surgery?

After the turbinate reduction procedure, patients can expect⁴Bielamowicz, S., Hawrych, A., & Gupta, A. (1999). Endoscopic inferior turbinate reduction: A new technique. The Laryngoscope, 109(6),

Discomfort or congestion due to the dressing and packing in nostrils. The packing aims to arrest post-surgery bleeding. Until it is removed, the patient needs to breathe through the mouth.
Mild bleeding can be expected from the nose after the surgery. The bleeding does not last for more than 15 minutes. In case of heavy bleeding, the patient must immediately contact the doctor.
Swelling and tenderness in the nose may be present for 2-3 days post-surgery.
Crusting (excessive accumulation of mucus) is common for 2-6 weeks post-surgery until the mucosa (inner skin) develops on the bone.
Mild pain and discomfort may be present during removal of nasal packing or nasal splint.

Turbinate Reduction Surgery Recovery

To recover from turbinate reduction surgery, patients are advised to⁵Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Take prescribed medicines (pain killers and decongestants) on time.
Apply ice/cold pack over the nose for 20 minutes (intermittently) for next 2-3 days post-surgery to reduce swelling.
Perform nasal saline spray or saline irrigation once or twice daily for 1-2 weeks after the surgery.
Visit the doctor for follow ups as recommended.

Precautions After Turbinate Reduction Surgery

After the turbinate reduction procedure, patients should follow these precautions⁶Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Avoid blowing of nose for at least a week.
Avoid sneezing with mouth closed. Instead, keep the mouth open while sneezing.
Breathing through the mouth is recommended due to presence of nasal packing or splint.
Avoid vigorous workouts, lifting heavy objects, or bending forward.
Avoid taking hot steam baths and showers.
Avoid smoking and drinking alcohol.
Avoid visiting crowded places.

Turbinate Reduction Pain After Surgery

Most patients state that after turbinate reduction surgery the level of pain they feel varies from minimal to moderate based on the technique chosen for the surgery and severity of the condition.

The technique which involves minimal intrusion also results in lesser discomfort. Meanwhile, aggressive techniques cause excessive trauma to bone and soft tissue, leading to postoperative pain for 3-4 days after the surgery.⁷Scheithauer MO. Surgery of the turbinates and "empty nose" syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc03.

Turbinate Reduction Surgery Side Effects

Potential side effects of turbinate reduction surgery are rare. Most common side effects include bleeding and crusting (excessive accumulation of mucus).

Depending on the technique opted, the side effects may include infection, necrosis of bone, rhinitis (inflammation of nose), perforation of nasal septum, synechiae (fusion between nasal septum and turbinates), persistence of nasal congestion, or, in rare cases, empty nose syndrome (loss or reduced sensation of smell).⁸Bergmark, R. W., & Gray, S. T. (2018). Surgical Management of Turbinate Hypertrophy. Otolaryngologic Clinics of North America

Pros and Cons of Turbinate Reduction Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:

Pros of Turbinate Reduction Surgery⁹Chang, C. W. D., & Ries, W. R. (2004). Surgical treatment of the inferior turbinate: new techniques. Current Opinion in Otolaryngology & Head and Neck Surgery, 12(1), 53–57.

The surgery can be performed under local anesthesia.
The surgery eases the breathing process by clearing the nasal obstruction created by enlarged turbinates.
The surgery improves additional symptoms such as snoring, sneezing, nasal discharge, post nasal drip (mucus entering the throat), and reduced sense of smell.

Cons of Turbinate Reduction Surgery¹⁰Mabry, R. L. (1984). Surgery of the Inferior turbinates: How Much and When? Otolaryngology-Head and Neck Surgery, 92(5), 571–576.

Healing is slow accompanied with crusting of nose in some patients.
Use of aggressive techniques to reduce enlarged turbinates is associated with increased complications.
It is a technical, sensitive procedure and requires exceptional skills.
Many techniques are available to reduce enlarged turbinates, and no single technique is established as gold standard. Proper assessment of the condition is required before opting the technique.

Turbinate Reduction Surgery Pictures

Here are some excellent photos that show the turbinate reduction procedure:

source

Turbinate Reduction Surgery Videos

Here are some excellent videos that show the turbinate reduction procedure:

Frequently Asked Questions – Turbinate Reduction Surgery

Here are answers to the most commonly asked questions related to turbinate reduction surgery:

Is turbinate reduction a major surgery?

The short answer is “yes”.

Many times, turbinate reduction surgery is performed in combination with septoplasty or other nasal surgeries. It can be performed under local anesthesia but in severe cases general anesthesia is preferred.

How long does turbinate reduction surgery take?

Turbinate reduction surgery may take a minimum of 20 minutes and when performed with septoplasty, takes ~77 minutes of surgical time and overall room time of ~110 minutes.¹¹Quinn, N. A., Alt, J. A., Ashby, S., & Orlandi, R. R. (2018). Time, Resident Involvement, and Supply Drive Cost Variability in Septoplasty with Turbinate Reduction. Otolaryngology–Head and Neck Surgery, 159(2), 310–314.

What is the recovery time for turbinate reduction surgery?

It may take 1-2 weeks to recover and resume work. The complete recovery may take ~6 weeks.¹²Scheithauer MO. Surgery of the turbinates and "empty nose" syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc03.

What is the cost of turbinate reduction surgery in the USA?

The cost of turbinate reduction surgery when combined with septoplasty may range between $852 to $10,559. The cost may vary depending on the technique opted, complexity of the case, surgeon’s expertise, reputation, clinical experience, and operating room’s fees.¹³Thomas A, Alt J, Gale C, Vijayakumar S, Padia R, Peters M, Champagne T, Meier JD. Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction. Int Forum Allergy Rhinol. 2016;6:1069-1074.

Sources:

1
Jackson, L. E., & Koch, J. R. (1999). Controversies in the Management of Inferior Turbinate Hypertrophy: A Comprehensive Review. Plastic and Reconstructive Surgery, 103(1), 300–312.
2
Galetti, G., Dallari, S., & Galetti, R. (1991). Turbinoplasty: Personal Technique and Long-Term Results. ORL, 53(2), 111–115.
3
Hamerschmidt R, Hamerschmidt R, Moreira AT, Tenório SB, Timi JR. Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis. Brazilian Journal of Otorhinolaryngology. 2016 Apr;82(2):131-9.
4
Bielamowicz, S., Hawrych, A., & Gupta, A. (1999). Endoscopic inferior turbinate reduction: A new technique. The Laryngoscope, 109(6),
5
Simpson JC. Postoperative Care of The Patient After Nasal Surgery
6
Scheithauer MO. Surgery of the turbinates and "empty nose" syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc03.
7
Bergmark, R. W., & Gray, S. T. (2018). Surgical Management of Turbinate Hypertrophy. Otolaryngologic Clinics of North America
8
Chang, C. W. D., & Ries, W. R. (2004). Surgical treatment of the inferior turbinate: new techniques. Current Opinion in Otolaryngology & Head and Neck Surgery, 12(1), 53–57.
9
Mabry, R. L. (1984). Surgery of the Inferior turbinates: How Much and When? Otolaryngology-Head and Neck Surgery, 92(5), 571–576.
10
Quinn, N. A., Alt, J. A., Ashby, S., & Orlandi, R. R. (2018). Time, Resident Involvement, and Supply Drive Cost Variability in Septoplasty with Turbinate Reduction. Otolaryngology–Head and Neck Surgery, 159(2), 310–314.
11
Thomas A, Alt J, Gale C, Vijayakumar S, Padia R, Peters M, Champagne T, Meier JD. Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction. Int Forum Allergy Rhinol. 2016;6:1069-1074.

Neti Pot for Deviated Septum: Your Complete Guide

Neti Pot for Deviated Septum: Your Complete Guide

Deviated Septum Surgery Recovery: How Long It Takes + Tips to Recover

Deviated Septum Surgery Recovery: How Long It Takes + Tips to Recover

Septoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

Septoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

What Doctor to See for a Deviated Septum? Who to See & What to Expect

What Doctor to See for a Deviated Septum? Who to See & What to Expect

Deviated Septum Laser Surgery: A Plain English Guide

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Deviated Septum and Sinus Infections: Cause, Diagnosis & Treatment

August 10, 2020 by Marc Leave a Comment

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In this complete guide we explain the connection between deviated septum and sinusitis (aka sinus infections), including the underlying connection, how can you tell if a deviated septum is the cause of your sinus problems, and how can you treat it.

Can a Deviated Septum Cause Sinus Infections?

A sinus can be defined as a cavity or hollow space in bone or other tissues. Sinuses are of many types and are found in different parts of the body.

The nose contains “paranasal” sinuses (air-filled spaces surrounding the nasal cavity) which are lined by respiratory mucosa (membrane). This membrane is responsible for secreting mucus¹Anatomy, Head and Neck, Nose Sinuses.

Sinus infections, or sinusitis, is defined as inflammation of the nose and the paranasal sinuses, occurring with two or more of the following symptoms:

Blockage/congestion
Discharge
Loss of smell and symptoms lasting less than 12 weeks
Other symptoms including toothache, pain, and fever²Sinusitis and its management.

The impact of a deviation of the nasal septum on sinus infections or sinusitis is unknown. This is because the nasal septum deviation can occur with different patterns and severity, therefore researchers are not aware of how much and how often the occurrence of nasal septum deviation leads to sinusitis³CLASSIFICATION OF NASAL SEPTAL DEVIATIONS – RELATION TO SINONASAL PATHOLOGY.

Some researchers have tried to divide the type of defects of the nasal septum into different classes, and they have found some trends regarding the correlation of nasal septum defects with sinus infections. (The classes of nasal septum deviation include seven different types, which are part of a broader classification based on the plane of the deviation, horizontal and vertical.)⁴Correlation Study Between Nasal Septal Deviation and Rhinosinusitis

The researchers found the following results⁵Correlation Study Between Nasal Septal Deviation and Rhinosinusitis:

1
Amongst horizontal deviations, type 4 deviation is most commonly associated with occurrence of sinusitis (see Figure 1 below for an image of type 4 deviation)
2
Type 1 and 2 vertical deviations are linked to sinusitis because they occur in the nasal valve area
3
Posterior (towards the back) deviations are more likely to develop sinus infections in comparison to anterior (towards the front) deviations

Figure 1.0: Different types of septal deviation. Type 7 is indicated to be a mixed type of septal deviation (middle)

Figure 2.0: indicates different parts of the nasal septum. A (anterior), B (middle) and C (posterior).

Will a Corrected Deviated Septum Stop My Sinus Infections?

Septoplasty is surgery that involves correction of a deviated septum to improve nasal function.

Nasal septum defects are one of the causes of sinusitis or sinus infections, because they can lead to inflammation and blockage of the nose and paranasal sinus.

A randomised study was performed to understand the effectiveness of septoplasty in improving symptoms of sinusitis in patients with significant septal deviation. Researchers found that septoplasty alone was significantly beneficial in improving symptoms of sinusitis as the success rates amongst the patients were 99.3%. These results suggest that septoplasty can be useful in patients suffering with persistent sinus infections⁶Is Septoplasty Alone Adequate for the Treatment of Chronic Rhinosinusitis with Septal Deviation?.

Other Sinusitis Treatments When You Have a Deviated Septum

If your sinus infections are caused by a deviated septum you should seriously look into having your septum corrected through septoplasty (also known as deviated septum surgery).

But if that’s not possible, here are some things you can do at home to reduce the septum’s impact on your sinus problems⁷Natural Treatment of Chronic Rhinosinusitis:

1
Consuming Vitamin C rich foods: Vitamin C is also called ascorbic acid, and a reduction of vitamin C levels in blood is linked with increased histamine (a compound present in the body responsible for causing allergic reactions).

Consuming more vitamin C-rich foods such as citrus fruits, kiwi, mango, and vegetables such as broccoli, tomatoes, and peppers can be effective in preventing allergic problems relating to sinusitis⁸Vitamin C.

Figure 4.0: Shows different types of foods that contain high levels of vitamin C.

2
Bromelain: Bromelain is a group of enzymes having anti-inflammatory properties (reducing inflammation) and mucolytic properties (making the mucous thin). It is commonly derived from pineapple fruit.

Several studies have shown that bromelain can be effective in reducing nasal inflammation and can provide a faster recovery from sinusitis. Moreover, Bromelain also provides relief from symptoms by thinning the mucous amongst those suffering from upper respiratory disorders such as sinusitis⁹Natural Treatment of Chronic Rhinosinusitis.

3
N-acetyl cysteine supplement: Foods such as onion contain N-acetyl cysteine (45mg NAC per Kg). It is an antioxidant and a precursor of amino acids which form proteins. However, its effectiveness comes from its mucolytic activity. The mucous is broken down by N-acetyl cysteine into smaller and thinner units. This makes clearance of mucous through the nasal canal easier. It has been reported in some studies that this clearance can be improved by up to 35%. The typical adult dose is 600 to 1500 mg daily. It is a very safe supplement, even at very high dosage. However, you may experience some side effects such as nausea, vomiting and digestive problems¹⁰Natural Treatment of Chronic Rhinosinusitis.
4
Saline nose drops: Using nasal drops not only cleanses the nose area but also removes mucous secretions.

Research recommends the use of 5% saline solution, instead of 3% or 0.9% solutions as it has been shown to be more effective to reduce histamine. In the research it was observed that people who used saline nose drops, reported improvement in their quality of life and minimal side effects. Furthermore, about 87% compliance rate was measured in one of the studies.

It is suggested that nasal drops should be used 1 to 3 times per day as they are an effective, simple and well tolerated method to control symptoms related to sinus infections¹¹Natural Treatment of Chronic Rhinosinusitis.

Figure 5.0: shows the correct way of applying nasal drops (right) and the wrong way of applying nasal drops (left).

5
Lifestyle changes: Improving air quality in households using high quality particulate air filtration reduces household mold levels and airborne fungi. People with sinus problems should limit their exposure to animal dander and dust mites. Furthermore, a study was able to find a relationship between natural gas use for cooking and upper respiratory disorders including sinusitis. Identifying and removing the sources of infection and allergens can help with decreasing recurrence of sinusitis¹²Natural Treatment of Chronic Rhinosinusitis.

Sources:

Deviated Septum Snoring: How Does a Deviated Septum Lead To Snoring?

Deviated Septum Surgery: How to Know When It’s Time to Do It

When to Ask for Help After Deviated Septum Surgery

How Quickly Can You Find A Surgeon For Deviated Septum Surgery?

Septoplasty and Rhinoplasty Surgery: Answers to Common Questions

Deviated Septum Insurance: What are Your Chances for Coverage?

Deviated Septum and Sleep Apnea: Cause, Diagnosis & Treatment

August 10, 2020 by Marc Leave a Comment

In this complete guide we explain the connection between deviated septum and sleep apnea:

What is the underlying connection between a deviated septum and sleep apnea?
How can you tell if a deviated septum is causing your sleep apnea?
How can you treat it?

Can a Deviated Septum Cause Sleep Apnea?

Sleep-related breathing disorders sit on a broad continuum, which ranges from simple or primary snoring at one end and obstructive sleep apnea at the other end.¹The role of the nose in snoring and obstructive sleep apnoea: an update

Sleep apnea is usually defined as cessation (stoppage) of airflow into the lungs which lasts for more than 10 seconds. Obstructive sleep apnea is defined as a common disorder characterized by repetitive episodes of nocturnal (night time) breathing cessation due to upper airway failure. Obstructive sleep apnea is a serious condition because of its effects on cardiovascular outcomes.²Obstructive sleep apnoea syndrome and its management.

A deviated nasal septum is related to restricting the nasal airflow, which leads to causing nasal obstruction³The Reason of Dissatisfaction of Patient after Septoplasty. This becomes more critical when the patient lies down (supine), as it leads to increased nasal resistance and restricts the flow even further.⁴The role of the nose in snoring and obstructive sleep apnoea: an update

There can be other causes of sleep apnea, apart from a nasal septum defect. These include other structural abnormalities such as enlarged turbinates (small structures present in the nose) and nasal valve collapse, and inflammatory causes, including nasal polyps (abnormal tissue growth), sinusitis and rhinitis.⁵The role of the nose in snoring and obstructive sleep apnoea: an update

Certain factors, such as snoring, day-time sleepiness, poor quality of sleep and sleep disturbances, are all associated with sleep apnea.

Figure 1.0: Shows the differences between a normal (left) and blocked airway (right).

Will a Corrected Deviated Septum Help Sleep Apnea?

Nasal obstruction is one of the major signs that septoplasty (deviated septum surgery) is needed, and as nasal obstruction is related to symptoms such as sleep apnea, septoplasty should successfully improve symptoms related to sleep apnea and other sleep disturbances.

Several studies have been undertaken to understand the effects of septoplasty on sleep apnea. One such study found that parameters that measure sleep apnea such as apnea-hypopnea index (severity of sleep apnea), severity of obstructive sleep apnea syndrome, and mean oxygen saturation, all showed significant improvements. In addition to this, the sleep satisfaction scores of patients improved significantly as well⁶Clinical Effect of Surgical Correction for Nasal Pathology on the Treatment of Obstructive Sleep Apnea Syndrome..

Another study depicted similar results, with significant improvements in sleep quality, nasal obstruction, snoring and sleep apnea⁷Effects of Functional Septoplasty in Obstructive Sleep Apnea Syndrome.

Other Sleep Apnea Treatments When You Have a Deviated Septum

If your sleep apnea is caused by a deviated septum we strongly recommend you look into having your septum corrected through deviated septum surgery (aka “septoplasty”).

But if it’s not possible for you to have septoplasty surgery soon, there are a number of things you can do at home to reduce the septum’s impact on your sleep apnea.

Here are our recommendations:

1
Continuous positive airway pressure (CPAP): Continuous positive airway pressure is a type of therapy in which airflow is introduced into the airways to maintain a continuous pressure to allow the airways to open, while they are breathing at the same time.

CPAP has shown in hundreds of studies to improve measures of sleep apnea, and is considered the “gold standard” of obstructive sleep apnea treatment. Measures that have been improved by CPAP in studies include reducing apnea-hypopnea index (severity of sleep apnea), and sleepiness.

It has been suggested that patients who have moderate to severe sleep apnea should consider continuous positive airway pressure therapy as it has shown in many studies to benefit health, quality of life and workplace productivity⁸Diagnosis and treatment of obstructive sleep apnea in adults.

Figure 3.0: depicts a continuous positive airway pressure machine (left) being used by a patient.

2
Oral Appliances: Patients who cannot use CPAP therapy and have mild to moderate sleep apnea can make use of oral appliances.

Oral appliances improve upper airway configuration and prevent collapse by changing the position of the jaw and tongue⁹Oral Appliance Treatment for Obstructive Sleep Apnea: An Update.

It has been shown in studies that these devices can enlarge the airway space. The best practice for oral appliance therapy involves fitting of the oral appliance by a dentist who has extensive experience and additional training in dental sleep medicine.

Research has shown that oral appliances can be as effective as continuous positive airway pressure therapy in patients with mild to moderate symptoms, and that these devices tend to provide better adherence in patients¹⁰Diagnosis and treatment of obstructive sleep apnea in adults.

Figure 4.0: shows oral appliance used to improve sleep apnea symptoms

3
Lifestyle changes: The Canadian Thoracic Society guidelines recommend that patients with sleep disordered breathing should make changes to excessive alcohol consumption and sedative use¹¹Diagnosis and treatment of obstructive sleep apnea in adults.

It has also been seen in research that exercise of modest intensity and weight loss by 10% of current weight in overweight and obese patients resulted in reductions in apnea-hypopnea index, hence, improving symptoms of sleep apnea¹²Diagnosis and treatment of obstructive sleep apnea in adults.

Some studies also suggested the use of dietary modification and implementing sleep hygiene, in order to reduce symptoms of sleep apnea¹³Lifestyle Modification for Obstructive Sleep Apnoea.

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