20 June 2019

Surgery to straighten a deviated nasal septum, also known as septoplasty, is worthwhile. Patients with a deviated (crooked) septum breathe more easily after this operation and their quality of life improves. The effects of this procedure have never been systematically investigated. Specialists have long debated its benefits. But now, researchers at Radboudumc have ended the controversy on 18 June with a publication in The Lancet.

The septum divides the nose into two halves. If the septum is deviated, various complaints can occur, such as chronic nasal obstruction, difficulty in breathing, or snoring. These complaints are so common that septoplasty is the most frequently performed ENT operation in adults. However, the effectiveness of this treatment has never been systematically investigated with a control group. As a result, the benefits of septoplasty have long been debated amongst healthcare professionals and policy makers. In England, the discussion even led to restrictions for the reimbursement of this procedure.
Weak evidence without control group
Radboudumc researchers Machteld van Egmond, Maroeska Rovers, and Niels van Heerbeek are the first to compare the outcomes of two groups of patients following different treatment strategies: septoplasty and non-surgical management, that is medication or watchful waiting. Machteld van Egmond, lead researcher for the project: “This procedure has been performed for many years, but in previous studies only surgical patients were assessed. Without a control group, you never know whether an observed improvement is actually the result of the intervention, or due to other factors, such as the natural course of the condition.”
Two-year follow-up
The researchers investigated the effect of septoplasty in more than 200 adults with nasal obstruction and a deviated septum. The study was performed in two academic medical centers and 16 secondary referral hospitals in the Netherlands. Half of the patients underwent septoplasty (surgical group), and the other half non-surgical management (control group). The researchers then measured the effects of both treatment strategies on patients’ quality of life and airflow through the nose. These measurements were performed at 3, 6, 12, and 24 months after the start of the treatment.
Breathing more easily
The quality of life of the surgical group had already improved at three months. They experienced fewer limitations in daily life due to nasal problems. Nasal airflow also increased after the operation. This positive effect was still present after two years. The patients had fewer nasal symptoms, fewer colds, breathed more easily, and slept better. All the effects were largest at six months after the operation, but persisted until the end of the study.

Publication in Lancet
Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial
Machteld M H T van Egmond, Maroeska M Rovers, Gerjon Hannink, Carine T M Hendriks, Niels van Heerbeek

Machteld van Egmond and Niels van Heerbeek are members of theme Reconstructive and regenerative medicineMaroeska Rovers is member of theme Urological cancers.

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