The turbinates are thin curved, bony shelves covered with nasal membranes, which project into the nose from along the sidewalls. Air passes over them it is warmed, humidified and cleaned. The membranes covering the turbinates shrink and swell in order to regulate airflow. There is a natural cycle to this which is why at times you breathe better on one side, then later on the other.
When the septum is deviated, the turbinate opposite the side of the deviation will enlarge permanently (called a “turbinate hypertrophy”). This can also happen in cases of chronic allergy.
One other effect of a deviated septum may be seen in the ear. The eustachian tube is a small passageway connecting the back of the nose to the space behind the ear drum (middle ear cavity ). It serves to equalize the pressure between the nose and the ear. If the septum is deviated, causing chronic inflammation, sometimes the opening of the eustachian tube into the nose doesn’t work well. This can cause difficulty clearing the ears and can sometimes lead to fluid behind the eardrum. Occasionally the fluid may even become infected. Eustachian tube function can often be helped by straightening the septum and restoring normal airflow patterns within the nose.
What is the treatment for a Deviated Septum?
If the septal deviation is not extreme we usually start treatment with a several week trial of intranasal steroid sprays such as Flonase®, Nasacort AQ®, or Rhinocort Aqua®. Although this does not straighten the septum per se it may shrink the membranes enough to significantly improve airflow. If the obstruction persists despite the trial of medication or the septal deviation is severe then the septum should be straightened and the turbinates reduced with an operation.
Septoplasty
The operation to straighten the septum is called a septoplasty. An incision is made inside the nose and the membranes are separated from the underlying crooked bone and cartilage on both sides. The deviated bone and cartilage are removed (you don’t need them), and the membranes simply fall back to the middle. It takes approximately one hour and you return home the day of the surgery (outpatient surgery). There is no bruising or swelling and you will look exactly the same after the surgery as you did before. We do not use “packing” which could be painful to remove. Sometimes we will splint the inside of the nose with very thin soft plastic splints, which are removed from your nose on the first post-operative visit. This does not hurt. Splint Removal Video
Turbinate Reduction
We often reduce the swollen nasal membranes during surgery as well (turbinate reduction). This is usually done by any combination of three techniques. Portions of the turbinate can simply be cut out (excised). A small needle may be placed into the turbinates and an electric current applied. This causes scarring between the membrane and the underlying bone thus shrinking the membranes back to a more normal size. The turbinates may also be pushed laterally (out-fractured) so that they do not project so far into the nasal airway.
What is recovery like after a septoplasty?
Recovery from the surgery feels like having a cold for a week. The internal swelling makes you feel a stuffy and so it can be a bit hard to sleep. Although we usually provide pain medication, many patients require nothing more than ibuprofen (Motrin®, Advil®) or Tylenol. We advise most people to take a week off of work, many find they can perform paperwork after two or three days.
After the surgery, you will find that your breathing is much easier. Most patients find that the quality of their sleep improves dramatically with the improvement in their nasal breathing. If you are having multiple episodes of sinusitis, they should be significantly reduced. If you are having fluid accumulate in your ear, this problem should be greatly reduced as well.
Finally, in addition to a deviated septum and turbinate hypertrophy, many people have allergies as well, which contribute to the swelling on the inside of the nose. The surgery will obviously not help allergies but other medical therapy is usually quite effective. This includes antihistamines, intra-nasal topical steroid sprays, and specific allergy testing with allergy shots (desensitization therapy).
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