What is nasal surgery?

The inside of the nose is divided into a right and left nasal passage by the nasal septum. The septum, made of cartilage and bone, should be straight and midline. A deviated septum is when the septum is crooked, resulting in narrowing in one or both nasal passages.

Septoplasty is the operation that straightens a deviated septum. The surgery involves making an incision inside the nose, removing the bent portions of bone and cartilage, and allowing the remainder of the septum to return to a midline position. There is no external incision, no “breaking of the nose”, and no “black eyes” or facial swelling. It is performed in the operating room, under general or local anesthesia.

Turbinate surgery is often performed at the same time as septoplasty. Turbinates are shelves of tissue that project into each nasal passage. They can become excessively enlarged due to a deviated septum, underlying allergies, or other causes. Surgery can reduce enlarged turbinates back to a more normal size.

What are the potential benefits?

The primary benefit is improved breathing through the nose. In fact, septoplasty, with or without turbinate surgery, significantly reduces nasal obstruction in more than 85% of cases. Obviously, improvement cannot be guaranteed in every case.

Nasal surgery is less likely to help with headaches, nasal drainage, and sinus infections. While these symptoms may improve, the main goal is better nasal breathing.

In regards to snoring, nasal surgery is beneficial in only 20% of cases. Snoring and sleep apnea are usually due to throat obstruction, not nasal obstruction. As such, throat surgery and palatal procedures are more effective snoring treatments.

What are the risks?

Risks include, but are not limited to, the following:

  • a hole in the septum (i.e., septal perforation), which could cause a whistling noise, nasal crusting, or recurrent nosebleeds.
  • a decrease in the sense of smell, which would also affect taste.
  • temporary or permanent numbness of the front teeth.
  • excessive bleeding during surgery or recovery which, on rare occasions, could require a blood transfusion.
  • infection, which could be localized within the nose or spread to the rest of the body.
  • a change in the external appearance of the nose due to a loss of nasal support structures.
  • anesthetic complications, both minor and life-threatening.

Fortunately, nasal surgery is commonly performed by ENT physicians and these complications occur in less than 2% of cases.

What can be anticipated during recovery?

Nasal obstruction tends to be the most bothersome complaint of patients after surgery. If nasal packing is placed, you will not be able to breathe at all through your nose until the packing is removed. Even without packing, your nose is likely to be more congested than usual. Although nasal sprays and ointments may help, the swelling and crusting usually take a few weeks to resolve. During that time, poor sleep quality, dry mouth, and fatigue should be anticipated.

Bloody nasal drainage is expected and may last several days. The blood coming out of the nose usually requires a gauze pad placed under the nose. The blood draining back into the throat may worsen post-anesthesia nausea.

Pain is usually easily controlled with medications. Instead of discomfort, patients more frequently complain about the fatigue and nausea caused by the nasal obstruction and bleeding.

What are the restrictions after surgery?

Although it partly depends on the occupation, most patients are allowed to return to work when feeling better, usually within 4-7 days. Traveling should be limited during the first 7-10 days, so that bleeding or any other complication can be readily managed. Physical exertion should initially be limited and gradually increased as tolerated.

What are the associated costs?

Since the surgery is performed in an operating room, costs include fees for the surgeon, anesthesiologist, and surgical facility. Fortunately, charges for septoplasty and turbinate surgery are usually covered by insurance. We will assist you in trying to obtain insurance approval. Even with insurance approval, you will be responsible for any deductibles, co-insurance, or co-payments.

What other procedures can be done along with this surgery?

Rhinoplasty is a cosmetic procedure designed to improve the external appearance of the nose. It may involve an external incision, fracturing of the nasal bones, increased postoperative pain and temporary bruising and swelling. While rhinoplasty can be conveniently done at the time of a septoplasty, rhinoplasty is usually not required to correct nasal obstruction. As such, rhinoplasty is generally not covered by insurance.

Sinus surgery removes the blockage at the openings between the sinus cavities and the nose. While nasal surgery primarily helps nasal obstruction, sinus surgery is more beneficial for recurrent infections, persistent drainage, and sinus pressure. Although it offers additional benefits, sinus surgery is only performed if clinically indicated, as it does have additional risks.

Throat surgery is more effective than nasal surgery for snoring and sleep apnea. Therefore, patients with sleep problems usually have nasal surgery combined with their throat surgery only if associated nasal obstruction exists.

What are the alternatives?

Medications are usually prescribed prior to surgery as they may provide adequate symptom relief. Decongestant pills, containing pseudoephedrine, shrink the mucosal lining inside the nose, possibly resulting in improved nasal breathing. Unfortunately, side effects of decongestant pills are common and include insomnia, jitteriness, high blood pressure, and difficulty urinating. While the decongestant may be combined with an antihistamine, the antihistamine only helps drainage and itching symptoms, not obstruction. Nasal steroid sprays are often prescribed as they can help with a variety of symptoms, including obstruction, especially if underlying allergies exist.

Office-based turbinate cauterization involves shrinking the size of the turbinates using electrocautery or other modality. While shrinking the turbinates may not provide as much long-term success as actually trimming them, turbinate cauterization can be accomplished in the office without significant discomfort. Obviously, this procedure will not correct nasal obstruction caused by a deviated septum.

Watchful waiting is always an option. The consequences of a septal deviation and large turbinates are quality of life issues, not life-threatening issues. In addition, postponing surgery does not make any subsequent surgery more difficult nor less successful.

Should I have nasal surgery?

The decision to proceed with surgery always involves weighing the potential benefits against the possible complications, postoperative recovery issues, and financial costs. We will only recommend surgery if we feel the potential advantages outweigh the disadvantages. Regardless, only you can determine if your nasal obstruction and associated symptoms are bothersome enough to warrant the risks, discomfort, and cost of surgery. Clinical studies do substantiate that the vast majority of patients are pleased with the results from nasal surgery and would do it again.

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