The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) have released a new clinical consensus statement on septoplasty. A consensus statement is an opinion by groups of experts who if they all share the same opinion on it but there is not enough evidence to create an official guideline. Dr. Shah will share his opinion as well with the statement.
Whether or Not to Have a Preoperative CT Scan is Necessary Before a Septoplasty
The consensus statement was that CT scan prior to septoplasty are unnecessary and may expose the patient to additional cost and radiation. Dr. Shah also feels that in the majority of cases CT scans do not contribute to the clinical diagnosis of a deviated septum. Dr. Shah’s opinion is based on his experience in diagnosing patients with nasal obstruction as well as his work in several areas of research including creating a new radiologic definition of septal deviation termed tortuosity which measures the degree of deviation off of a midline point. Based on these studies as well as correlating patient’s examination findings with CT scans, he feels that CT scans are not necessary prior to surgical intervention.
Medical Therapy for 4 or More Weeks Prior to Surgery
The consensus statement was that medical therapy prior to surgery was not necessary to establish whether or not a patient is a surgical candidate. The statement wants clinical correlation. The importance of this statement is that some insurance carriers demand a 4 week trial of medical therapy before surgery. Dr. Shah’s agrees with clinical correlation. In obvious septal deviation where the source is readily identified, patients may not need a clinical trial of nasal sprays. However, in some cases, where the nasal obstruction is not clearly identified, medical sprays can be helpful to determine the impact of allergies and mucosal changes may have in the patient’s outcome.
Nasal Endoscopy to Diagnosis Septal Deviation
The consensus statement was the nasal endoscopy may provide more information in certain cases prior to surgery. Dr. Shah agrees again that clinical correlation and selective use of nasal endoscopy may be helpful in diagnosis of septal deviation and other causes of nasal obstruction. In particular, younger patients, usually less than 21 year of age, may have enlarged adenoids contributing to their nasal obstruction and may benefit from adenoidectomy at the same time as surgery.
Obstructive Sleep Apnea and Septoplasty
The consensus statement is that septoplasty may improve patient’s tolerance of CPAP but does not typically improve OSA. Dr. Shah agrees that reestablishing nasal airflow when possible is better for sleep and that septoplasty may improve tolerance of CPAP, particularly in patients with high pressure levels as well as deviated septums.
Use of Antibiotics With Septoplasty
The consensus statement is that antibiotics are not necessary with septal surgery. Since Dr. Shah often utilizes cartilage for support for the nose, he utilizes perioperative antibiotic coverage. Despite the consensus stating otherwise, in rhinoplasty, the vast majority of surgeons use preoperative antibiotics and some chose antibiotics post procedure. Dr. Shah utilizes both pre and post antibiotics as the benefit to risk ratio is worthwhile in his opinion.
Concomitant Turbinate Reduction
The consensus statement was that turbinate reduction should be addressed at the same time as the septum. Some insurance companies are reluctant to pay for two procedures at the same time. Dr. Shah believes in also fixing any valve issues (internal or external) as well as turbinates during the surgery. The benefit of fixing the valves is that cartilage used from the septum can be used to support the airway as well. The main goal of these types of surgeries is not to just straighten the septum but to restore airflow.
While Consensus Statements are released by various societies their message is to help physicians and patients achieve better outcomes.