Should I get a 2nd opinion about surgery for my nose?
December 27, 2010 1:37 PM   Subscribe

YANAD, but I need some advise on a problem with a deviated septum. Is it worth getting a second opinion from an ENT? Complication: Sleep Apnea. More inside

I have both a deviated septum and sleep apnea. I use a CPAP machine with a nose mask when I sleep. I cannot sleep on my left side because my nose completely clogs up when I do, and on my back or stomach isn't an option either because I had back surgery a few years ago and can no longer lay flat without my lower back becoming sore. So my only option is to sleep on my right side.

However, at times this causes soreness in my right shoulder, and I'm worried it could become more severe as I get older. I went to an ENT, on the advise of my sleep doctor, to see if any surgery could alleviate some of my apnea. He said he could remove some of the excess tissue from the back of my throat, as well as my tonsils, but would not recommend it as the pain and recovery wouldn't be worth it (it wouldn't get me off the CPAP).

I also asked him to take a look at my deviated septum. I'm pretty certain that "curing" my sleep apnea would not fix my nose (according to my doc, quitting smoking is the #1 thing that would help my apnea, followed by losing weight. The deviation contributes very little to the apnea). He took a look at it and again recommended against surgery, for 2 reasons. First, it wouldn't help my apnea (which I already knew) and second, because of where the deviation is, it would essentially flatten the tip of my nose a good bit. He gave me some steroid spray and said I should use it every day to see if it helps. It really didn't do anything, and he really didn't say what it was supposed to do anyway.

After I got done at the ENT, I started thinking while driving home, and it occurred to me that he may have misunderstood my question about my septum. Like maybe he saw it as "will fixing my septum cure my apnea?" when in fact, it was more like "can you fix my septum? my shoulder hurts when I wake up and I'd like to be able to breathe regularly through my nose, even when I'm awake".

So I'm thinking about going to another ENT for another opinion on surgery. I ended up with a lot of questions that I should've asked the first one that I didn't think of. Is the nose flattening unavoidable? Was that steroid he gave me supposed to fix the septum eventually, or did he expect me to stay on it for the rest of my life? Am I doomed to the fact that even if I lose 100 lbs, stop smoking, and get off the CPAP completely, I'll still be sleeping on my right shoulder forever? I need help!
posted by ChrisLSU to Health & Fitness (8 answers total) 1 user marked this as a favorite
Here's the thing: the success rate for sustained weight loss is less than 5%, so doctors saying that they can't do anything to help you but that is a crap answer. Sure, losing a bunch of weight might help your sleep apnea and your overall health, but there's a 95+% chance that you won't be able to do that, so why not also look at interventions that have a stronger likelihood of success?

See another doctor, and I would suggest looking for one with expertise in Minimally Invasive/Endoscopic sinus surgery.
posted by Sidhedevil at 1:57 PM on December 27, 2010

It's your frickin' nose and your ability to breathe. I'd say seeing another doctor to discuss possible options is the least you can do under the circumstances.
posted by zachlipton at 3:29 PM on December 27, 2010

My neurologist says that most of his patients who lose weight still have sleep apnea. Mine is vastly improved since I have lost 110 pounds, but I still have it.

Go see the ENT.
posted by elsietheeel at 5:17 PM on December 27, 2010 [1 favorite]

Best answer: I'm midway through my ENT residency and have seen scores of patients with obstructive sleep apnea (OSA) and nasal septal deviations. OSA is a difficult problem because it can be multifactorial. Any collapse or narrowing of the airway from the nostril down to the voicebox (and even trachea) can cause OSA, and oftentimes there are several areas of narrowing or collapse. Subsequently, there are quite a few surgical interventions, from the simple to the brutal, that can be employed to improve (usually) or completely fix (rare) the problem. It sounds like your septal deviation is causing you a real problem, even if it isn't contributing to your apnea and I agree with the above commenters that a second opinion could be valuable.

The steroid was likely prescribed in an attempt to decrease any inflammation that was present, not to fix the septum. It kind of strikes me as voodoo in this case, but folks would be surprised how pressured physicians can feel to write a prescription for *something* (despite medical cost, side effects, etc). This is most evident with unnecessary antibiotics prescribed for viral infections. I digress. Nasal steroids are fantastic drugs for allergic rhinitis, but they aren't going to fix an architectural problem.

As far as the nose-flattening, there are well-recognized complications of septum surgery (septoplasty), but these typically occur because the surgeon resects too much septum or takes cartilage too close to the nasal bridge or columella. Ask your ENT how often he does septoplasties and ask if he feels confident that your anatomy is conducive to a good cosmetic result.

OSA can be a miserable problem and I'm glad that you're already on CPAP and that hopefully it is controlled. Hopefully, you can find a doc that you're comfortable with and that your nose is amenable to a relatively easy fix.
posted by robstercraw at 5:42 PM on December 27, 2010 [1 favorite]

Definitely get a 2nd opinion. My mom had the sleep apnea surgery (removal of her uvula as well as a lot of the tissue in the back of her throat) and while it helped, she still has milder apnea and she chokes easily. They could probably do the septum and the apnea surgeries at the same time.
posted by IndigoRain at 7:58 PM on December 27, 2010

I have a deviated septum too, thanks to one of those rough Stuart kids across the road. Nasal irrigation can help keep your nose clear. I never used to be able to breathe through my nose, but now I can.
posted by Joe in Australia at 1:59 AM on December 28, 2010

Like you I have a back problem and a problem breathing through my nose on one side. I slip a pillow under my knees to enable me to sleep on my back too.
posted by mirileh at 11:41 AM on December 28, 2010

I have a deviated septum too, thanks to one of those rough Stuart kids across the road.

That should be the first line of a poem.
posted by mecran01 at 8:02 AM on May 26, 2011

« Older The novel, not sane, stood by itself against its...   |   Please sir, can I have some more? Newer »
This thread is closed to new comments.