In this consultation, the patient is an adult, but could be male or female. The patient could even be you.
Doctor: Good morning. How are you today?
Patient: Pretty good, except that I can’t seem to breathe out of the left side of my nose as well as I can out of the right side.
Doctor: Is that what brings you in today?
Patient: Yes.
Doctor: Can you tell me a little bit more about that? What problems do you have now?
Patient: What do you mean by that?
Doctor: I mean what is it that bothers you?
Patient: It seems a little stuffier on the left and I can’t seem to breathe as well.
Doctor: Does that bother you all the time, or during the night, or only while exercising?
Patient: During the day it is not such a big problem but I notice it a lot when I am exercising or jogging.
Doctor: Have you ever broken your nose?
Patient: I don’t think I have ever broken it but I used to play soccer in high school and got hit a few times. The ball landed on my face a few times but it never broke my nose.
Doctor: Do you have any problems with allergies, pollens, dust, or molds?
Patient: I don’t think so, but how would I know?
Doctor: The symptoms of allergic rhinitis are itchy nose, itchy eyes, and sneezing.
Patient: No, I don’t think I have any allergies.
Doctor: Do you take any medication?
Patient: No.
Doctor: Are you otherwise healthy?
Patient: Yes, I do some daily exercise and I eat right.
Doctor: Are you in school or do you work?
Patient: I am a student and I work part-time.
Doctor: Have you ever had any sinus problems?
Patient: Outside of having colds, no.
Doctor: Have you ever had sinusitis with nasal congestion, discharge for a long time after a cold something that required antibiotics?
Patient: No.
Doctor: Is your sense of smell is good?
Patient: I don’t know how good is but I think I can smell fine.
Doctor: Well, let me examine you for a moment and we will go from there.
The ENT examination is performed.
Doctor: I finished looking at your nose and indeed the septum is crooked.
Patient: What is the septum?
Doctor: The septum is the cartilage in the center of your nose. If you ever pick your nose or put your finger in your nose for whatever reason you can feel the cartilage in between. It is never perfectly straight in anyone, but it is supposed to be relatively straight. In your nose, and actually if you feel with your finger, you can feel that it is quite crooked to the left side so the left side of your nose has 10% of the airway that the right side has. Therefore you really don’t get lot of air through the left side of your nose which is why you complain of the congestion and necessity to breathe through your mouth when you are running.
Patient: Is there something I can do about that?
Doctor: There is. There is an operation.
Patient: Can you tell me more about that?
Doctor: The operation is called a septoplasty. We normally do that with you asleep. It is performed in an operating room, usually in our same day surgery operating room.
Patient: Will I receive any anesthesia?
Doctor: Once you are asleep I put some anesthesia in your nose, which makes the surgery a little easier for you and easier for me, and then make an incision on the inside of your nose. I lift the lining of the septum off of the septum. I am then looking directly at the cartilage and the bone which form the septum and it will be crooked and misshapen, and may be even fractured. Sometimes we remove a little bit, but any case we straighten it all out and then put a suture or two in the incision and then another suture that goes back and forth, like a basting suture, and that completes the surgery.
Patient: Is there any packing for this procedure?
Doctor: We don’t use packing anymore. You may have friends or relatives who had nasal surgery in the past had packing, which was the most unpleasant part of the surgery. Today we don’t use packing. We put a little piece of plastic on either side of the septum, one each in each nostril. These are called splints and they are very gently sutured together and this holds everything straight for anywhere from four to 10 days while things heal.
Patient: When do you take the splints out?
Doctor: I normally will see you back on the fourth post-operative day and we take the splints out then.
Patient: Does removing the splints hurt?
Doctor: No, I don’t think so.
Patient: How long does it take to heal?
Doctor: Normally people are a little groggy the first day after the anesthesia and have a little discomfort. We give you some medicine to help with that and usually by the second or third day you should be starting to feel reasonably well. You can return to somewhat normal life by day four or five. After I take the splints out you will be able to breathe through your nose and so you can return to normal life, although I won’t let you do any rigorous activity like running for a period of about two weeks.
Patient: Are there any risk for this operation?
Doctor: There are risks and complications to this surgery as there are with any operation. The standard ones are infection, bleeding, scarring, even death from anesthesia.
Patient: Does that happen often?
Doctor: It does not, but the national statistics are that 1 in 100,000 people will die from a simple operation, even like this.
Patient: Is the surgery usually successful?
Doctor: You mean in terms of breathing?
Patient: Yes, that’s what I meant.
Doctor: It is 80% of the time. One would think it would be more like 90 or 95% but it isn’t.
Patient: Why is that?
Doctor: It turns out that the cartilage has some memory of its own and even though I do all the things that I think are important to reshape it and place it back where its supposed to be, it sometimes scars in such a way that deformity results again and the operation may not be successful.
Patient: If that happens, is there something else that can be done?
Doctor: It depends on what happens. If that’s what happens, then often we need to do a second operation and generally that will fix it.
Patient: Is that an operation risk?
Doctor: I don’t think so. It is just an annoyance of having to go through the whole thing once again.
Patient: Would having the surgery change the appearance of my nose?
Doctor: Is that something you would like to happen?
Patient: No.
Doctor: Then there is no reason why it should. All of the surgery is on the inside. It should preserve all of the supporting structures so your current nasal appearance would not change.
Patient: After hearing all of this I think I would like to have the surgery done.
Doctor: Good. We will fill out the paperwork and the nurse will go through some of the pre-operative information. You will have to have a physical examination just to make sure that surgery is going to be safe for you and then our scheduler will get in touch with you and we will find a date that is convenient for the both of us.
Patient: Thank you very much.
Doctor: You are welcome.