OT - Deviated Septum

[dekindy]

After suffering with sinus infections for 48 years I went to an allergist and after testing and two years of allergy shots, antihisimines, and nasal washes my symptoms are under control. I now rarely have an attack and even avoid getting a cold when my wife and son do. Usually it was the other way around, I would always get a cold when they did and sometimes when they did not.

The allergist says it is now time to address my deviated septum. I still have difficulty with one nostril due to "significant deviation of the osseous nasal septum to the right". There was constant discharge this Winter and is continuing into the Spring.

Currently my symptoms are alleviated beyond my wildest dreams and I am happy. I can actually breathe through my nose now. The allergist thinks that getting the septum corrected might mean the difference between whether I will need allergy shots for the rest of my life or discontinuing them after the normal 3-5 year treatment period.

Has anyone had experience with getting their deviated septum operated on? Time off the bike, etc? Should I wait until winter and do it them?

Did it improve your breathing? Was there noticeable improvement in your cycling performance that could be directly attributed to this procedure?

[Birddog]

Isn't that where they run an auger up yer nose and bore it out? Maybe it's a little better these days.

Birddog

[Hardlyrob]

It is better than BirdDog suggests.

I had this done about 20+ years ago after getting hit by a car and badly breaking my nose. My diagnosis was beyond a deviated septum - it was "convoluted". My nose had been broken at least twice before the hit by the car, and that was probably what the real problem was.

It made a gigantic difference in my ability to breath. If you snore, it may even help that to some extent.

Back then the recovery was no big deal. They pack your sinuses with gauze, and a few days later you are fine.

I'd get it done if I had to do it over.

Cheers!

Rob

[Liberace]

I had it done in September 1999 after breaking my nose seven times in high school and college. I was at a point where I couldn't breathe out of my left nostril and would get horrible sinus infections. After consulting the best ENT at the time in NJ, I had the surgery. It took about 2-3 years to see the benefits. I had to have a number of blood vessels cauterized the year after the surgery, so it wasn't too pleasant.

I would just do your homework and get a couple opinions. Make sure they don't remove your turbinates.

Sean

[paulh]

Put "nasal" in the search box. There's quite a bit of experience here.

[dekindy]

Put "nasal" in the search box. There's quite a bit of experience here.

I usually do a search but had not. Thanks for that. Septum was a better search word for what I was looking for. I have an appointment for Friday morning and will report back on the diagnosis.

[Gothard]

Get a sinus CT scan done. Images and actual measures of the room left for your sinuses to breathe/drain are paramount. The rest is the opinion of a guy who would make money if he gets to operate on you. A deviated septum does not mean much. The worst subjective symptoms of obstruction I have seen were in patients with TONS (too much) of space.

[dekindy]

Get a sinus CT scan done. Images and actual measures of the room left for your sinuses to breathe/drain are paramount. The rest is the opinion of a guy who would make money if he gets to operate on you. A deviated septum does not mean much. The worst subjective symptoms of obstruction I have seen were in patients with TONS (too much) of space.

Yes, this was done two years ago. I have read that the conservative approach is to take care of allergies first and then determine if further improvement can be made by correcting the septum. The allergies are under control so it is time to address the other. I will have CD in hand for the appointment. I was surprised that the imagining center gave me a copy at no charge and it only took less than 30 minutes from the time of request until they delivered it to me while I waited.

[Gothard]

Yes, that is now common practice. We (my office) can give a CD in 5 minutes after the exam is finished. CDs are dirt cheap, the cost is in the engraving, and the expertise behind it all.

That said, It may be worth to repeat the CD to see how the sof tissue regression (de-swelling from successful treatment) has freed up the air spaces/airways.
Your ENT should ask for it if he feels it is useful. 2 years is enough time for even *bone* to remodel.

[dekindy]

Yes, that is now common practice. We (my office) can give a CD in 5 minutes after the exam is finished. CDs are dirt cheap, the cost is in the engraving, and the expertise behind it all.

That said, It may be worth to repeat the CD to see how the sof tissue regression (de-swelling from successful treatment) has freed up the air spaces/airways.
Your ENT should ask for it if he feels it is useful. 2 years is enough time for even *bone* to remodel.

Thanks for the thoughtful suggestion. I would have not considered the improved flow resulting from the allergy treatments. I was probably thinking in terms of an X-Ray that shows only the bone structure. Can the improved airflow only be measured accurately by comparing scans and the ENT cannot determine the improvement by his examination and reviewing a scan from 2 years ago? Is this what you mean?

[Gothard]

Yes and no. There are 2 facets.
An ENT can easily determine whether air and fluid flow is impaired or adequate, thereby determining the adequacy of a surgery.

However, as stated before, an ENT has interest in performing surgery. It really hangs on how well you know the ENT and how trusting you are. Yes I am cynical.

I'd have a CT performed anyway for several reasons, not least to plan precisely what need to be done and how to have it done in the least "modifying" way to your nasal cavity. Too much room causes as much symptoms as too little room.

And, as always, the above has to be read with the knowledge that I am about 4K miles from you and NOT licensed to practice medecine in the USA.

[dekindy]

Gothard, thanks for all your comments. I feel that I am much better prepared for the appointment.

Both the allergists I have seen were Mayo Clinic trained. The first allergist was new to the practice and I saw him until my most recent appointment. The first allergist left the practice so I saw the second allergist for my recent appointment. The second allergist is the only one in the practice now and is the founder of the practice. He referred me to the ENT.

So far I just have the second allergist's comments regarding my septum. He seemed to indicate that fixing my septum would be beneficial. If I understood him correctly it might mean the difference between continuing allergy shots indefinitely versus being able to discontinue them. Is this possible or did I not understand him correctly?

I did not think to ask the second allergist if he was only reading the doctor's findings (doctor who read the scan, not the first allergist) regarding the scan or if he actually had the scan stored in his computer and was looking at the pictures.

I have been impressed with the detailed notes that this practice has kept regarding my case. They spend ample time with me and and the doctor's assistant and doctor both asked me lots of questions about my condition.

I do not recall what the first allergist said, if anything, about fixing my septum at a future date.

[Gothard]

If I understood him correctly it might mean the difference between continuing allergy shots indefinitely versus being able to discontinue them. Is this possible or did I not understand him correctly?

I did not think to ask the second allergist if he was only reading the doctor's findings (doctor who read the scan, not the first allergist) regarding the scan or if he actually had the scan stored in his computer and was looking at the pictures.

I have been impressed with the detailed notes that this practice has kept regarding my case. .

I gather from the quoted parts above, that the allergist feels if there should be any swelling from allergy, it would compromise airways. A surgery would then make enough room to allow free-er airways even with swelling of the mucosa.

It is usually NOT a good thing if any non-radiology doc reads radiology exams. Sure they know their stuff and what they are looking for, but they sorely lack the *radiology* knowledge to see the complete picture. Kind of like the orthopedist DHSing the broken femoral neck precisely from reading our images, NOT our report, yet failing to ID the osteosarcoma 10 inches lower, which was duly reported in the attached letter (you know, the one he threw with disdain in the trash...). Yes that happened.

And yes, ANY private practice will keep detailed records, to treat you better, have a complete picture of your problems, and for medico-legal reasons.

Again, usual disclaimers apply...

[znfdl]

Has anyone had experience with getting their deviated septum operated on? Time off the bike, etc? Should I wait until winter and do it them?

Did it improve your breathing? Was there noticeable improvement in your cycling performance that could be directly attributed to this procedure?

I had my deviated septum repaired (high school wrestling injury) and sinuses trimmed / cleaned out.

No infections for almost 2 years, used to run 2-3 infections per year.

Breathing has greatly improved and the snoring noise decreased about 90%

[Birddog]

Wow Zin, that's amazing. You had your septum repaired and your wife quit snoring. That's something!

Birddog

[dekindy]

I had my doctor appointment today. The procedure is optional but since my right nostril is almost completely blocked I am going to have the surgery. The doctor cannot guarantee anything other than the airflow will be improved. Since I am breathing through only one nostril I don't see how it will not have some positive effect.

The allergy shots have been a success so I am doing this with the expectation that any improvement will be much less incremental than the allergy treatments. If I see improvements in sleeping or athletic performance, then that will be icing on the cake.

I am kind of anxious to see how it feels to breath through my whole nose. Being able to begin breathing through just one nostril has been pretty good. I am not sure that I ever could breath through my nose until the allergy shots. I certainly don't recall any event that caused me to quit breathing through my nose so I must have had allergies and a deviated septum all my life.

I guess the fact that my sneezing and infections got worse was a good thing because it caused me to finally seek treatment. Surgery is next Friday so in a few weeks I will know the results. Success rates are 95% on the first operation so the odds are with me that I won't have to go through it twice.

[znfdl]

Wow Zin, that's amazing. You had your septum repaired and your wife quit snoring. That's something!

Birddog

Birddog:

I only wish, earplugs for me, but she sleeps better ;)

Dekindy: Good luck on the surgery.

[vjp]

I had a septoplasty about 16 years ago and I am so glad that I did. I don't have allergy problems but it would cause me to be a mouth breather which is not attractive and at night my mouth would dry out and cause my gums to recede. It was actually my dentist who got me to do it.

It was day surgery for me and I was really out of it for a few days and looked rough for a couple of weeks. Removing the packing is fairly unpleasant but they used the dissolving stitches so they didn't have to be pulled. I could breathe better right after they brought me back to life and after the swelling went down it has been good ever since. The inside of my nose was tender for well over a year but it wasn't a "problem".

Good Luck

vjp

[Elefantino]

True story:

I broke my nose as part of a 01 bike accident and never had it surgically repaired because I'd had enough of surgeries. I could hardly breathe out of my right nostril, but so what.

Then, about two years ago, I was walking and tripped over a tent stake. Fell flat, literally, on my face. Got up, dazed, and realize I'd broken my nose again. I also realized I could breathe out of my right nostril. Again.

Moral: Fall on your face for better health.

[dekindy]

I had the surgery this morning and am at home recovering nicely. Everything went very smoothly and as long as I do not get up and move around the bleeding is minimal. I can already breathe through my right nostril and it will only get better. I am optimistic that the minor discomfort and time off the bike this coming week will be worth it. The doctor said that I could go 75% midweek on the bike. I think I will try some walks first to make sure it does not start bleeding. I have a followup appointment next Friday and I may wait until after then to ride. Meanwhile my sweet and lovely wife is taking good care of me and I am going to sit back in the shade and enjoy the warm weather and sunshine.

[djg21]

After suffering with sinus infections for 48 years I went to an allergist and after testing and two years of allergy shots, antihisimines, and nasal washes my symptoms are under control. I now rarely have an attack and even avoid getting a cold when my wife and son do. Usually it was the other way around, I would always get a cold when they did and sometimes when they did not.

The allergist says it is now time to address my deviated septum. I still have difficulty with one nostril due to "significant deviation of the osseous nasal septum to the right". There was constant discharge this Winter and is continuing into the Spring.

Currently my symptoms are alleviated beyond my wildest dreams and I am happy. I can actually breathe through my nose now. The allergist thinks that getting the septum corrected might mean the difference between whether I will need allergy shots for the rest of my life or discontinuing them after the normal 3-5 year treatment period.

Has anyone had experience with getting their deviated septum operated on? Time off the bike, etc? Should I wait until winter and do it them?

Did it improve your breathing? Was there noticeable improvement in your cycling performance that could be directly attributed to this procedure?


I had it done a bunch of years ago. I had let a broken nose sustained playng sports in college go untreated, and my nose healed incorrectly. I could not breathe out of one nostril, and I constantly was getting sinus infections.

The surgery helped considerably. I am no longer prone to sinus infections, and I can actually breathe through my nose.

I was off of my bike for a week. When you get home after the procedure, your sinuses will be packed with gauze, and you will want to sleep for a day. The packing makes you uncomfortable, and you will feel like you have a bad sinus headache. I can't recall if I was on pain meds.

The gauze will be removed after a couple of days. That is the worst part of the process, as the doctor will pull what feels to be a mile-long strip of packing out of your nose. You'll then have a bunch of scabbing and crud in your sinuses for a week or so. Most will excrete on its own, but the doctor may pull some out during a follow up visit.

It has been over 10 years since I had mine fixed, and it is a big inprovement.

[MarleyMon]

Sounds like a good result.
Heal fast so you can get back to riding.

[ty-ro]

Best of luck for a speedy recovery.

I have a pretty bad deviated septum due to a nose break on a multi-day hiking trip. This was when I was 10 years old. He said I would need surgery in my teens to correct it. I have never had the surgery. I use the Breath Right strips at night and have found that they have a profound effect on my sleep. I also do Zyrtek and Nasacort during allergy season, otherwise the sinus infections come. I also find that the breathe rights help if I happen to get a sniffle so that it does not turn into a full blown infection. Also, if I'm going on a long, hard ride, I will use a breathe right strip. Seems to help the breathing quite a bit.

[dekindy]

I still cannot recall a specific instance where my nose got hit hard enough to damage my septum. It must have occurred because the doctor noted that there was a lot of scar tissue.

My recovery went great this and I have been cleared for all activity. He cautioned me that if my nose started throbbing that I should reduce my effort. This does not happen often but might indicate my nose will start bleeding.

It is great to be able to breathe out of both nostrils. Now I can get air when I have to keep my mouth closed to avoid swallowing bugs, etc. Since my nose will continue to get clearer I have even more to look forward to. I wish I would have known about this sooner.

I had not problems on a ride Wednesday night. I followed the doctor's recommended reduced effort guideline.