Post-operative nocturnal hypoxia in septoplasty: the value of nasal packing with airway tubes

Middle ear pressure after septoplasty

OBJECTIVES

The aim of this study was to determine the level of middle ear pressure and alterations in middle ear pressure levels after septoplasty among the individuals having advanced degree isolated nasal septal deviation.

METHODS

A prospective randomized study was conducted. The study included 72 adult patients who had severely deviated septum. The middle ear pressure values at both sides of nasal obstruction and opposite side were determined using tympanometry before the surgery and at postoperative week 3. The middle ear pressure values were divided into 2 groups, side of nasal obstruction (group 1) and opposite nonaffected side (group 2). The middle ear pressure values obtained before and after septoplasty were compared.

RESULTS

Before the septoplasty, the median middle ear pressure value was -54 dPa at the side of nasal obstruction, and -46 dPa at the opposite side. Three weeks after the septoplasty, it was -38 dPa at the side of nasal obstruction, and -40 dPa at the opposite side. The middle ear pressure improved by approximately 30% at the side of nasal obstruction and by 11% at the nonaffected side; a statistically significant decrease was found at the side of nasal obstruction (P < 0.05).

CONCLUSIONS

In adult patients with isolated nasal septum deviation, the middle ear pressure is lower at the side of nasal obstruction, but it remains within reference ranges. An approximately 30% improvement occurs in the middle ear pressure after septoplasty.

Sleep, breathing and the nose

During sleep there is a discrete fall in minute ventilation and an associated increase in upper airway resistance. In normal subjects, the nasal part of the upper airway contributes only little to the elevation of the total resistance, which is mainly the consequence of pharyngeal narrowing. Yet, swelling of the nasal mucosa due to congestion of the submucosal capacitance vessels may significantly affect nasal airflow. In many healthy subjects an alternating pattern of congestion and decongestion of the nasal passages is observed. Some individuals demonstrate congestion of the ipsilateral half of the nasal cavity when lying down on the side. Nasal diseases, including structural anomalies and various forms of rhinitis, tend to increase nasal resistance, which typically impairs breathing via the nasal route in recumbency and during sleep. A role of nasal obstruction in the pathogenesis of sleep-disordered breathing has been implicated by many authors. While it proves difficult to show a relationship between the degree of nasal obstruction and the number of disturbed breathing events, the presence of nasal obstruction will most likely have an impact on the severity of sleep-disordered breathing. Identification of nasal obstruction is important in the diagnostic work-up of patients suffering from snoring and sleep apnea.

Evaluation of Time of Nasal Packing After Nasal Surgery: A Randomized Trial

A randomized, prospective trial was carried out to compare the rate of hemorrhagic complications after removal of nasal packing left for 24 and 48 hours. A total of 104 patients underwent nasal surgery and were randomly assigned to 1 of 2 groups: group 1, 24 hours of nasal packing; group 2, 48 hours of nasal packing. No statistical difference was observed between the groups in terms of occurrence of hemorrhagic complications. Hypertension was the only prognostic factor for postoperative bleeding. The routine use of 48-hour postoperative nasal packing after nasal surgery is not justified because of the low incidence of bleeding and the potential associated morbidity. At the end of the procedure, surgeons should evaluate the risk of postoperative bleeding (ie, presence of hypertension) and decide whether 24-hour nasal packing is enough.