No need for turbinate reduction if doing septoplasty?

Reading about septoplasty and turbinate reduction, it strikes me how often people have both problems. It seems like one must be causing the other.

But if the deviated septum is causing the enlarged turbinate, that seems like the turbinate is merely chronically inflamed by the congestion or something. In that case, why use lasers, radiation, or mini-saws to carve up the poor turbinate? Just fix the septum and let the inflammation naturally go away.

I had septoplasty, turbinectomy and a bone spur removed in September. It was the best thing I ever did. I am 28 and do not ever remember breathing through my nose. I had 10 days of pain, Maybe a good 4 out of 10. I asked the ENT that same question. He said it would take a long a long time for it to reduce, if it ever did. Also he told me it would help with my drainage. I was not willing to chance another sinus infection over it. Just my 2 cents, I hope this helps.

1041 wrote:Reading about septoplasty and turbinate reduction, it strikes me how often people have both problems. It seems like one must be causing the other.

You are confusing correlation and causation.

mattd65636 wrote:I asked the ENT that same question.

Thanks for responding mattd65636; feels good to know I'm not the only one who wondered.

SleepingUgly, then there would be a shared source. Maybe mouth breathing, or orthodontia?

This is outside my area of specialty. I don't know... Enlarged turbinates can be caused by allergies. Maybe if they are caused by poor air flow due to a very deviated septum... I don't even know if it can cause that. I had both repaired. Just make sure you find someone good who won't go whole hog on your tubinates and leave you with empty nose syndrome or something. I didn't have splints or packing put in my nose, and I think that's what made it so much more tolerable (that and I had a tonsillectomy simultaneously, and the contrast effect probably made the nose seem like a breeze).

The ENT said my enlarged turbinate was caused by my repeated sinus infections, up to five a year. It is hard
to say because I was a 10 year, 2 bottles a week Afrin user. If you have a question find a trusted ENT and ask. Mine was confident and straight forward. All of my questions were answered no matter how dumb it was.

"nasal surgery success rate is so low"

"If someone has very unfavorable upper airway anatomy, moderate/severe sleep apnea, no or small tonsils and no redundancy in the soft palate, I would tell them that the only good option for them is the MMA. Otherwise, don't do any surgery." -Kasey Li

It seems like many UARS sufferers end up in MMA in desperation. Why doesn't nose surgery work? Don't UARS people generally have nasal issues but their throats don't close off so much (that's why they have mostly RERA not apnea)?

Don't UARS people generally have nasal issues but their throats don't close off so much (that's why they have mostly RERA not apnea)?

No. The airway blockage is typically (90%+) at the oropharynx for all forms of obstructive sleep-disordered breathing (SDB).

Most patients who have blockages in the nose reflexively open their mouths while sleeping and the nasal blockage becomes moot as far as SDB concerns. Of course mouthbreathing is not as healthy as nasal breathing so the nasal problem should be corrected even if the patient does not have SDB.

BTW, count me as one who considers surgical septum correction and surgical turbinate reduction as one of the best things I ever did. The recovery was pretty easy and quick.

Good luck.

1041 wrote:"nasal surgery success rate is so low"

For a cure for apnea, agreed. For tolerating CPAP and all around better breathing, disagree.

"If someone has very unfavorable upper airway anatomy, moderate/severe sleep apnea, no or small tonsils and no redundancy in the soft palate, I would tell them that the only good option for them is the MMA. Otherwise, don't do any surgery." -Kasey Li

He would not say not to do septoplasty or turbinate reduction, he just doesn't think they will cure apnea. And you can infer from what he said that if someone has large tonsils (or redundancy in the soft palate), he would recommend surgery (e.g., tonsillectomy, etc.).

It seems like many UARS sufferers end up in MMA in desperation.

I think those that turn to MMA are by definition desperate.

Why doesn't nose surgery work?

Who nose. Sorry, couldn't resist.

Don't UARS people generally have nasal issues but their throats don't close off so much (that's why they have mostly RERA not apnea)?

I don't think we can say that UARS is caused by nasal issues and OSA is caused by throat issues.

I think the best candidates for an MMA are those who benefit from CPAP and who have craniofacial features that would benefit cosmetically from the surgery (although I don't know if anyone benefits cosmetically from having their jaw advanced to the degree that Kasey Li and others doing it for apnea are advancing the jaw--something to look into). If someone doesn't benefit from CPAP, it would be a great leap of faith for them to think they will benefit from an MMA.

1041, it sounds like you are considering septoplasty, turbinate reduction, and/or tonsillectomy?

This is all very interesting. I saw my ENT today. He said I have a severely deviated septum and hypertrophic turbinates. My turbinates are very swollen and red and my nasal passages are almost totally blocked. My ENT is recommending Septoplasty and Turbinate Coblation. He thinks surgery will improve my sleep apnea.

I've read so many pros and cons of surgery, but it appears as though more people are in favor of it. I hope I am doing the right thing!

SleepingUgly wrote:If someone doesn't benefit from CPAP, it would be a great leap of faith for them to think they will benefit from an MMA.

You are right not to take such a surgery lightly. I myself can't believe it has come to this (if septoplasty and turbinate reduction - tonsils already removed - and oral devices don't work).

merhaba12 wrote:This is all very interesting. I saw my ENT today. He said I have a severely deviated septum and hypertrophic turbinates. My turbinates are very swollen and red and my nasal passages are almost totally blocked. My ENT is recommending Septoplasty and Turbinate Coblation. He thinks surgery will improve my sleep apnea.

I've read so many pros and cons of surgery, but it appears as though more people are in favor of it. I hope I am doing the right thing!

Even if that surgery doesn't cure your apnea, it may be totally worth it. I don't have apnea (my husband does) and I had that same surgery one year ago Dec 13th. It was AWESOME!!! My ENT did tell me that most of my results would be from the septoplasty. I have not had one sinus infection in the last year (and I had lots of them before, many of them taking 4-5 rounds of antibiotics to clear up) and I can actually move snot when I blow my nose now. Sinus rinses are more productive and I am thrilled.

I am looking for long term (e.g. 5+ years) success rates for surgery on the septum/turbinates with success being defined as maintaining at least a minimum peak airflow rate (or something to that effect).

Could somebody help me find that ?

Better wrote:I am looking for long term (e.g. 5+ years) success rates for surgery on the septum/turbinates with success being defined as maintaining at least a minimum peak airflow rate (or something to that effect). Could somebody help me find that ?

OK, so I've decided to elaborate a bit so you understand where I'm coming from.

1 year ago I was diagnosed with SDB having an RDI of 11. Mostly RERAs. CPAP worked and gave me the best sleep I've had in over 20 years this but I couldn't tolerate it for a number of reasons. I then saw an ENT who wanted to perform the following procedures on me : septoplasty, inferior turbinate reduction, raise my soft palette and uvula (UPPP), coblate (reduce the size of) the rear of my tongue, and remove my tonsils. I have had none of those done yet. I have a BMI of 20, am fit, young (42) and otherwise very healthy.

In order to get a refreshing sleep I have opted for the following things in order of discovery:

1. Nasal Saline rinse to clean out mucus from nose each night before bed
2. Nasal dilating strips (Breath Right)
3. AveoTSD device to hold my tongue forward preventing it occluding my airway (this offers the BIGGEST benefit)
4. Oxymetazoline (Afrin) nasal spray in each nostril at night (I know the long the side effects which is why I want the turbinoplasty done, and the massive benefits for me outweigh the risks right now)

SO.... who of you have had a turbinoplasty performed at least a few years ago and think it is good as it ever was, or do they need re-doing every so many years?

regards
Peter