Pre-Operative Endoscopic Septoplasty and Inferior Turbinate Reduction Surgery Patient Education

[@kanishkdudeja559]

Hello, I have a question! Thank you in advance! If one opts for an endoscopic correction of just the posterior part of a deviated septum (leaving the anterior deviation as is), is there a risk of a recurrence of compensatory turbinate hypertrophy (due to the anterior part being still deviated) ?

[@timcepin3386]

Can balloon sinuplasty be done over again to rid the nasal cavity/turbinates of inflammation and drain the sinuses?

[@kanishkdudeja559]

I need to undergo this surgery and I have a question. How should I decide between radofrequency coblation and microdebrider for my turbinate reduction surgery? Which technique is more long lasting (in terms of effectiveness) and carries lower risk of causing ENS?

[@zmpatel_md]

@kanishkdudeja559 speaking to your own surgeon about the technique they feel most comfortable with and what they get the best results from is the best idea. I personally prefer the submucosal resection with microdebrider and bone removal technique which preserves the functional mucosal lining best for most people. However, there are some patients who are not able to go to the operating room or prefer in-office procedures and other techniques may be better for them.

[@timcepin3386]

Why after turbinate reduction and balloon sinuplasty is my nasal breathing alternating and being blocked in one nostril and then switching nostrils, etcetera?

[@zmpatel_md]

@timcepin3386 only your own surgeon would be able to answer questions about your post-operative course and whether or not your symptoms are expected. I generally do not do a lot of balloon sinuplasty as I do not find many indications for it in my own patient population.

[@timcepin3386]

Can balloon sinuplasty be done twice within 7 weeks if balloon sinuplasty with turbinate reduction was done beforehand?

[@zmpatel_md]

@timcepin3386 I don't believe there is any situation where repeat balloon sinuplasty would be indicated in a patient. If balloon sinuplasty failed to relieve your symptoms, either you did not have a good indication for the procedure, or you needed real sinus surgery, not a balloon dilation.

[@Ben-im2ev]

Hi Dr. Patel, how do you determine how much to reduce in a turbinate? It seems that there is no real standard/guideline among ENTs and most seem to just look to create a WIDE airway in the nose. I think there are issues with this since they are taking patients BEYOND what a healthy nose looks like. Most people with healthy noses do not have huge airway space, instead they have a healthy amount of space that allows them to breathe comfortably.

[@zmpatel_md]

Hi @Ben-im2ev, it's a great question, and the answer is that it should be tailored to each specific patient's nose. you are right in that we should not be aiming to create an overly wide airway - just get people back to their normal airway. Any well trained, fellowship trained rhinologist knows this, but the physiology may not be as well understood in the general ENT population.

[@timcepin3386]

Can propel be added in as additional treatment?

[@zmpatel_md]

Propel is not something that is indicated for use after septoplasty/turbinate reduction.

[@timcepin3386]

Is there a risk doing so?

[@salamazzzz]

Can you have septoplasty due to trauma & not have a turbinante reduction? Or does septoplasty must include turbinante reduction?

[@zmpatel_md]

@salamazzzz You don't necessarily have to have a turbinate reduction at the same time as a septoplasty, but what happens commonly is the turbinate opposite to the side of the septal deviation tends to grow over time to encompass the space it's been given, so when you put the septum back in the middle, then it will be touching that turbinate. That is why we commonly do the procedures together - to create the most symmetry possible for the nose.

[@HemaChettri-i4i]

Hello. Had this procedure done. Septoplasty with microdebrider turbinate reduction. I am feeling I am getting in a lot of air. Will my body adapt it soon ???. Your answer would be helpful

[@zmpatel_md]

@user-er1tj4vh8u it is not really possible to know the answer to your question without looking inside your nose, as not every surgeon performs this in the same way.

[@gosman949]

I had septoplasty and tubinate reduction surgery about 14 years ago. I'm having trouble again breathing at night and my CPAP machine is now going up to 20 pressure! Do turbinates grow back and if so, is it a simpler procedure just to reduce the tubinates again?

[@zmpatel_md]

@gosman949 if you do not use a regular regimen of topical therapy to keep your turbinates at the new baseline they were brought to at your prior procedure, then they definitely can swell again. Nothing about surgery changes the underlying reason as to why the turbinates became enlarged to begin with - that's where ongoing topical medical therapy comes in. Revision surgery may be straightforward or more difficult, depending on how the surgeon performed the first one. It is typically not a simpler procedure to revise any type of surgery.

[@gosman949]

@@zmpatel_md thank you. This is exactly what my new ENT doc told me too. So we are watching my allergies and using a topical therapy. A nose scan was done to show that I have good nasal airflow.

[@eduardoramos7607]

Thank you for this valuable information. I had my septum surgery and turbinate reduction. How long is the average recovery time and the inflammation gone?

[@zmpatel_md]

In my hands I tell patients to expect a tough first week, and then continuous improvement until 4-6 weeks after surgery when they will be all healed up and feel like they are at their new baseline. But the time of healing really depends on the surgeon and surgical technique used.

[@aadityagahlot7347]

Plzz tell about ur recovery journey tell about

[@timcepin3386]

Does coblation destroy any of the mucosa lining of the nasal cavity?

[@zmpatel_md]

I do not commonly use coblation, so cannot speak from personal experience, but the FDA requires extensive testing to show safety and efficacy of any device before approving it's use in the US.

[@timcepin3386]

Thank you.

[@traciebarthel3319]

Thank you for the great explanation Dr. I will be having Fess, and a turbinate reduction in 2 weeks. The Dr said he will use packing that will have to stay in for 1 week, that was a bit concerning for me..I enjoy scuba diving and I wonder how long I will have to wait before I can safely do that again. Any thoughts?

[@zmpatel_md]

@traciebarthel3319 it would be impossible for me to say when another surgeon is performing the procedure, especially if they are using packing, as that is not my practice, but I can tell you that I let my own patients get back to doing all their normal activities after the first week. That would include scuba diving for my patients. Hope all goes well for you!

[@traciebarthel3319]

@@zmpatel_md I definitely understand that. Thanks for your response

[@s.f.2426]

Can the turbinates “grow back” after celon? What’s your opinion on wedge-shaped bone resection?

[@zmpatel_md]

Hi @s.f.2426 Yes, the turbinate tissue is dynamic. Meaning that if topical therapy is not continued to control inflammation, turbinates can again swell and become enlarged. This can happen with any type of reduction, however we do know that submucus resection technique has better longterm results than the ablation/cauterization type procedures, as long as patients continue on maintenance medications.

[@korit758]

@@zmpatel_md if the turbinates can grow back then what is the point of reducing it with surgery?

[@dougferguson2563]

Turbinate reduction is a scam. Don't let ENTs touch your nose unless your life depends on it.

[@zmpatel_md]

@@korit758 surgery can rapidly get a patient back to a much better baseline and therefore better nasal breathing. If, after that type of surgery, a patient keeps up with routine topical therapy (rinses and sprays) to maintain that baseline, the turbinates will likely not grow back to their prior size. It is only when patients stop using that topical therapy that inflammation can again run out of control and cause repeat swelling.

[@korit758]

​​@@zmpatel_md if the turbinates can grow back than your baseline theory is not correct. If the turbinates can grow back there is no baseline becuase the baseline line can be crossed (the turbinates can grow back). In my opinion, turbinate reducation surgery is not going to help no one. but what you said about nasal sprays and rinses could help some people. I cant rinse my nose or use nasal sprays because my nose is blocked 24/7, i can breath only from my mouth 24/7, so how would i use nasal sprays and rinses if my nose is always blocked? dip my head in the sea (salt water)?

[@faraz1231]

Excellent! Really appreciate some finer details... Also liked the responses to questions... I have a few questions... Do you routinely put anterior nasal packs for 24 hours? What is your preferred method of choices for turbinate reduction? Could you also do an endoscopic septoplasty to see how you do it? Should each and every deviated portion be removed? How to approach deviation high up near the dorsum of nose where removal might risk saddle nose/supratip depression? Some patients have enlarged middle turbinate... Almost touching septum... How do you approach that? Can it be addressed during septoplasty... I know a lot of questions but they were on my mind and I appreciated your way of explaining Thanks!

[@zmpatel_md]

@faraz1231 in response to your questions: I never use nasal packs. My preferred method of reduction is shown in the IT reduction video. The only video of septoplasty on my channel is endoscopic septoplasty - that's the only way I perform septoplasties. All obstructing portions of a deviated septum should be addressed. If the patients main deviations are in their dorsal or caudal portions, they should have an open septorhinoplasty to remove those deviations and then reconstruct the structural support in the midline. I do not do this procedure - I refer those patients to my facial plastics colleagues. Enlarged middle turbinates or concha bullosa can easily be addressed endoscopically - whether or not you are performing a septoplasty or any other surgery at that time. All my best.

[@faraz1231]

@@zmpatel_md thanks for the succinct responses

[@teglanigiro7187]

Hi Dr, How big of a role does the resection of the bone play in alleviating symptoms? I had a bilateral turbinate micro-debrider reduction and a S shaped septal deviation repair. My turbinate bones were not resected. I still face issues sleeping and during the day due to swollen turbinate. I have used corticosteroids (Flonase) to very little benefit. In your experience, are revision turbinate procedures common and helpful?

[@zmpatel_md]

@teglanigiro whether or not someone needs a revision turbinate reduction, and how much they would benefit from that, really depends on the method used for the first surgery and whether they have remained on routine topical therapy after the procedure. Soft tissue always has the ability to swell again in reaction to the environment if regular use of rinses and sprays are not utilized.

[@Laila-r4w]

I have had two turbinectomies (2012, 2014), and my right side has more resection than my left. However, i breathe normally through my right (no ens), but my inferior turbinate hypertrophy has started causing obstruction. Im afraid to go for a third turbinectomy with the ens risk, and the coblation treatment (2010) was of no use.. are there any other surgical procedures other than turbinectomy thats a recent discovery?

[@Ben-im2ev]

Look into nasomaxillary expansion! The most notable is EASE by Dr. Kasey Li

[@zmpatel_md]

There are dozens of different procedures available to patients with nasal obstruction, turbinate reduction is just one. To find out which you may or may not be a candidate for would require a visit to an ENT and a nasal endoscopy to thoroughly evaluate your nasal anatomy and mucosal quality. Good luck.

[@kanishkdudeja559]

Do you operate on international patients? I'm considering flying to the US to get this surgery done. I have test reports and a prescription from my local doctor here in India.

[@zmpatel_md]

@kanishkdudeja559 yes I often operate on international patients who travel to get an operation with me. This is the website for our International Medical Services who can help you with logistics and answer any questions you may have about getting that coordinated. stanfordhealthcare.org/for-patients-visitors/international-services.html All my best.

[@attamuhammadattamuhammad9953]

Hi, Aslam o alikum madam What is the proper treatment of nose sinuses and allergy.🌺🥀🌹For You.

[@zmpatel_md]

@attamuhammadattamuhammad9953 there are many different treatment options, and they depend on what each patient's anatomy and underlying disorder is. There is no one answer suitable for everyone. I would suggest seeing a rhinologist ( an ENT doctor specializing in the nose and sinuses) to get the best answer.

[@mikekaraoke]

Enjoyed this video, I had my Balloon Sinuplasty and Eustachian Balloon Dilatation which I had with anaesthetic with some sedation! Took me less than 48 hours to recover- I will then have Turbiate Reduction via local anaesthetic done with Celon in late Jan. My ENT also does KZbin videos and is very good at his job-he told me when he does Turbinate Reduction he only reducesthe left/right sides of each turbinates and doesn't touch the middle parts. + when he has done it has never given anyone ENS. Then later on in 2024 will have a septoplasty with my deviated septum and a spur on the left side. I will be having this all done for free as I'm from UK so will be on the NHS + will have that with local anaesthetic and with sedation if I wanted it👍🏻 BTW-you have a lovely smile 😀 If you don't see my post before Xmasm hope you have a good Xmas!

[@aryanchettri2251]

Have you already finished turbunite reduction?.

[@mikekaraoke]

@@aryanchettri2251 I did say in my post, having it done in late Jan!

[@gosman949]

@@mikekaraoke and how are you doing?