question-icon

What Causes Pulsing Sensation In The Nose After A Septoplasty Procedure?

default
Posted on Wed, 26 Apr 2017
Question: Original problem:
I had a septoplasty with bilateral inferior turbinectomy in Oct'15 (bony spur on left gauged out too).
Prior to surgery, I had a tight pressing strain in the front of head for a month (sudden onset after a 12 hour travel), and stabbing dull pain at the tip of nose and eye bridge.
Post Surgery both of these pain disappeared slowly over 2 to 3 months. Specifically, over a period of 2-3 weeks the pain in the front head went from pressing pain to general warm sense to completely normal.
Meanwhile the right nostril was regularly getting irritated. From time to time it would seems like a rolling fold is crawling down inside, causing substantial pain. There was also a constant general dull pain in the nose. Any irritation from polluted air would completely shut the right nostril in an instant.
I also had numbness in the front right tooth.

Current situation:
Its been 1.5 years now since surgery, Apr'17. The situation as of now is that I have this constant pulsing feeling in the nose (only the right nostril ofcourse), general strain and pulsing in the sides of the head all the way back down to the neck. There is general strain behind the eye sockets too. From time to time the pain in the upper right nostril is quite noticeable. The pulsing feeling gives me a almost subtle rocking feeling, makes it hard to focus on work while on it.

The numbness in the right tooth has went away slowly, although its still identifiable if we press it.
There is also frequent instances of fasciculation, which were not present before surgery. Its all over the body, head, back and hands.
The septum has deviated back to the right, worse then before in my opinion.

My CT scan report says that both middle turbinate show paradoxical curvature posteriorly. Deviation of septum is seen towards right. Minimal soft tissue thickening is seen in right sphenoid sinus suggesting sinusitis. The brain and pranasal sinuses MRI gave no new information.
I have been to a number of ENT's but they don't seem to be bothered about the septum deviation (although i think is worst than what it was before the surgery, I'm breathing from the left nostril some 70% of times), also sinuses seems clear to them.

I do not have any problem in holding up normal conversation, but the above symptoms come out in full force when i focus on my work (mathematics/software), or say reading up a name plate on a moving object, anything where i have to focus intensely would start the pulsing feeling and strain more intensely.

Miscellaneous/Transition from original to current situation:
This is just to explain the timeline of symptom evolution, in case this could give you more information. As a general rule, the symptoms have gone from more potent to more benign. After surgery it was quite easy to get dizzy by sudden movement, e.g. opening a door in a hurry.

There were a few weeks(6 months post surgery) where the pulsing feeling (right after waking up from a nap on a desk) would be all over the body, including the legs, which would make it seem indistinguishable from an earthquake experience.
There was a week or two when bending down to pick something up would give me a shooting pain on the sides of the head.
Right after surgery the fasciculation were also present above the eyelids.

Final request: I think there is a strong cause and effect scenario here. Post surgery symptoms were not there at all before surgery. I have read that the tooth numbness is quite explainable, and have read the cause of it. Could you please help me out with diagnosing the problem. I would not mind going for a corrective surgery, if there is a clear reason for it (perhaps with the guidance of both ENT and neurosurgeon). It's not possible to ignore the situation as it is now, as it negatively interferes with my work.

doctor
Answered by Dr. Priyanka Aggarwal (49 minutes later)
Brief Answer:
Post septoplasty

Detailed Answer:
Hi
Welcome to HealthcareMagic and thanks for putting up the query
I have read your whole history.

Any deviation seen after a septoplasty is either a left over deviation or an uncorrected one. Any septal deviation can be treated only surgically.

As you have said that you have undergone turbinectomy, please let me know that whether it is turbinectomy i.e. removal of inferior turbinates or turbinoplasty i.e. reduction because removal is usually not done now says and it is followed by complications like dryness of nose I.e feeling of nasal blockage or sometimes pain.

Pain behind the eyes is probably because of sphenoid sinusitis as you said you have it. The eye pressure and headache is explainable with that but still get you refraction done to rule out any eye strain.

The tooth paraesthesis are a common outcome of nasal surgery because sometimes the nerves get anaesthetised. This may take even few months to disappear may be not completely resolved.

The dizziness or imbalance is not related to nasal disease. it can be due to ear problem or neurological. You have to consult a neurologist if no ear complaints are there.

Please send me your CT SCAN films both pre and post operative pictures so that I can suggest you better.

In my opinion, you may need another surgery but best would be if you can send me CT reports. You can simply upload them at the reports section of this web page.

Any further questions are always welcome.
Take care
Thanks and regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Priyanka Aggarwal (3 days later)
Thank you very much for your reply doctor. I tried to arrange for the CT scans, but its not possible right now as i'm in different location. I would get the latest CT scan soft copy in a week, but pre-surgery CT scan cant be found.

I will just write the pre-surgery report card of the surgeon , so that you can have some idea about it:

Diagnosis:
DNS RIGHT/ITH/CB LEFT
Septoplasty, Excision of Cocha Bullosa Left, Reduction of IT, laser assisted, under GA
Operative findings:
Gross ANT DNS RIGHT, Bony spur on left
ITH Bilateral
CB Left
Steps of Surgery:
1. Left septal incision made, flaps elevated, bony spur on left gouged out, right ward deviation removed, septum brought to midline
2. Bilateral inferior turbinates reduced with ANT laser incision followed by submucosal removal of ANT 1/3 of IT MTONE
3. Medial incision made left MT bone- ANT half of CB excised

I do not have the diziness and imbalance feeling to the extent that it was right after the surgery, but as i said the pulsing in nose (right nostril) and head (side and back) gives me a almost subtle rocking feeling. It seems related to the nasal area (right nostril has healed abnormally, there is general strain, mild pain and pulsing there) perhaps nerves in that area, and the affect that the surgery had on them. If so, is there any way to definitively diagnose it.

I have had eyes tested, there was no issue there. Ear seems fine too.

I would upload the latest ct scan and endoscopy later on, and would get back to you again. Thanks again for your help.
doctor
Answered by Dr. Priyanka Aggarwal (19 minutes later)
Brief Answer:
Post septoplasty

Detailed Answer:
Hi
Thanks for the information.
Your operative findings say septal deviation was corrected and turbinoplasty was done.
as you have symptoms on right side it can be due to synaechie formation I.e during healing it is very common that mucosal healing forms tags between lateral wall of nose and septum. These occur very commonly and these need to be cut under local anaesthesia. I would advise you to send me your post operative reports either CT or endoscopy. That can help me to diagnose and advise you better.
For the time being you continue using nasal spray twice daily.
Also do nasal douching.
Any further questions are always welcome.
Take care
Regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
Dr.
Dr. Priyanka Aggarwal

ENT Specialist

Practicing since :2008

Answered : 1389 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

152 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
What Causes Pulsing Sensation In The Nose After A Septoplasty Procedure?

Brief Answer: Post septoplasty Detailed Answer: Hi Welcome to HealthcareMagic and thanks for putting up the query I have read your whole history. Any deviation seen after a septoplasty is either a left over deviation or an uncorrected one. Any septal deviation can be treated only surgically. As you have said that you have undergone turbinectomy, please let me know that whether it is turbinectomy i.e. removal of inferior turbinates or turbinoplasty i.e. reduction because removal is usually not done now says and it is followed by complications like dryness of nose I.e feeling of nasal blockage or sometimes pain. Pain behind the eyes is probably because of sphenoid sinusitis as you said you have it. The eye pressure and headache is explainable with that but still get you refraction done to rule out any eye strain. The tooth paraesthesis are a common outcome of nasal surgery because sometimes the nerves get anaesthetised. This may take even few months to disappear may be not completely resolved. The dizziness or imbalance is not related to nasal disease. it can be due to ear problem or neurological. You have to consult a neurologist if no ear complaints are there. Please send me your CT SCAN films both pre and post operative pictures so that I can suggest you better. In my opinion, you may need another surgery but best would be if you can send me CT reports. You can simply upload them at the reports section of this web page. Any further questions are always welcome. Take care Thanks and regards