April 07, 2019

If I Have Bad Allergies, Can I Benefit from Nasal Obstruction Surgery (Septoplasty, Turbinate Reduction)?

Normal Septum without Mucosal Swelling
Allergies are very common and is well known to contribute to nasal obstruction. A deviated septum and turbinate hypertrophy are also common anatomic reasons for nasal obstruction as well. As such, it is also not uncommon that patients suffering from bad allergies also have nasal anatomic reasons for nasal obstruction.

The quandary is whether surgical intervention to resolve nasal obstruction will actually work if the same patient also has bad allergies.

The answer is YES... with a big BUT.

• Such patients must understand that surgery will NOT cure allergies and that allergy management will still need to occur even after surgical intervention.

• Nasal obstruction may STILL occur if allergies flare up during a particularly bad pollen season or with extensive animal exposure to pets you are allergic to.

• The perceived benefit after nasal surgery from patients with very bad allergies will not be as significant compared to patients with only mild allergies.

• Finally, overall allergy symptoms may paradoxically become worse in some ways after surgery than before. Why? Because pollen and other antigens can more easily enter the nose when nasal obstruction has been alleviated.

That said, the benefit of having nasal surgery even with bad allergies are that the nasal obstruction and congestion symptoms typically are not as bad and that allergy attacks have to be more severe in order to cause equivalent significant sino-nasal symptoms.

The reason is because after nasal surgery, there is more "space" for allergy-triggered swelling to occur before nasal obstruction happens. Take a look at what happens after a septoplasty in the images below. The blue arrow points to a deviated septum in the first image, whereas the septum is straight in the second image.


Compared to the normal septum without mucosal swelling shown at the very top... allergy-triggered mucosal swelling will certainly cause some degree of nasal obstruction and congestion even after surgery as shown in the second image above. However, in the setting of a deviated septum, the nasal obstruction and congestion will be more severe as shown in the first image above.

Same is true after turbinate reduction... Allergies will still cause the turbinate mucosa to swell... but will not occur as severely after surgical reduction.

Reference:
A Prospective Study of Outcomes of Septoplasty with Turbinate Reductions in Patients with Allergic Rhinitis. Otolaryngol Head Neck Surg. 2019 Mar 26:194599819838761. doi: 10.1177/0194599819838761. [Epub ahead of print]


Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. He is also the chief medical officer of O2Labz, a medical and scientific 3D animation company.

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