I have a deviated septum and allergies, and it is sometimes hard for me to breathe. Would an operation actually help?

L.A.C.

First, let me assume that you CAN breathe through your nose perfectly well from time to time. This may seem painfully obvious, but it's actually an extremely important point. If you have problems only from time to time, this tells me that your anatomy is probably fine, or at the very least, it is NOT the primary problem. Consequently, while surgery may improve your nasal airway (by changing your anatomy), it is probably not necessary. Instead, your doctor needs to ask the question, "Why is it that my patient's nasal airway is, on occasion, obstructed?" Allergies are one of many possible explanations. (A few other possibilities are bacterial infection of the nose, sinus infection and chemical sensitivity.) Your doctor needs to determine the cause of the recurrent inflammation and treat it accordingly.
Nasal airway surgery is indicated whenever there is an anatomic abnormality (such as a deviated septum) causing nasal airway obstruction that is present all of the time, or very nearly all of the time. The septum is the structure that divides your nasal cavity into a left and right compartment. It is made of cartilage and bone sandwiched between two layers of soft tissue. Septal deviation occurs when the septum has shifted from the midline. Birth trauma, a broken nose or even simple growth changes can lead to a deviated septum. The operation to correct a deviated septum, known as septoplasty, involves movement of all septal components back to the midline.

Turbinate hypertrophy can also contribute to nasal airway obstruction. Turbinates are sausage-shaped structures on the side wall of each nasal cavity. Turbinates warm, humidify and filter the air we breathe. These structures may become abnormally enlarged (hypertrophic) and obstruct the nasal airway. Turbinate hypertrophy can occur due to chronic bacterial infection or chronic allergies. It may also occur if septal deviation makes one nasal cavity much larger than the other. A turbinate in the larger nasal cavity will typically grow much larger than a turbinate in the smaller nasal cavity. Because the turbinates perform a necessary function, they cannot simply be removed. Many different operations have been devised to make the turbinates smaller. The general term for such an operation is turbinatoplasty.

Quite frequently, septoplasty and turbinatoplasty are performed together in order to get the best possible nasal airway. This may be done under local anesthesia but is more commonly performed under general anesthesia. All incisions are within the nose, so there are no facial scars from this procedure. It is a "same-day" surgery, and the recovery time is typically three to seven days. (It may take one month or more for the tissues within the nasal cavity to heal, but you should be able to return to nonstrenuous work within a week.)

If you have nasal airway obstruction due to septal deviation AND allergies, one conservative approach would be for your doctor to treat your allergies first, and then consider performing a septoplasty only if you continue to have significant nasal airway obstruction. If your doctor takes the opposite approach (ignores the allergies and straightens the septum) you may be very disappointed with the results. Swollen nasal tissues (from allergy) can obstruct a nose very easily -- whether the septum is straight as a carrot or crooked as an elbow macaroni.