Should my partner get surgery for a deviated septum?

July 14, 2017 4:41 AM

My partner recently saw an ENT surgeon on the advice of the clinic treating her sleep apnea, and was told to her surprise that she had a severely deviated septum and narrowed nasal passages. Since while any treatment would be covered under Australia's Medicare so cost is not a concern, she's still not sure if the surgery is worth pursuing given the >10% chance of no improvement and the significant recovery time. We were hoping to hear from anyone who has had similar surgery on what positive or negative results we might expect.

When we looked at similar questions in the past, the best outcomes seemed mostly to relate to relieving much more serious symptoms than my partner has experienced. Currently they only noticeable symptom (except for a possible effect on her sleep apnea) is that she finds it difficult to draw in sufficient air through her nose sometimes, particularly when exercising. This can make it look a little like she has asthma because she has to breathe through her mouth as soon as she needs more air than normal.

posted by Proofs and Refutations to Health & Fitness (14 answers total)

When I was a teenager I had surgery to correct a deviated septum. I was in a fight and the guy broke my nose. I had a hard time breathing normally before the surgery and it was a godsend.
I also had apnea surgery on my throat several years ago. It too worked wonders for me. I did not want to go through life with a CPAP.
So if I were in your shoes I would give the surgery serious thought.
posted by jtexman1 at 5:21 AM on July 14, 2017

I had surgery to correct a deviated septum a few years ago and I would not make the same decision again. It's hard to say categorically whether or not there was any improvement—I don't really trust my ability to objectively compare my current symptoms with my memory of my pre-surgery symptoms—but certainly if there was any improvement it was extremely minor, and my partner believes (based on their observation of me while sleeping) that I still have sleep apnea (though I haven't done a sleep study). I still have difficulty breathing through my nose. And the recovery was really unpleasant (they stuff your nasal cavity with "packing" while it heals).
posted by enn at 5:37 AM on July 14, 2017

My husband had this surgery because of an accident when he was a baby and rolled off a table that affected his nose and caused a deviated septum. He had frequent nosebleeds because of the tortured vascular anatomy, and one nostril was severely constricted. I don't remember his complaining of difficulty breathing and he is athletic, and doesn't have sleep apnea, but it's possible the weird anatomy caused his vessels to have weak areas that often bled. The surgery required an unpleasant recovery for a week or so with packing that made mouth-breathing mandatory until it was removed, but the results were so worth it. The surgery was about 20 years ago and he has not had a nosebleed since. The insurer required before and after photos to verify that this wasn't a sleight-of-hand move to do a cosmetic procedure, so he still has the same crooked nose.

Sleep apnea is a serious condition, and can cause serious heart damage. Whether your partner chooses to have the surgery or not, it should be addressed. If the ENT believes correcting a physical structure can do this, it might be worth the discomfort, but it is also very possible that any improvement will be modest. The bottom line is that the sleep apnea is the most important health-impacting condition, and the doctor's suggestion seems ultimately aimed at addressing sleep apnea.
posted by citygirl at 6:02 AM on July 14, 2017

There is a longish thread , plus a few others on the whirlpool forums from Australians who have had this. Outcomes definitely seem to be mixed.
posted by smoke at 6:15 AM on July 14, 2017

I also had a severe injury to my nose (self-inflicted) as a small child that required extensive surgical correction as a young adult, including fixing a deviated septum. Had additional surgical correction around 15 years after that.

Definitely worth it. Restricted airflow is no joke & can lead to all kinds of things such as polyps in the sinuses because they aren't able to clear properly. citygirl is correct, though, that sleep apnea is the biggest thing to worry about. If there is a likelihood that the deviated septum is causing or significantly contributing to sleep apnea, it is worth correcting.

It's hard to say what the surgery and recovery will be like. My first surgery was quite extensive and effectively involved re-breaking my nose in a bunch of places, then putting everything back together the way it was supposed to be. My entire face looked like an eggplant afterwards and recovery took a pretty long time. The second surgery was only to further straighten my septum and open up the airflow, which sounds more like what your partner might have. Recovery wasn't such a big deal for that one. Yes, there was some packing and yes I did have to breathe through my mouth for several days. But I didn't have gigantic black eyes, etc. and I was even able to go back to work fairly soon.

One thing I will say is that it's not like you notice a huge difference right away. At least I didn't suddenly think, "my god! I am breathing so much more easily now!" But it did actually make a pretty significant difference. Importantly, I haven't had a sinus headache since my second surgery, and I don't seem to get sick with colds and other nose-related things nearly as often.
posted by slkinsey at 6:21 AM on July 14, 2017 [1 favorite]

Well, this is timely. I am 21 days post-op from septoplasty to correct my deviated septum. I put off surgery for a time because I was worried about the recovery time, because I didn't think my breathing was so awful, and because, as a performer, I was concerned about changes to my appearance and my singing voice. Those concerns have been partially validated. But also? I can breathe all the oxygen in the world now, and it's shocking and amazing.

Like your partner, the main symptom I noticed was difficulty breathing in enough air through a narrowed nasal passage. A clue was that no matter how fit I got, I always had to breathe through my mouth when engaging in strenuous exercise. (For me, this had the follow-on effect of making me more susceptible to exercise-induced asthma, especially in cold weather.)

Unlike your partner, I also had a visible deviation of my columella, though you had to get into a rather intimate angle with me to notice it. I also was not ever diagnosed with sleep apnea, though my doctor had her suspicions based on my anatomy.

The first week of recovery was rather awful. I was hugely swollen from my upper lip to the bridge of my nose. I had stitches inside and out, and two hard plastic splints lining the inside of my newly straightened septum. My nasal passages were not packed with anything, but I was too swollen to breathe through them anyway. I bled freely for almost 24 hours, and then sporadically for another 72. The pain was notable, and the drugs I was given to knock it back had deeply unpleasant side-effects. My husband and best friend gave generously of their time and sleep to take care of me.

At my post-op visit, the exterior stitches and splints were removed. (Everything you've read in those other mefi threads is true, by the way: the splints are huge, and their removal is a uniquely painful/horrifying relief.) The surgeon vacuumed some small prunes blood clots out and all of the sudden - whoosh! - I could breathe. And in the two weeks since, it's continued to get better. I mean, If you had asked me years ago, I would have sworn my breathing was fine, if annoying at times. But I didn't realize how compromised it was. How could I? The difference is huge, and now I'm noticing all the times my mouth is hanging open a little bit as I go about my daily life. Habit, I guess? Anyway, I pull it shut, take a deep inhale through my nose, and walk on. It's magic. I have also noticed that my lips aren't chapped anymore.

But, even as I am now in possession of a functional nose, it is not quite the same nose I had three weeks ago. I don't look radically different, and my voice seems to be unaffected, but it's still an adjustment. My surgeon was double-board certified plastics/otolaryngology and external changes were a known risk for my procedure. This might not be a concern for your partner, but I note it here anyway for others seeking the surgery.

I would be happy to tell you how I'm doing in three or six months. But as of today, I am more glad than not that I've done this.
posted by minervous at 6:42 AM on July 14, 2017 [2 favorites]

Put me in the 'worth it' category. I had my septum corrected, along with some excess sinus folds removed and a tear duct cleared, about 4 years ago. The doctor took the bandages out after less than 24 hours, so the worst of the recovery was short (the bandages up the nose was, by far, the worst of it, especially if you have allergies). I didn't really experience any pain. The results were well worth it! I can actually breathe from both nostrils again. I was using Afrin before bed every night so that I could breathe, and now I don't need any nasal sprays. Even my allergies became less annoying. Before the surgery, I would just get completely plugged up from them. Now I just get a runny nose, but can still breathe.

I should mention that my doctor was highly rated, so I'm sure that was a big factor in the success. I've heard from patients of different doctors who had to keep the bandages in for far longer, which would have driven me insane! You may want to ask your doctor about this.
posted by Don_K at 6:57 AM on July 14, 2017 [1 favorite]

Response by poster: My partner just wants to clarify that she is using a CPAP machine for the sleep apnea, and that the surgeon she consulted cautioned her that the surgery probably wouldn't improve that condition.

Thanks for all the answers so far, it's really helping to get as many perspectives as possible.
posted by Proofs and Refutations at 7:42 AM on July 14, 2017

minervous my voice seems to be unaffected

Unless you're singing with your soft palate unsealed (somewhat common in pop singing nowadays, but deprecated for classical singing) it is extremely unlikely there would be any difference to the actual sound of your voice. When the soft palate is sealed, the nasal cavity is not a significant resonator for vocal sound. Voice teachers and singers sometimes speak of the sinuses and other cavities as though though they contribute to resonance, but this is largely pedagogical imagery and studies have shown (e.g., by filling the sinuses with gel) that they do not contribute unless the soft palate is unsealed. At most, your voice might sound a bit different to you, but this is because we largely perceive our own voices via internal transmission. The only real difference opening things up might have on the actual sound of someone's singing or speaking voice would be if the nasal passages were so constricted that the person always sounded "stuffed up." In this case, I think the change would be accounted positively.
posted by slkinsey at 7:42 AM on July 14, 2017

I can tell you that I suffered from sleep apnea due to a deviated septum that caused a 95% blockage. Waking up dozens of times a night and often scaring the crap out of my wife when I would just stop breathing. I was actually addicted to NeoSynephrine in order to get to sleep. When I went to my ENT he lectured me for 5 minutes about how bad that was for me until he actually looked up my nose and said "Oh, I understand".

At the time the surgery was the worst medical experience of my life...bled for 8 days and lots of follow up visits. That being said I'd do it again in a heartbeat. Changed my life. I actually sleep now and have a sense of taste again. I feel better due to the fact that I had apparently been walking around with a sinus infection for decades.

Your mileage may vary.
posted by jeporter99 at 10:47 AM on July 14, 2017

I had the surgery in March, and I'm happy that I did. All of my breathing and sinus problems are gone. Recovery was a drag for about 5 days, but the difference is amazing--my nose holes are huge and whistling caverns!
posted by feste at 11:04 AM on July 14, 2017

I did it and my even partial results were life changing. I sleep so much deeper than I did, and one side failed.

So - as part of the 20% that don't qualify as a success under the medical definition, the downside is super low on this and the upside is high.
posted by notorious medium at 11:49 AM on July 14, 2017

I had the surgery 18 months ago. I stayed in hospital overnight as I didn't have anyone at home but I was home alone after that and recovery was fine. I am so glad I had it done, I can breathe through my nose and my sleep is a lot better. I get less sore throats too.

I'm also in Australia.
posted by kitten magic at 3:41 PM on July 14, 2017

Mr. BlueHorse had his done last year. Major broken nose. He's a big wimp, and absolutely hates doctors, so it took a while before he finally had enough misery to do it. He hated it, and was a big wimp about it, although it was pretty horrific. Both he and I wish he'd have done it years ago. As said above, no major nasal epiphany overnight, but lots of small changes that have made it so worthwhile.
posted by BlueHorse at 8:17 PM on July 14, 2017