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American Journal of Medicine and Medical Sciences 2017, 7(10): 350-355
DOI: 10.5923/j.ajmms.20170710.02
Time for Recovery of Symptoms after Septoplasty
Abdullah Alotaibi1, Bassam Ahmed Almutlaq2, Hussain Gadelkarim Ahmed2,*
1Department of Otolaryngology Head and Neck Surgery, College of Medicine, Hail of University, Saudi Arabia
2College of Medicine, University of Hail, Saudi Arabia
Abstract Background: Nasal obstruction is one of the mutual clinical presentations that otorhinolaryngologists faces in
every day practice. Deviated nasal septum (DNS) is one of the most frequent reason for the nasal obstruction. Therefore, the
aim of the present study was assess the suitable timing for recovery of nasal obstruction associated complications after
Septoplasty. Methodology: This study included a series of 104 patients presented with nasal obstruction and subsequently
undergone septoplasty. Several nasal obstruction clinical complains were evaluated after 3 months and one year of
septoplasty. Results: Statistically significant improvement with increase of time has been achieved in nasal blockage,
breathing distress, sleeping distress, nasal congestion, exercise, and other complications. Conclusion: A significant
improvement of nasal obstruction associated complications start after 3 months of Septoplasty but ultimate benefit may occur
after one year.
Keywords Septoplasty, Nasal blockage, Nasal obstruction, Breathing distress, Nasal congestion, Sleeping distress
1. Introduction
Obstructed nasal breathing can occur due to deviation of
the nasal septum [1]. Nasal obstruction is one of the most
common problems in otolaryngology practice. Nasal
obstruction can be caused by several factors such as
deviation of nasal septum, nasal valve collapse, turbinate
hypertrophy and nasal polyposis [2]. Among them, septum
deviation is the main etiologic factor and more than half of
the population have this problem [3, 4].
Septoplasty is one of the most frequently performed
otorhinolaryngological procedures which might be very
challenging for the surgeon [5]. Successful septoplasty
involves accurate assessment of septal pathology and sound
technique to avoid persistent symptoms and new
complications [6]. An accurate preoperative diagnosis of
pathologies of the septum in the context of the nasal cavity is
essential for the success of surgery. Intraoperative
visualization through microscope or endoscope is very
helpful for the surgeon and for the training of the residents.
The modern technique of septoplasty with the phases of
approach, mobilization, resection/repositioning and
reconstruction/fixation is presented. Furthermore, the
extracorporeal septoplasty in extreme deviations of the
septum and alternative techniques for use in cases with
limited pathologies as well as aspects of septoplasty in
children are discussed. As particularly pathologies of the
* Corresponding author:
hussaingad1972@yahoo.com (Hussain Gadelkarim Ahmed)
Published online at http://journal.sapub.org/ajmms
Copyright © 2017 Scientific & Academic Publishing. All Rights Reserved
caudal septum are responsible for failures of septal surgery,
some special problems of this region such as the vertical
fracture of the caudal septum, the lack of caudal septum or
anterior convexities of the cartilaginous septum are argued
[5].
Most studies show that objective measures to quantify and
determine surgical success in the treatment of nasal
obstruction do not correlate with subjective improvement as
reported by patients [7]. Since there are many septoplasty
procedures, each with its limitations, a variety of
postoperative complications, which might be associated with
preoperative complaints or associated with the surgical
modification can occur. Therefore, the aim of the present
study was assess the suitable timing for recovery of nasal
obstruction associated complications after Septoplasty.
2. Materials and Methods
This study included a series of 104 patients presented with
nasal obstruction and subsequently undergone septoplasty.
Archives related to all patients selected for septoplasty
between 2012 and 2017 were retrieved from ear, nose, throat
(ENT) department, King Khalid hospital in Hail, Northern
Saudi Arabia. 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. Only
patients with apparent nasal obstruction related clinical
presentation (complains) were considered. Several nasal
obstruction clinical presentations were recorded included:
nasal congestion, nasal blockage, breathing distress, sleeping
distress, and exercise unease. Demographical characteristics
American Journal of Medicine and Medical Sciences 2017, 7(10): 350-355 351
including; age, gender and residence were also recorded.
The different initial clinical presentations and
complications were compared after three one year 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
The present study examined records of 104 patients
presented with different clinical complains related to nasal
obstruction. Out of the 104 patients, 82/104(78.8%) were
males and 22/104(21.2%) were females, giving males'
females' ration of 3.73: 1.00. The ages of the patients ranging
from 17 to 42 years with a mean age of 27 years old. The
majority of the patients were at age group 21-25 years
followed by 26-30, and <20 years, representing
34/104(32.7%), 25/104(21.9%) and 16/104(15.4%),
respectively. For males most of them were at age range
26-30 years followed by 21-25 and 30-35 years
constituting 25/82(30.5%), 23/82(28%) and 13/82(15.9%)
correspondingly. For females most of them were at age range
21-25 years followed by <20 and 36+ years constituting
11/22(50%), 6/22(27.3%) and 3/22(13.6%) correspondingly,
as indicated in Table 1, Fig 1.
With regard to occupation, most of the study subjects were
students followed by others and employees representing,
31/104(29.8%), 25/104(24%) and 24/104(23%), respectively.
For males most of them were employees, followed by
students and teachers constituting 23/82(28%), 21/82(25.6%)
and 13/82(15.9%), in this order. For females most of them
were students, followed by others and teachers constituting
10/22(45.5%), 8/22(36.4%) and 2/22(9%), in this order, as
indicated in Table 1, Fig 1.
Table 1. Description of the study subjects by demographical
characteristics
Variable Category Males Females Total
Age
<20 years 10 6 16
21-25 23 11 34
26-30 25 0 25
31-35 13 2 15
36+ 11 3 14
Total 82 22 104
Occupation
Employee 23 1 24
Teacher 13 2 15
Student 21 10 31
Solder 7 0 7
Medical 1 1 2
Other 17 8 25
Total 82 22 104
Figure 1. Description of the study subjects by demographical characteristics
0%
10%
20%
30%
40%
50%
60%
Total
Males
Females
352 Abdullah Alotaibi et al.: Time for Recovery of Symptoms after Septoplasty
The majority of patients attended with nasal blockage
followed by, sleeping distress, breathing distress, nasal
congestion, exercise unease, and other complains,
representing 100/104(96%), 95/104(91.3%), 94/104(90.4%),
88/104(84.6%), 81/104(77.9%) and 4/104(3.8%),
respectively.
Table 2 summarizes the distribution of the patients by
nasal obstruction related clinical complaints before
septoplasty, after 3 months and after one year of septoplasty.
For nasal blockade, symptoms completely disappeared from
39/100(39%) and 69/100(69%) of the patients after 3 months
and one year respectively. Severe and moderate symptoms
present only in 5 and 13 patients respectively, after 3 months,
hence, severe and moderate present only in 2 and 6 of the
cases respectively after one years, as indicated in Table 2,
Fig 2. These findings indicated that septoplasty is important
for the management of nasal distress, as well as the
maximum timing for recovery of complaints can be achieved
after one year of Septoplasty, and this was found to be
statistically significant P <0.0001.
For sleeping distress, symptoms completely disappeared
from 59/95(62%) and 76/95(80%) of the patients after 3
months and one year respectively. Severe and moderate
symptoms present only in 5 and 22 patients respectively,
after 3 months, hence, severe and moderate present only in 3
and 5 of the cases respectively after one years, as indicated in
Table 2, Fig 2. These findings indicated that septoplasty is
important for the management of sleeping distress, as well as
the maximum timing for recovery of complaints can be
achieved after one year of Septoplasty, and this was found to
be statistically significant P <0.0001.
Table 2. Distribution of the study subjects by nasal obstruction related clinical complains before septoplasty, after 3 months and after one year of
septoplasty
Variable Category Before Septoplasty After 3 month
Septoplasty
After 1 year
Septoplasty P value
Nasal Blockade <0.0001
No complaint 4 43 73
Mild 12 43 23
Moderate 17 13 6
Severe 71 5 2
Total 104 104 104
Sleeping Distress <0.0001
No complaint 9 68 85
Mild 16 22 11
Moderate 16 9 5
Severe 63 5 3
Total 104 104 104
Breathing Distress <0.0001
No complaint 10 58 77
Mild 16 29 22
Moderate 21 13 5
Severe 57 4 0
Total 104 104 104
Nasal Congestion <0.0001
No complaint 16 39 70
Mild 9 47 26
Moderate 26 13 7
Severe 53 5 2
Total 104 104 1
Exercise Problem 104 <0.001
No complaint 23 82 93
Mild 27 18 11
Moderate 24 4 0
Severe 30 0 0
Total 104 104 104
American Journal of Medicine and Medical Sciences 2017, 7(10): 350-355 353
Figure 2. Description of patients by clinical symptoms at initial presentation, after 3 months and after one year of septoplasty
Table 3. Distribution of patients by clinical presentations and gender at initial presentation, after 3 months and after one year of septoplasty
Variable Category Males Females Males Females
Before Before After 3 months After 1 year After 3 months After 1 year
Nasal Blockage
None 3 1 31 57 12 16
Mild 7 5 36 17 7 6
Moderate 13 4 10 6 3 0
Severe 59 12 5 2 0 0
Total 82 22 82 82 22 22
Sleeping Distress
None 7 2 55 67 13 18
Mild 10 6 15 9 7 2
Moderate 14 2 7 3 2 2
Severe 51 12 5 3 0 0
Total 82 22 82 82 22 22
Breathing Distress
None 7 3 44 61 14 16
Mild 10 6 25 17 4 5
Moderate 19 2 10 4 3 1
Severe 46 11 3 0 1 0
Total 82 22 82 82 22 22
Nasal Congestion
None 12 4 27 55 12 15
Mild 7 2 41 21 6 5
Moderate 20 6 9 5 4 2
Severe 43 10 5 1 0 0
Total 82 22 82 82 22 22
Exercise Unease
None 16 7 65 74 17 19
Mild 23 4 13 8 5 3
Moderate 18 6 4 0 0 0
Severe 25 5 0 0 0 0
Total 82 22 82 82 22 22
69%
80%
71%
61%
86%
39%
62%
51%
26%
73%
96%
91%
90%
85%
78%
0%
20%
40%
60%
80%
100%
120%
Nasal blockage
Sleeping distress
Breathing
distress
Nasal
congestion
Exercise unease
Absent after one year
Absenct after 3months
Present before Septoplasty
354 Abdullah Alotaibi et al.: Time for Recovery of Symptoms after Septoplasty
For breathing distress, symptoms completely disappeared
from 48/94(51%) and 67/94(71%) of the patients after 3
months and one year respectively. Severe and moderate
symptoms present only in 4 and 13 patients respectively,
after 3 months, hence, severe and moderate present only in 0
and 5 of the cases respectively after one years, as indicated in
Table 2, Fig 2. These findings indicated that septoplasty is
important for the management of breathing distress, as well
as the maximum timing for recovery of complaints can be
achieved after one year of Septoplasty, and this was found to
be statistically significant P <0.0001.
For nasal congestion, symptoms completely disappeared
from 23/88(26%) and 54/88(61%) of the patients after 3
months and one year respectively. Severe and moderate
symptoms present only in 5 and 13 patients respectively,
after 3 months, hence, severe and moderate present only in 1
and 7 of the cases respectively after one years, as indicated in
Table 2, Fig 2. These findings indicated that septoplasty is
important for the management of nasal congestion, as well as
the maximum timing for recovery of complaints can be
achieved after one year of Septoplasty, and this was found to
be statistically significant P <0.0001.
For exercise unease, symptoms completely disappeared
from 59/81(73%) and 70/81(86%) of the patients after 3
months and one year respectively. Severe and moderate
symptoms present only in 0 and 4 patients respectively, after
3 months, hence, no severe or moderate was found after one
years, as indicated in Table 2, Fig 2. These findings indicated
that septoplasty is important for the management of exercise
unease, as well as the maximum timing for recovery of
complaints can be achieved after one year of Septoplasty,
and this was found to be statistically significant P <0.0001.
Table 3 summarized the distribution of the patients by
clinical presentations before septoplasty, after 3 months and
after one year of septoplasty by gender. All initial clinical
complications (including: nasal blockage, sleeping distress,
breathing distress, nasal congestion and exercise unease)
were significantly modified after one year of septoplasty (P
<0.0001), both for males and females. However, within each
gender group there was variations within the degree of
symptoms. While, other complications such as bleeding and
loss of smell were completely disappeared, about
40/104(38.5%) of the patients witnessed a change in the
shape of their noses, particularly after one year of
septoplasty.
4. Discussion
Nasal airway obstruction can be a source of discomfort
and can have a significant impact on daily life. Nasal
obstruction may lead to difficulty in breathing, eating,
speaking, sleeping and overall physical activity of an
individual. Septoplasty is a treatment of choice to relief these
complains particularly when the obstruction is associated
with DNS. In most instances the timing for recovery from
these symptoms is chiefly depends on Septoplasty method
involved.
Outcome analysis is one vital mean for the evaluation of
quality of medical carefulness. It assesses to what level the
aims of medical care have been succeeded. Miscellaneous
approaches are in use to execute this task. In the present
study assess the suitable timing for recovery of nasal
obstruction associated complications after Septoplasty.
Three sets of nasal obstruction related complications
associated data were compared to find out the suitable timing
to a chief ultimate recovery of initial symptoms after
Septoplasty.
After three months of septoplasty we found statistically
significant improvement of all assessed initial clinical
complications (P <0.001). Many factors have been involved
in the determination of the outcomes of Septoplasty.
Procedures used for the diagnosis and treatment of DNS vary
according to indications for the procedure and surgeon
option, which in turn determine the fast or delayed recovery
of obstruction symptoms [8]. Studies have shown that nasal
obstruction clinical presentations start to recover after 15
days of septoplasty [9, 10].
However, great improvements have been achieved after
one year of septoplasty in all obstruction related symptoms,
but with high number nasal deformities. Some patients suffer
from persistent obstruction after their primary septoplasty
and may undergo a revision septoplasty to improve their
nasal passageway It was found that a significant number of
patients who undergo revision septoplasty also have nasal
valve collapse. Thus it was recommended that in addition to
septal deviation and inferior turbinate hypertrophy, nasal
valve function be fully evaluated before performing
septoplasty. This will help to ensure a complete
understanding of a patient's nasal airway obstruction and,
consequently, appropriate and effective surgical intervention
[11].
However, the effectiveness of septoplasty for nasal
obstruction in adults with a deviated nasal septum remains
uncertain [12]. Scientific evidence is scarce and inconclusive,
and internationally accepted guidelines are rare. There is a
discrepancy between the occasionally heard opinion that
septoplasty is an easy operation and its relatively high failure
and complication rates [13].
This clinical agreement declaration was developed by and
for otolaryngologists and is anticipated to inspire
evidence-based care for patients undergoing septoplasty with
or without inferior turbinate reduction. A complete definition
of septoplasty with or without inferior turbinate reduction
was first developed, and extra statements were consequently
produced and assessed addressing diagnosis, medical
managing prior to septoplasty, and surgical considerations,
as well as the proper role of perioperative, postoperative, and
adjuvant measures, in addition to outcomes. Moreover, a
series of clinical statements were developed, such as
"Computed tomography scan may not precisely demonstrate
the degree of septal deviation," "Septoplasty can assist
delivery of intranasal medications to the nasal cavity,"
"Endoscopy can be applied to enhance visualization of
American Journal of Medicine and Medical Sciences 2017, 7(10): 350-355 355
posterior-based septal deviation during septoplasty," and
"Quilting sutures can obviate the need for nasal packing after
septoplasty." It is expected that the application of these
guidelines will result in reduced discrepancies in the care of
septoplasty patients and an upsurge in the quality of care
[14].
Although most of the initial clinical complications were
subsided or diminished to mild symptoms, but patients
satisfactory represent the major challenge. Although
septoplasty offers sufficient correction of septal deviation,
patients are not always satisfied with the procedure [15]. The
level of satisfaction after Septoplasty may be influenced by
individual differences in the perception of one's nasal
passage changes and emotional factors. Thus of the
limitations in the present study, the studied variables were
less measureable.
5. Conclusions
Maximum recovery of symptoms associated nasal
blockage can be achieved after one years of Septoplasty,
through significant improvement can be acquired after three
months. Individual perceptual variances of air passage
modifications and emotional factors do not guess biased
symptom enhancement after septoplasty. However, initial
clinical presentations were the only prognostic factor for
patient contentment after septoplasty.
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