Research in Otolaryngology 2017, 6(6): 73-80
DOI: 10.5923/j.otolaryn.20170606.01
Post-surgical Outcomes of Patients Undertaken
Septoplasty with Regard to Initial Clinical Complains
Abdullah Alotaibi1, Bassam Ahmed Almutlaq2,*
1
University of Hail, College of Medicine, Department of Otolaryngology Head and Neck Surgery, Saudi Arabia
2
University of Hail, College of Medicine, Saudi Arabia
Abstract Background: Septoplasty is commonly performed to offer qualitative and quantitative advantage to those with
nasal obstruction owing to septal deviation. Therefore, the aim of the present study was to assess the post-surgical outcomes
of patients undertaken septoplasty with regard to initial clinical complains. Methodology: This study included a series of
patients presented with nasal obstruction and subsequently undergone septoplasty. In the present study, patients presented
with different clinical complains; 83.2% presented with nasal congestion, 94% with nasal blockage, 87% with breathing
trouble, 84% with sleeping trouble, 71% with exercise problem, and 3.8% with other complications (e.g bleeding, loss of
smell). Conclusion: In patients with nasal obstruction due to DNS or other causes, nasal septoplasty results in significant
improvement in reduction or completely eliminates the prior complications.
Keywords Septoplasty, Deviated nasal septum, Nasal obstruction, Breathing trouble
1. Introduction
Septoplasty or surgical modification of the deviated nasal
septum (DNS), is the most common ear, nose and throat
(ENT) operation in adults [1]. Patients with a septal
deviation and worries about nasal obstruction regularly
undertake septoplasty to mend nasal airflow [2]. Obstructed
nasal breathing can happen due to deviation of the nasal
septum. When the external nose looks grossly normal and
cosmetics is not the emphasis, septoplasty has been the
method performed to straighten the septum with the goal of
improving nasal airflow [3].
Presently, the key sign to do septoplasty is nasal
obstruction. Nasal obstruction is commonly defined as
patient discomfort manifested as a sensation of inadequate
airflow through the nose [4]. The etiology of nasal
obstruction is generally divided into mucosal and anatomical
causes. DNS is the most common anatomical cause of nasal
obstruction [5]. Still, underlying pathogenesis is often
multifactorial. For example, DNS is commonly attended
with compensatory mucosal hypertrophy of the contralateral
turbinate [6]. This corrected mechanism is presumed to
shield the more patent nasal side from the drying and
crusting effects of extra airflow [7]. Compensatory
hypertrophy can happen in both the inferior as well as the
middle turbinate on the side contralateral to nasal septal
* Corresponding author:
dr.bassam.almutlaq@gmail.com (Bassam Ahmed Almutlaq)
Published online at http://journal.sapub.org/otolaryn
Copyright © 2017 Scientific & Academic Publishing. All Rights Reserved
deviation [8]. It has been revealed that turbinate
amplification not only includes mucosal elements, but may
also encompass the conchal bone [6]. Since these variations
may not be spontaneously reversible, they sometimes
requisite to be amended in combination with septal surgery
to prevent nasal obstruction on the non-deviating side
postoperatively [9, 10]. By straightening the DNS and
carrying out simultaneous turbinate surgery, nasal passages
are expected to extend and as a consequence nasal breathing
is thought to improve.
At present the efficacy of septoplasty in adults with nasal
obstruction and a DNS remains uncertain. Objective
measurements do not always correlate with subjective
measures to evaluate the efficiency of septoplasty [11].
Furthermore, additional benefits of corresponding turbinate
surgery are unidentified, and signals and procedures applied
vary greatly [12, 13]. Unusually, the literature displays a
prevalence of nasal septal deviation of up to 80 %, while only
a minority of subjects suffers from nasal obstruction [14].
More essential in this respect, is the fact that scientific
publications on the effects of septoplasty are rare and
inadequate [14].
Following primary septoplasty, however, some patients
have persistent symptoms due to nasal valve dysfunction and
may need nasal valve surgery. Nasal valve dysfunction
remains an underdiagnosed entity and should be considered
in all patients with septal deviation before septoplasty,
especially in patients with a severe dorsal deflection and a
narrow middle vault [2]. Therefore, the aim of the present
study was to assess the post-surgical outcomes of patients
74
Abdullah Alotaibi et al.: Post-surgical Outcomes of Patients Undertaken
Septoplasty with Regard to Initial Clinical Complains
undertaken septoplasty with regard to initial clinical
presentations and complications.
2. Materials and Methods
This study included a series of patients presented with
nasal obstruction and subsequently undergone septoplasty.
Archives related to all patients selected for septoplasty
between 2012 and 2017 were retrieved from ENT
department, King Khalid hospital in Hail, Northern Saudi
Arabia. Only adults over 18 years of age were included in the
study. Patients’ medical records were investigated, and
patients with a history of rhinoplasty, cranial and facial
trauma or bone deformity (except DNS), and patients with a
mass in the nasal cavity were excluded from the study.
Several nasal obstruction clinical presentations were
recorded included: nasal congestion, nasal blockage,
breathing trouble, sleeping trouble, and exercise problems.
Demographical characteristics including; age, gender and
residence were also recorded.
The different initial clinical presentations and
complications were compared after three months of
septoplasty.
Ethical consent
Our study protocol was conformed according to the 2013
Declaration of Helsinki and this study was approved by
ethics committee of College of Medicine, University of Hail,
Saudi Arabia.
Statistical analysis
Statistical analysis was performed using SPSS software
for Windows (version 16.0, SPSS Inc., Chicago, IL, USA).
Categorical variables are given as frequencies and
percentages, and continuous variables. For all statistical
comparisons, a p value below 0.05 was considered
statistically significant.
3. Results
In the present study, 131 patients presented with clinical
presentations mainly nasal obstruction subjected them for
septoplasty selection. Out of the 131 patients, 112 were
diagnosed with deviated nasal septum (DNS) and the
remaining 19 patients were diagnosed with other nasal
obstructive conditions. The 131 patients presented with
different clinical presentations; 109/131(83.2%) presented
with nasal congestion, 123/131(94%) with nasal blockage,
114/131(87%) with breathing trouble, 110/131(84%) with
sleeping trouble, 93/131(71%) with exercise problems, and
5/131(3.8%) with other complications (e.g bleeding, loss of
smell).
Table 1 summarizes the distribution of the study
population by nasal obstruction related clinical
complications before septoplasty and after 3 months of
septoplasty. For nasal congestion, symptoms completely
disappeared from 30/131(22.9%) patients. Severe and
moderate symptoms disappeared from 55/62(88.7%) and
14/30 (46.7%) respectively, as indicated in Table 1, Fig 1.
These findings indicate that septoplasty is critical for the
treatment of nasal congestion and this was found to be
statistically significant P <0.0001.
For nasal blockage, symptoms completely disappeared
from 52/131(39.7%) patients. Severe and moderate
symptoms disappeared from 73/82(88%) and 12/30 (40%)
respectively, as indicated in Table 1, Fig 1. These findings
indicate that septoplasty is critical for the treatment of nasal
blockage and this was found to be statistically significant
P <0.0001.
For breathing trouble, symptoms completely disappeared
from 60/131(45.8%) patients. Severe and moderate
symptoms disappeared from 65/70(93%) and 11/30 (36.7%)
respectively, as indicated in Table 1, Fig 2. These findings
indicate that septoplasty is critical for the treatment of
breathing trouble and this was found to be statistically
significant P <0.0001.
For sleeping trouble, symptoms completely disappeared
from 67/131(51%) patients. Severe and moderate symptoms
disappeared from 62/70(88.6%) and 10/30 (33.3%)
respectively, as indicated in Table 1, Fig 2. These findings
indicate that septoplasty is critical for the treatment of
sleeping trouble and this was found to be statistically
significant P <0.0001.
For exercise problems, symptoms completely disappeared
from 69/131(52.7%) patients. Severe and moderate
symptoms disappeared from 34/34(100%) and 25/30 (83.3%)
respectively, as indicated in Table 1, Fig 2. These findings
indicate that septoplasty is critical for the treatment of
exercise problem and this was found to be statistically
significant P <0.0001.
The distribution of patients by clinical presentation before
and after septoplasty by gender was summarized in Table 2.
All clinical presentations (including: nasal congestion, nasal
blockage, breathing trouble, sleeping trouble and exercise
problem) were significantly improved after 3 month of
septoplasty (P <0.0001) both for males and females.
However, within each sex kind there was variations within
the degree of symptoms, as shown in Fig 3, Fig 4.
Table 3 summarised the distribution of the study
population by age. The improvement after septoplasty was
statistically significant in all age groups (P < 0.0001).
However, the improvement has inconsistent variability in
different ages, as indicated in Table 3.
Other complications such as bleeding and loss of smell
were completely disappeared.
Research in Otolaryngology 2017, 6(6): 73-80
75
Table 1. Distribution of the study population by nasal blockage related clinical complications before and after 3 months of septoplasty
Variable
Category
Before Septoplasty
After Septoplasty
P value
<0.0001
Nasal Congestion
No
22
52
Mild
17
56
Moderate
30
16
Severe
62
7
Total
131
131
Nasal Blockage
No
8
60
Mild
15
48
Moderate
26
14
Severe
82
9
No
17
77
<0.0001
Breathing Trouble
Mild
17
33
Moderate
27
16
Severe
70
5
<0.0001
Sleeping Trouble
No
21
88
Mild
20
25
Moderate
20
10
Severe
70
8
No
38
107
19
<0.0001
Exercise Problem
Mild
31
Moderate
28
5
Severe
34
0
<0.001
63%
47%
46%
43%
40%
37%
23%
17%
13%
20%
12%
5%
Nasa-congestion before Nasa-congestion after
None
Mild
12%
6%
11%
7%
Nasal-blockage before
Nasal-blockage after
Moderate
Severe
Figure 1. Description of the patients by nasal congestion & nasal blockage and degree of symptoms before and after 3 months of septoplasty
76
Abdullah Alotaibi et al.: Post-surgical Outcomes of Patients Undertaken
Septoplasty with Regard to Initial Clinical Complains
Severe
Moderate
Mild
None
Exercise-problem after
Exercise-problem before
Sleeping-trouble after
Sleeping-trouble before
Breathing-trouble after
Breathing-trouble before
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Figure 2. Description of the patients by breathing trouble, sleeping trouble, exercise problem and degree of symptoms before and after 3 months of
septoplasty
Table 2. Distribution of patients by clinical presentations and gender
Variable
Category
Males
Before
Females
After
Before
After
Nasal Congestion
None
17
35
5
17
Mild
11
47
6
9
Moderate
23
10
7
6
Severe
48
7
14
0
Total
99
99
32
32
None
6
43
2
17
Mild
8
38
7
10
Moderate
19
11
7
3
Severe
66
7
16
2
Nasal Blockage
Breathing Trouble
None
11
56
6
21
Mild
11
26
6
7
Moderate
22
13
5
3
Severe
55
4
15
1
Sleeping Trouble
None
15
67
6
21
Mild
13
17
7
8
Moderate
15
7
5
3
Severe
56
8
14
0
Exercise Trouble
None
26
80
12
27
Mild
25
14
6
5
Moderate
20
5
8
0
Severe
28
0
6
0
Research in Otolaryngology 2017, 6(6): 73-80
77
0%
None
10%
Severe
20%
Mild
30%
Moderate
40%
50%
60%
70%
80%
90%
Figure 3. Description of males by clinical presentations before and after septoplasty
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
None
Severe
Mild
Moderate
Figure 4. Description of females by clinical presentations before and after septoplasty
78
Abdullah Alotaibi et al.: Post-surgical Outcomes of Patients Undertaken
Septoplasty with Regard to Initial Clinical Complains
Table 3. Distribution of patients by clinical presentations and age
Variable
Category
< 20 years
Before
After
20-24
Before
25-29
After
Before
30-34
After
Before
35+
After
Before
After
Nasal congestion
Absent
2
8
12
23
5
11
2
6
1
4
Present
25
21
31
20
23
17
17
13
13
10
Absent
2
15
3
18
1
12
1
9
1
6
Present
25
12
40
25
27
16
18
10
13
8
Absent
5
19
6
28
4
15
2
9
0
6
Present
22
8
37
15
24
13
17
10
14
8
Absent
5
18
8
29
5
18
3
15
0
8
Present
23
9
35
14
23
10
16
4
14
6
Absent
12
26
12
36
6
20
6
15
2
10
Present
15
1
31
7
22
8
13
4
12
4
Nasal blockage
Breathing trouble
Sleeping trouble
Exercise problem
4. Discussion
In the present study, patients presented with multiple
clinical presentations and complications with most
frequently encountered; nasal congestion, nasal obstruction,
breathing trouble, sleeping trouble, exercise problems.
Moreover, some patients attended with complications such
as bleeding and loss of smell.
However, the initial diagnosis for this series included
DNS in 112(85.5%) and the remaining 19(14.5%) have nasal
obstructive but without DNS. Although, there are varying
prevalence rates of DNS, our findings in the present study
might be categorized within the highest occurrence rates
among patients presented with nasal obstruction. In a study
to determine the prevalence of nasal septal deformities
among Turkish school children, the overall prevalence of
NSD has been found to be 34.9%. For the age groups, the
prevalence of NSD was 16.5% in pre-school children, 38.7%
in primary school children and 39.9% in secondary school
children [15]. In another study to classify the NSD according
to the Guyuron and Mladina classifications, and to evaluate
the correlation between anterior rhinoscopy and CT findings.
Of 970 patients, 50.3% had NSD. According to the Guyuron
and Mladina classifications, type 2 (41.4%) and type 1
(35.4%) were most common, respectively [16].
However, in the present study all studied clinical
presentations including nasal congestion, nasal obstruction,
breathing trouble, sleeping trouble, exercise problems; have
significantly all disappeared or reduced to lower degrees
(severe became moderate or mild). These findings indicated
the benefit of septoplasty in management of DNS and other
causes of nasal obstruction. However, the outcomes of
septoplasty differ according to many factors including the
method of performance. There are multiple different
methods of performing this operation. Each specific method
of performing a septoplasty has its own benefits and
advantages. Irrespective of the method, septoplasty is a
valuable procedure in nasal surgery [17]. Subjects with
anterior septal deformities were shown to benefit the most
from septoplasty. Selection of patients on clinical grounds
alone does carry, however, a considerable risk of patient
dissatisfaction with end results. Nevertheless, despite a very
strong correlation between anterior septal deviations and
increased nasal resistance, preoperative rhinomanometry
data failed to prove useful in predicting the long-term
surgical outcome. Surgeons' appreciation of the types of
septal deviation that do benefit from surgical correction falls
short of desirable. Patients' satisfaction, however, did not
improve if rhinomanometry was included in the preoperative
evaluation [18]. Anterior septal reconstruction has been
shown to be a safe and effective means by which to address
severe caudal septal deviation and long-term reduction in
preoperative symptoms [19].
Nevertheless, there are some studies reported similar
findings to our results. In a study investigated 86 patients
with septal deviation they were asked using an outcomes
instrument (the Nasal Obstruction Symptom Evaluation
scale) before and 3 and 6 months after septoplasty.
Seventy-seven patients (89.5%) reported a subjective
improvement in their nasal obstruction [20].
Despite the significant number of septoplasties performed
each year, complications after this procedure are relatively
uncommon. Most complications result from inadequate
surgical planning or poor technique and often can be
prevented. Surgeons should discuss these risks with patients
before surgery as part of the informed consent process. The
Research in Otolaryngology 2017, 6(6): 73-80
septoplasty surgeon must be aware of all the possible
complications that may arise so as to convey the benefits and
risks of surgery effectively to prospective patients [21].
Septoplasty may lead to the following complications:
nasal obstruction, nasal septal hematoma, nasal septal
abscess, saddle nose or other nasal deformity, nasal septal
perforation, epistaxis, acute or chronic rhinitis. All these
complications are rare (occurring in less than 1 % of all cases)
and most of them resolve without additional treatment. In
selected cases, an additional intervention (drainage of
hematoma or abscess, antibiotics, additional nasal packing,
surgical correction of saddle nose or other nasal deformities)
may be needed to resolve the complication [1]. However,
none of these complication has been experienced in our
series.
Although the findings of the present study may provide
platform as well as inspiration for further research in this
perspective but it has some limitations; sleeping distress,
breathing distress, nasal congestion, exercise unease, and
other complaints, are to some extent subjective rather than to
be measureable, but at least give some orientations in this
context.
5. Conclusions
79
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