FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

CHRONIC NASAL CONGESTION MAY NEED "COLD STEEL" CURE

Question: I've had difficulty breathing through my nose for as long as I can remember. Now, I seem to be losing some of my sense of smell, too. I've tried all the non-prescription medications for colds, allergies and sinus congestion without any lasting improvement. I saw an ear-nose-throat specialist who said my septum is crooked and causing my symptoms. He wants to operate on my nose, but I'm reluctant to do it. Can you help me decide?

Answer: Perhaps I can help you in one sense I can provide information that you should consider before making a decision to have surgery. But you are the one who must finally make the decision, and this is the way it should be. You are the one who will gain the benefits from surgery as well as the one who suffers the discomfort both physical and financial associated with the procedure.

I think you will understand my explanation a bit better if I review the anatomy of the nose first. The nose if divided into right and left sides by a partition the septum that is made of cartilage and bone. The cartilage is the supporting tissue is the part of the nose that extends forward from the cheeks. The flexibility of this cartilage portion allows talented individuals to wiggle their nose to amuse those around them. But of greater importance, the flexibility allows motion from minor bumps without causing broken bones or other serious damage. As a general rule, the cartilage portion of the nose doesn't cause problems with nasal blockage, however its shape is often surgically altered for cosmetic reasons.

The septum extends deep into the nasal passages. At about the level of the cheek bones, the cartilage part of the septum joins the bones that make up the remainder of its length. And that length of bone is where you have troubles. In the "normal" drawing in anatomy books, the septum is shown as being straight, dividing the right and left halves of the nasal passages so that one side is the mirror image of the other. In most individuals the septum is slightly bowed to one side destroying the "mirror image" symmetry. In some individuals the septum can curve so much that it nearly touches the bones that form the side walls of the nasal passages. This can reduce markedly the space available for air to pass through and make this narrowed side of the nose always seems "stopped up."

There are some unfortunate individuals that have a septum that forms a complex "S" shape instead of being straight or deviated to only one side. In these individuals the septum approaches the wall of the nose on one side, and farther back in the nasal passages, the septum swings over to block the other side of the nose. I suspect that you are one of these unfortunate individuals. Your surgeon hopes to "un-block" your nose by straightening out your crooked septum and, thereby, making more space for air passage.

There are several surgical techniques that are utilized to repair a deviated septum. The differences between them is really of no major significance since all have the same success rate. Over 90 percent of individuals report satisfaction with relief of nasal blockage within a few weeks. However, the satisfaction rate drops to about 70 percent by the time four years have passed. The chance that repairing your deviated septum will improve your sense of smell is about 60 percent, so don't get your hopes too high about "a surgical cure" for this problem.

The complications from this type of surgery are fairly low. Infection within the nose and bleeding occur in about 1 percent of cases, and a slight nasal deformity is produced about 2 percent of the time. These are the most common complications, and it is unlikely that any of them would result in serious or permanent difficulties.

Now you should have enough information to ask your surgeon specific questions about your surgery. Then you can decide if you want to proceed.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.