Septoplasty: Long-Term Evaluation of Results
Paulo Borges Dinis, MD and Haula Haider, MD
Objective: The goal of this study was to ascertain how accurately the surgeons’ selection
criteria for septoplasty, which largely relies on clinical judgement alone, is able to anticipate
patients’ long-term satisfaction.
Study Design and Setting: A 10-year retrospective study was undertaken in a tertiary care
Methods: All patients who underwent septoplasty at the same otorhinolaryngology depart-
ment in the past 2to 10 years were mailed a questionnaire to evaluate their perception of the
procedure’s results. Clinical ﬁles were reviewed to establish the initial type of septal
deformity. Because some surgeons used rhinomanometry to support their decision to
recommend surgery, its capability of predicting patients’ satisfaction was simultaneously
Results: Subjects with anterior septal deformities were shown to beneﬁt the most from
septoplasty. Selection of patients on clinical grounds alone does carry, however, a consid-
erable risk of patient dissatisfaction with end results. Nevertheless, despite a very strong
correlation between anterior septal deviations and increased nasal resistance, preoperative
rhinomanometry data failed to prove useful in predicting the long-term surgical outcome.
Conclusions: Surgeons’ appreciation of the types of septal deviation that do beneﬁt from
surgical correction falls short of desirable. Patients’ satisfaction, however, did not improve
if rhinomanometry was included in the preoperative evaluation.
(Am J Otolaryngol 2002;23:85-90. Copyright 2002, Elsevier Science (USA). All rights re-
A straight nasal septum is not a common
ﬁnding in adults.
It is estimated that as many
as 75% to 80% of individuals exhibit some
type of anatomic deformity of the nose.
cause nasal obstruction is probably the most
often encountered chronic complaint in rhi-
nologic practice, the clinician is frequently
confronted with the issue of whether the sep-
tal deformities detected on physical examina-
tion are actually the cause of the patients’
symptoms. In many cases, the answer is not so
straightforward as it may seem.
An extremely deviated septum that com-
pletely obstructs a nasal passage undoubtedly
requires surgery. However, with less pro-
nounced deformities, which are the most fre-
quent, surgeons are often left to trust their
subjective assessment of the degree of obstruc-
tion to make therapeutic decisions that ulti-
mately involve surgery. Thus, variation and
error are inevitable. Surgeons’ experience may
aid in reducing the margin of inaccuracy, but
it is unrealistic to expect similar degrees of
expertise from all otorhinolaryngology clini-
cians. From a scientiﬁc and legal point of
view, this practice may prove unsatisfactory.
It is, therefore, not surprising that some
investigators criticize the number of unneces-
sary septoplasties performed each year world-
The importance of a thorough preop
erative evaluation has been stressed, because
other causes of nasal obstruction (such as
chronic rhinitis and rhinosinusitis) are fre-
quently concomitant and tend to be over-
looked when the surgeon’s attention is imme-
diately drawn to an obviously deviated
septum. However, few authorities agree on
which objective diagnostic means can be
trusted to determine whether or not septal de-
formities affect nasal function. Imaging, albeit
extremely useful in showing concurrent sino-
nasal pathology, fails to assess the degree of
airway dysfunction that a septal deviation
Likewise, both acoustic rhinom
etry and rhinomanometry have not yet proven
to be diagnostically useful in this area, despite
enthusiasm from some academic centers.
The purpose of the present investigation is
twofold. Firstly, we evaluate the accuracy of
From the Department of Otorhinolaryngology, Hospi-
tal de Pulido Valente, Lisbon, Portugal.
Address reprint requests to P. Borges Dinis, MD,
Otorhinolaryngology Department, Hospital de Pulido
Valente, Alameda das Linhas de Torres 117, 1769-001
Copyright 2002, Elsevier Science (USA). All rights reserved.
85American Journal of Otolaryngology, Vol 23, No 2 (March-April), 2002: pp 85-90