What are my options for a deviated septum with some prior drug use?

Question

I'm in pain but I am scared to tell my doctor the truth. I had an ENT suggest a septoplasty to help my breathing. I've almost gone through with it twice but I am extremely worried about the procedure failing and ending up with collapse but my nose hurts and I can't breathe well so I'd like it done. In college, I dabbled with cocaine but it was mostly spread out not daily. I never plan to do it again. He's never asked if I did cocaine after examining me. Will telling my doctor I used it result in insurance not covering it? Is the procedure safe for me?

Kevin Ende, MD · Answer

Most people that dabbled with cocaine do not have any signs of it in their nose, but typically a surgeon will put the history together with the physical exam to give you the best advice.  With that said, the surgeon may want to re-examine you after learning that you used cocaine in the past to make sure he didn't miss any issues with the first exam.

J. Phillip Garcia, MD, FACS · Answer

A deviated septum can cause headaches if it is severe.  The main symptom however is nasal obstruction.  Prior, casual (not current) cocaine use is not a contraindication to septoplasty and you should be at no more risk than any other patient with regards to nasal collapse.  In the context of a septoplasty, this is due to over resection and loss of external support.  In the hands of a competent surgeon, this is very rare and unusual. If you have true nasal obstruction verified with a CT scan as well as been medically treated, your insurance company will cover the surgery regardless of history.Best of Luck,

Robert S. Schmidt, MD · Answer

Thanks for your question. As long as you didn't do any permanent damage with the cocaine use, it shouldn't keep you from having surgery to help with your breathing. Depending on where it is deviated, you likely wouldn't need to worry about collapse. Now, as far as telling your doctor, you should definitely have a pre-op visit with them and discuss it. Some doctors will still use it in the operating room for anesthesia, but I wouldn't recommend that given your history. He will also be able to check you for signs of permanent damage. As far as insurance coverage, prior drug use shouldn't affect that at all. Good luck!

William Portuese, MD · Answer

A thorough internal examination of the nose is required to obtain medical necessity by your ENT surgeon. The amount of deviation must be significant and medically necessary,  and it is best to try and fail medical management first. Prior drug abuse from many years ago will have no detrimental effects, as long as there is no septal perforation present.

Michael Elam, MD (retired) · Answer

Dear HappyGoLucky, If your prior drug use did not result in a septal perforation then this will not affect the outcome of your septoplasty surgery. An in office examination will be performed to determine a proper diagnosis of deviated septum and the surgeon can then discuss your options as far as insurance billing. Best regards, Michael V. Elam, M.D.

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