What causes difficulty in breathing after a septoplasty?

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Posted on Sat, 6 Jun 2015 in Ear, Nose and Throat Problems
Question: hi....I am a 40 year old male. I had a septoplasty and bilateral inferior turbinate reduction 3 weeks ago.
I still cant breathe properly through my nose.i probably can about 25 percent. I still have a feeling of dryness, stuffiness/congestion.
Before the operation my right nostril was worse but since the operation my left nostril feels more narrower and more congested.
Pre-op the deviation was more towards the right nostril.
My own doctor checked the nose and said that there is not much swelling now but i feel there is alot of swelling and discomfort when breathing.
I was using Neilmed Sinus Rinse so i think most of the blood and debris have cleared. However, I still have alot of dry green mucus coming out of my nose and green wet mucus from my throat.I dont know if this is an infection at the wrong time or the green mucus is just due to my allergy to house dust mites etc? I hardly get a runny nose but when i blow my nose when using the sinus rinse then some wet and dried up mucus comes out.
Due to the allergy i started using Fluticasone Propionate Nasal Spray about a week ago but it has not helped but probably a little. So i have started using Nasonex ( Mometasone Furoate ) since today so i dont know if this is going to work or not? Could you please tell me what do you think about the dryness and congestion which is worse in the left nostril 3 weeks post surgery and also wether i can continue with the steroid spray because it has been 3 weeks since the surgery?
Also doctor has prescribed me Flucloxacillin 500mg × 28 tablets 4 times a day on my insistence. Can i take these or should i hold back for a few days?
Also , from your experience how long will it take for me to see a significant improvement in my breathing , for the swelling and dryness to go away and for the cilia,mucus glands etc to start functioning properly? I have taken fexofenadine, cetirizine and desloratadine from time to time and they do help a little but not for the congestion. Also , Pseudephedrine via oral administration and Xylometazoline Spray when taken occasionally does not help much only a little perhaps 10 to 20 percent . Also , I havent slept a single night for the last 2 months and the doctors dont prescribe me sleeping tablets on a temporary basis.
I look forward to your reply in detail .
Thank you.
doctor
Answered by Dr. Sumit Bhatti 29 minutes later
Brief Answer:
Give 4-6 weeks for immediate healing.

Detailed Answer:
Hi,

Thank you for your query.

1. It is a bit surprising to know that you have undergone septoplasty and bilateral inferior turbinate reduction when a few weeks ago, your nasal endoscopy showed evidence of atrophic rhinitis.

2. Did you undergo a Sinus CT before the procedure? If yes, upload the images.

3. These surgeries are usually not done in atrophic rhinitis, so did you have a pre-op discussion with your surgeon as to the rationale behind the procedure? Do you have access to the operative notes? If yes, upload the intra-op findings.

4. Right now, wait for 4-6 weeks and re-assess. Alkaline, hypertonic nasal washes seem to be the best option for you at present.

5. If this problem persists, get a post-op Sinus CT Scan done. Upload the image.

6. Avoid the steroid nasal sprays for a few weeks since you have a very long history of their use. Avoid Flucloxacillin. Get the mucus examined and cultured.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 1 hour later
I had surgery after meeting 3 different ENT Surgeons.All of them agreed that i needed Septo Plus Turbinectomy.I had my surgery in Pakistan becsuse in the UK the waiting time is 3 to 4 months and private surgery in the UK for Septo and Turbinectomy would cost 5,300 pounds.My 3 cousins have had similar surgery done by the same surgeon n it has been a success for them.
Also ,the surgeon said a CT Scan was not required becsuse i was having no sinus pressure, no excess mucus etc......
Could you please tell me wether The isotonic solution will not be enough to get rid of my green dried mucus?
Also , could you please tell me wether 3 weeks down the line is normal for me to be having stuffiness, congestion and dryness?
Would you also tell me if sometimes it can takw longer than 6 to 8 weeks for the nose to function properly and wether i should be worried?
Also, i have slight discoloration and light bruising on the outside of my nose? How can i speed up the healing of the bruising by applying heat, eating bromelain or what would you suggest?
When i use the Neilmed Sinuse Rinse then the nose feels slightly better but this feeling only lasts about 30 minutes or so before i start feeling pressure ?
doctor
Answered by Dr. Sumit Bhatti 9 hours later
Brief Answer:
Post operative care is discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. An isotonic solution is fine, but you can take a trial with hypertonic solution.

2. Yes, it is normal to get nasal stuffiness, congestion, dryness, crusts, scabs, nasal discharge (sometimes blood stained) for 4 to 6 weeks after the nasal surgery.

3. Full internal healing may take 4 to 6 months and more for the nose to start functioning properly. Usually the nose is not operated upon for at least 1-2 years.

4. The discoloration and bruising on the nose will disappear in a few weeks even without any treatment. You may apply thrombolytic cream carefully.

5. The nasal rinse should continue. Bring this to the attention of your doctor. He can do a check nasal endoscopy and look for the reason for the stuffiness and pressure.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 1 hour later
Also , could you please tell me if i can continue with the mometasone furoate nasal spray? I only started using it yesterday and i definitely need to control my Allergic Rhinitis orelse i will get nasal swelling, rinnorhea, watery eyes etc in addition to post op swelling .
I have fexofenadine , Cetirizine and Montelukast .Should i try any one of these? I keep thinking that the antihistamines will dry up my mucus and my nasal mucosa even more.How possible is this sir?
As i mentioned previously that i tried Fluticasone Propionate for 7 days but had no benefit at all.If u agree i can continue with Mometasone Furoate then would you advise me how long i should take it before discontinuing if it has no or minimal benefit?
Is it possible that non of these INCS will not work because the nose has not regenerated etc or is this medically incorrect?
I have acute asthma also and i am taking Beclomethasone Dipropionate inhaler and Salbutamol? Would Montelukast be a good temporary choice for both ie Asthma and Allergic Rhinitis and would the Montelukast and some of the Antihistamines help the nasal congestion?As far as i know sir they are not effective for nasal congestion.
Thank you and i look forward to your reply.
doctor
Answered by Dr. Sumit Bhatti 5 hours later
Brief Answer:
Details are discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Mometasone nasal spray can be safely used after the first few days after nasal surgery.

2. You can use fexofenadine or cetirizine with monelukast. Anti-histamines do cause dryness. You can counter that with mucolytics and nasal washes.

3. The steroid nasal sprays require at least a week of continuous use to show their full benefit.

4. INCS will help, irrespective of the condition of the mucosa.

5. Montelukast will be beneficial in allergic rhinitis as well as asthma. However you should take medication only under medical supervision.

6. Nasal decongestants. steam inhalation, nasal rinses will help relieve congestion. I would like to review Sinus CT images to check what the current situation is. I usually get a pre and post decongestion Sinus CT done.First a plain Sinus CT is done. Then the nose is decongested using 5-8 drops of 0.1% Xylometazoline drops in each nostril. After waiting for 15 minutes, another Sinus CT is done and the images compared keeping in mind the symptomatic improvement.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 42 minutes later
I appreciate greatly for your valued advice.
May you please also tell me why my left nostril feels more congested ? Before the operation my right nostril was worse because the septum had deviated more towards the right .Now my left nostril is worse. Sometimes it feels there is some bone,skin ,mucus or sonething else stuck in there.Can it just be some swelling in the left nostril or are the above all possibilities?
That unilateral problem with the left nostril is causing me the most concern- more than the congestion or the dryness.From your experience sir is it highly likely it will just be more post op swelling/pressure in the left nostril than some complixation of surgery? Is it possible that bone,cartilage etc might have moved to the left anteriorly/posteriorly after the operation or is this medically highly unlikely or almost impossible? I understand you will be answering these questions without visibily looking at me but i am still asking you these questions thinking that you have the expertise and the experience in the field sir.
I conclude by asking how long should i give this swelling/congestion and healing phase before i start to get extremely worried and see an ENT Specialist ?
Also, could you please tell me how successful in general Septoplasty and Turbinectomy surgeries are?
Once again, i thank you for your expert advice and pray that you have a healthy and fruitful life sir.
doctor
Answered by Dr. Sumit Bhatti 17 hours later
Brief Answer:
This is common and will settle down in a few weeks.

Detailed Answer:
Hi,

Thank you for writing back.

1. It is common for the other nostril to feel constricted after a septal surgery since you were used to the left side being more open. This should settle down after a few weeks.

2. You should let this settle for a few more weeks and the reassess the situation.

3. There can be many reasons. The best way is to get the nose examine, get a nasal endoscopy and if it persists a Sinus CT.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2574 Questions

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