I have had constant nasal congestion, head aches, sinus infections, ear infections, pressure in my ears, and post nasal drip for a while now. I recently got health insurance because I no longer live with my parents and can't be covered under their policy. My dr. gave me claritan, an antibiotic, singular, nasonex, and flonase. nothing improved my breathing after two weeks on all of the meds so my dr. ordered the ct scan of my paranasal sinuses those were my results. Will I need surgery?
Septal Deviation of 5-6mm and Nasal Septal Spur: Severe Enough to Need Septoplasty?
Doctor Answers 6
Great question. A septoplasty is largely an elective procedure, thus its not really proper to suggest that anyone "needs" or must have a septoplasty. That being said, if you do not breathe well through your nose and there is some discernible obstruction of the nose by your septum then surgery is an excellent option for most patients. Simply put, if you want to breathe better through your nose, and you have a deviated septum, in my opinion there is no single treatment that will improve your breathing more than a well done septal surgery. Septopalsty is exceedingly well tolerated due to little or no pain, and nearly universally successful in improving breathing. Hope this helps.
CT scan is only part of the equation
Degree of septal deviation needed for septoplasty
A moderate to severe septal deviation documented on a CAT scan along with a history of symptoms that are unrelieved with medications is usually an indication for surgical intervention. It is important to try medications first and make sure that they are not working prior to undergoing surgical intervention such as a septoplasty. In addition, it is also important to address turbinates if they are hypertrophic and once lateralized can improve the airflow dynamics through the nose. Chronic sinus infections are addressed through endoscopic sinus surgery if there are polyps located inside the sinuses. This can all be done simultaneously.
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Indications for septopasty
In my practice, the indication for septoplast is based on clinical exam and patient history. If allergy is an issue then complete that part of the workup and treat before moving on to an invasive procedure.
Deviated septum doesn't always need septoplasty
A septoplasty is required when the septal cartilage or bone is deviated to the point that it obstructs the nasal breathing. This can't be detrmined by a CT scan but needs to be determined by an examination of each nasal airway. If you have adequate space between the septum and the inferior turbinate, you don't need a Septoplasty.
The Septoplasty will not address the list of symptoms that you listed which maybe due to airborne allergies. You might consider seeing an allergist for testing to rule that out. Nasal steroid sprays are helpful but don't really take effect until they're used for 4 weeks.
You must be seen
Most doctors do not operate on an x-ray report only. You must be seen and evaluated prior to making any decision regarding surgery. The ct was probably ordered because if you expect your insurance to pay the doctor, they require it. Most well trained physicians can look in your nose and see if you need to have your septum fixed.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.