Posted by Dr. Anil R. Shah

Which is better for treating chronic sinus issues? Septoplasty or septoplasty with endoscopic sinus surgery. This is a fascinating study and something I’ve observed over years. So here’s the premise. The idea is that sinusitis is an inflammation and disease of your sinuses, which can create opacification pressure in your sinuses. And the thought process here is that it’s well known, at least in my patients, that if I correct their septal deviation, their sinuses seem to get better. A recent study in The Egyptian Journal of Otolaryngology* in 2021 was written by Dr. Soad Yehia Mostafa, Dr. Fatma Mohamed Abd-Elgaber, Dr. Bothina Ahmed Mohamed, and Dr. Al-Shimaa Said Hammad. They found that when they did septoplasty alone versus septoplasty with endoscopic sinus surgery, there was no difference in the improvement of patient symptoms. So Septoplasty by itself is an effective treatment.

This is something I’ve observed for years in my patients. And I’ll have patients come in and say, “I can’t breathe my nose. And I have pressure in my sinuses.” This is what I typically tell patients. I will fix your nose. I will fix your septum to the best of my ability. I will make it as straight as possible. And let’s just see what happens to your sinuses. It’s not supposed to improve your sinuses, but oftentimes it does. And if you need further treatment, I will refer you to an otolaryngologist afterward for sinus surgery.

You know, how many times I have referred patients to an otolaryngologist for sinus surgery afterward? Not many. A handful. And I think most of those patients have a high correlation with allergies. So this is an interesting phenomenon. And the question is, why is this happening?

What I think is happening is the septum, when it’s crooked, leads to turbulent airflow. And this turbulent airflow seems to disrupt the sinuses and sinus cells. So when you correct the septum, in theory, we should be improving how the air flows through your nose leading to improvement. In some ways, the way it ventilates your sinuses. And for a lot of patients, this is all they need. For some patients, however, their allergies and other symptoms might require an additional procedure like sinus surgery. But the vast majority of patients are gonna improve alone with septoplasty.

This is super exciting news for patients who sometimes will have multiple procedures at the same time, including sinus surgery, septic surgery, and rhinoplasty. Maybe hold off on that sinus surgery. Hold off, see how you do with the proper septoplasty and with your rhinoplasty. If you’re doing it at the same time, see if your symptoms get better. And if they do? Fantastic. You avoided surgery. And if they don’t, you can always go back and do something either in the office with a balloon sinuplasty or with formal endoscopic sinus surgery.

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