Is Only Septoplasty Justified in Deviated Nasal Septum with Chronic Rhinosinusitis?

Introduction: Nasal septal deviation is a common condition and it alters the nasal cavity airflow dynamics which causes hypertrophy of sino-nasal mucosa. It leads to impaired mucociliary clearance, osteo-meatal complex obstruction and sinusitis. Aim: To compare the adequacy of septoplasty and Functional Endoscopic Sinus Surgery (FESS) done concomitantly and septoplasty alone in patients with Chronic Rhinosinusitis. Materials and Methods: Fifty patients of refractory Chronic Rhinosinusitis (CRS) with Deviated Nasal Septum (DNS) were included in the study. They were randomly divided into two groups of 25 each. First group (Group A) underwent septoplasty with FESS while the second group (Group B) underwent septoplasty alone. The results were analysed to find out the efficiency of each procedure when done independently and concomitantly. Results: At 6 months follow-up, in patients who underwent FESS and Septoplasty only 2 patients out of 25 had nasal obstruction giving 92% improvement while 3 out of 19 patients showed persistent nasal discharge showing an improvement of 84.22%. Post nasal drip was still present in 3 out of 14 patients giving an improvement of 78.58% patients. In Group B, 9 out of 25 patients still had nasal obstruction giving only 64% improvement whereas 13 out of 17 had nasal discharge showing 23.53% relief. Post nasal drip was present in 8 out of 13 giving an improvement of only 38.47% patients. Postoperative Contrast Enhanced Computer Tomography (CECT) PNS demonstrated the midline position of the nasal septum in patients of both groups in unilateral or bilateral disease. In Group A, Osteo-Meatal Complex (OMC) Obstruction reduced from 14 to 3 patients in unilateral disease and from 11 to 2 in bilateral disease. Mucosal hypertrophy reduced from 7 to 2 and 6 to 1 patients in unilateral and bilateral disease respectively. Polypoidal-sinonasal mucosa decreased from 4 to 1 in unilateral disease and is not seen in any of the 6 patients in bilateral disease. There was less improvement in Group B for same parameters than Group A. Conclusion: Though both groups reported improvement in symptoms as compared to pre-operative state, it was more in group which underwent FESS with septoplasty rather than septoplasty alone. In deviated nasal septum with features of chronic rhinosinusitis, septoplasty alone is inadequate, therefore FESS must be concomitantly done with septoplasty.