I have been told by a consultant that I have a deviated septum. I do not have trouble breathing through that nostril all the time, but I have been told I need a submucous resection. Is there any laser treatment available to correct this, or alternative treatment that does not require a general anesthetic? I have never been in hospital and I don't fancy the option of full surgery.

P.

If you can breathe intermittently through both nostrils, then you probably do not need a septoplasty or submucous resection. We've previously discussed septums and septoplasties. Septoplasty is an operation in which the shape and position of the septum is altered. Submucous resection, or SMR, is a somewhat more radical operation. The septum is a sandwich: In the middle is cartilage and bone, and for "bread," there is a layer of mucosa on either side. In an SMR, portions of the cartilage and bone are removed -- sometimes very large portions -- and the mucosal layers are then allowed to heal against each other.

To answer your primary question, you do not necessarily need a general anesthetic to have an SMR. This operation can be done under local anesthesia. If you discuss your concerns with your doctor, he may be willing to accommodate your wishes.

A better (and more controversial) question is whether SMR is even necessary. Obviously, unlike your doctor, I have not examined your nose. But I feel compelled to repeat: If you can occasionally breathe through the "problem side," there is a very real possibility that your septum, while deviated, is not the main problem.

What else could be the problem? The turbinates. Your nose is a busy place (so's mine, too, now that I think about it), and there's more in there than just your septum. On the sides opposite the septum are the turbinates. Of particular relevance to your nasal airway are the inferior turbinates. Turbinates are sausage-shaped structures that have a bony core and a mucosal "jacket." This mucosa is very special, and is a good deal different from the mucosa that lines your septum. This mucosa is erectile tissue, not too dissimilar to the tissue inside a penis. I'm not kidding. If you think about it, you will quickly grasp that this must be true; otherwise, how could your nasal airway close so rapidly in response to dusts, pollens, irritating fumes and so forth?

Turbinates are extremely important. They humidify, warm and filter the air that you breathe, preparing this air so that it is suitable for your lungs. You can live without turbinates, but not happily. Severe crusting, dryness and a paradoxical sensation of congestion may result from overaggressive reduction of the turbinates.

So you can't take them out, but you can alter them in other ways to enlarge the nasal airway. There are a variety of procedures for altering turbinate shape (turbinatoplasty). Some procedures are office-based, while others must be performed in the operating room under anesthesia. You may want to discuss these operations with your ear, nose and throat doctor (ENT).

All of this assumes that surgery is even necessary. Have you exhausted all possible nonsurgical treatments? Without seeing you as a patient, I cannot make any specific recommendation in this regard. However, there are many nonsurgical methods for improving the nasal airway. Whether any of these treatments are appropriate for you depends on the nature of your nasal airway obstruction. That's beyond the scope of this article, and so you will just have to take this up with your ENT.