The statement says that a trial of medical therapy of more than four weeks is unnecessary to establish candidacy for surgery. In some cases, such as severe caudal septal deviation with complete obstruction, there’s no way that a nasal spray could get into the cavity, Dr. Lian said. In those cases, it seems unreasonable to have a month’s trial of medical management. But, some carriers ask for that. “If there are other elements in the history, such as allergic rhinitis, that are suggestive that they may respond to steroid nasal spray, and if it appears it’s able to be delivered, then a month is a reasonable time,” said Dr. Lian.
Explore This IssueNovember 2015
Perioperative Antibiotics and Turbinoplasty with Septoplasty
The statement says there is no benefit to administering antibiotics perioperatively unless nasal packing or a splint is placed during the procedure. Dr. Stringer noted that the literature suggests that antibiotics provide no benefit, even in cases with packing or splints, but the experts chose to make an exception in packing or splint cases. “There is a lot of belief in our specialty that splints and nasal packing are different,” said Dr. Stringer. Both he and Dr. Lian added that they very rarely use packing or splints anyway.
Dr. Stringer also advised that, even though insurers sometimes are hesitant to approve coverage for turbinoplasty in addition to septoplasty, the panelists “came to a consensus fairly rapidly” that the turbinates need to be addressed as well. “I think it’s important that we have that in there,” he said. “We’re not really treating the septum alone. We’re treating an airflow issue.”
Septoplasty and OSA
The statement says that septoplasty can improve continuous positive airway pressure (CPAP) tolerance for patients with obstructive sleep apnea (OSA) and a deviated septum, but does not say that septoplasty alone directly improves OSA.
The panel also emphasized the improved sensation of nasal airflow. “The perception is that when a patient lies down to sleep that they can then breathe unobstructed through their nose,” he said. “While it may not change their polysomnography, the patient’s happiness is improved.”
Thomas Collins is a freelance medical writer based in Florida.