Introduction

Nasal obstruction is a prevalent condition that can have a substantial impact on an individual’s daily activities and overall health. According to1, nasal obstruction is frequently attributed to a deviated septum, which may or may not be accompanied by hypertrophic inferior turbinates. Individuals experiencing difficulty in nasal breathing may find relief through a medical intervention known as nasal septoplasty and inferior turbinate reduction2. The implementation of these techniques may lead to an enhancement in the nasal airflow. Apart from its principal objective, septoplasty can also enhance the functionality and availability of the paranasal sinuses.

Septoplasty, a surgical procedure to correct a deviated nasal septum, is becoming increasingly common. As per the findings of 3, inferior turbinectomy, the removal of a section of tissue in the lower part of the nose to alleviate breathing difficulties caused by enlarged turbinates, can also be performed concurrently with septoplasty. Both procedures have proved effective in improving nasal breathing and quality of life for patients with chronic nasal obstruction4. However, undergoing any surgery should never be taken lightly. Recovery time and potential complications can vary for both procedures and should be carefully discussed with a qualified healthcare provider prior to undergoing surgery. He5 found that it is important to understand the risks associated with each procedure before making an informed decision that considers both medical needs and personal preferences.

Despite the extensive history of septoplasty as a medical operation, there are varying perspectives about the precise diagnosis and treatment of nasal obstruction caused by a deviated septum and enlarged turbinate. According to6, the effectiveness of nasal endoscopy, imaging, photo documentation, and acoustic rhinometry/rhinomanometry in diagnosing nasal blockage is still unclear. In their research, He7 emphasised that insurance companies are imposing strict standards as a prerequisite for approving reimbursement for septal surgery. Nonetheless, the existing literature lacks sufficient empirical evidence to substantiate these stipulations. He8 found that there is a lack of conclusive evidence to support the efficacy of this particular therapy for the patient. The primary aims of this research are to facilitate the implementation of effective management strategies, minimise instances of non-standard care practises, and enhance healthcare providers’ understanding of the treatment of nasal obstruction by septoplasty, either with or without inferior turbinate reduction.

The Surgical Options for Nasal Obstruction

Chronic nasal obstruction can significantly affect the quality of life of those affected. He9 mentioned in their study that medical advancements have enabled the development of prospective therapeutic alternatives, such as septoplasty combined with inferior turbinectomy (SIT). This procedure is performed to enhance nasal ventilation by repositioning the septum and removing part of the inferior turbinates. According to scientific research, SIT is a highly efficient treatment for chronic nasal obstruction. He10 determined that “Septoplasty with Inferior Turbinectomy can significantly improve nasal breathing and quality of life for patients with chronic nasal obstruction.” Those who undergo this procedure report improved sleep, reduced wheezing, and fewer adverse drug reactions. SIT has positive effects on both physical and mental health in addition to its physical benefits11. The inability to breathe adequately through the nostrils can result in frustration, anxiety, and diminished selfesteem. Patients who have undergone SIT, on the other hand, report feeling more comfortable in public when their respiration is no longer restricted.

According to12, individuals suffering from respiratory issues resulting from a deviated septum often undergo this surgical intervention, which has shown significant efficacy in such instances. The issue surrounding the simultaneous performance of inferior turbinectomy and septoplasty is a topic of ongoing academic discourse. She13 performed research demonstrating the efficacy of septoplasty, with or without inferior turbinoplasty, in the relief of nasal symptoms among persons with a deviated nasal septum and hypertrophy of the contralateral inferior turbinate. The research showed a statistically noteworthy improvement in both treatment cohorts. The findings of this study suggest that septoplasty confers significant benefits, even in cases when inferior turbinectomy is not performed. While this surgical treatment shows potential in assisting patients with deviated septums, it may not adequately target the underlying cause of enlarged turbinates. In such instances, a single nasal septum repair procedure may be insufficient. According to14, healthcare practitioners must do a thorough evaluation of each patients’ distinct needs in order to choose the most suitable therapies that would yield the most positive outcomes.

Before making the decision to have surgery, it is essential to carefully evaluate a multitude of considerations. Considering the unique recovery timeframes and potential hazards associated with each treatment choice, it is important for patients to actively participate in open and truthful discussions with their healthcare professionals about these aspects prior to making any definitive assessments15. He16 assert that the duration of recovery and the likelihood of problems might differ for both procedures, and it is advisable to engage in a thorough discussion with a competent healthcare professional prior to undertaking surgery. This underscores the need to establish a communicative exchange between the patient and the practitioner prior to the commencement of surgical operations. According to17, patients must possess a comprehensive comprehension of the anticipated events during the recuperation phase in order to adequately equip themselves both physically and emotionally. Moreover, acknowledging any potential complications beforehand allows patients to make informed decisions about their healthcare options while minimising risk.

Literature Review

Nasal obstruction is a prevalent medical condition that significantly affects individuals’ quality of life. It refers to the partial or complete blockage of the nasal passages, impeding the normal airflow through the nose. He18 stated that the prevalence of nasal obstruction in adults ranges from 15% to 30%, highlighting its widespread impact.

The causes of nasal obstruction are diverse, but two of the most common contributors are septal deviation and inferior turbinate hypertrophy. According to19, septal deviation refers to the displacement of the nasal septum, which is the thin partition that separates the nasal passages from its typical anatomical position. The condition might arise due to congenital reasons or be acquired as a consequence of trauma. The study conducted by20 revealed that septal deviation was present in 70% of persons with chronic nasal obstruction, highlighting its substantial contribution to this particular medical problem. On the contrary21, stated that inferior turbinate hypertrophy refers to the pathological condition characterised by the expansion of the inferior turbinates located inside the nasal passages. These structures are essential for the regulation of airflow and the humidification of inhaled air. He22 carried out research which revealed that inferior turbinate hypertrophy accounted for 45% of cases of nasal obstruction. The aforementioned numerical data underscores the need to acquire a more profound comprehension of these underlying factors in order to achieve precise diagnosis and effective therapy.

The treatment options for nasal blockage include septoplasty, turbinectomy, or a combination of both23. However, the selection of the most suitable therapy relies on the precise diagnosis of the condition. Several diagnostic instruments can be utilised to identify the source of the problem: When assessing the degree of septal deviation and the extent of the inferior turbinates, minimally invasive nasal endoscopy, which provides direct visualisation of the nasal passages, may be advantageous. He24 highlighted that by using rhinomanometry, a device for quantifying nasal ventilation and resistance, it is possible to gain a clearer understanding of the functional aspects of nasal obstruction. He25 determined that for the diagnosis of nasal obstruction owing to septal deviation, rhinomanometry had a sensitivity of 85% and a specificity of 91%. He26 stated that acoustic rhinometry provides essential information on the morphology of the nasal passages by documenting the reflections of sounds inside the nostril. By quantifying changes in nasal dimensions2, found that this method effectively diagnosed nasal obstruction in 88% of cases.

Septal deviation, the most common cause of nasal obstruction, can be surgically corrected with a procedure called septoplasty27. Indications, risks, and benefits, as well as the various septoplasty techniques, will all be discussed in this section.

The most frequent candidates for septoplasty are those with nasal obstruction induced by a deviated septum. Both congenital disabilities and trauma may cause this deformity. According to clinical research, septal deviation contributes to persistent nasal obstruction in approximately 80% of patients28. Frequent occurrences of sinusitis and sleep disturbances resulting from nasal blockage are often cited as justifications for advocating the implementation of a septoplasty procedure. Septoplasty may provide several advantages for patients. Due to the resumption of normal nasal ventilation, the most notable advantage is improved respiration. He29 stated that septoplasty has been shown to enhance nasal ventilation in around 90% of patients substantially.

Advantageously, the frequency and severity of sinus infections are diminished. According to29, septoplasty, which enhances sinus drainage, has been shown to minimise sinus infections by up to 70%. Additionally, the majority of patients report improved sleep quality and reduced wheezing after surgery. While there are no significant risks associated with septoplasty, there are still some. Perforation of the septum occurs in approximately 1% to 3% of septoplasty cases30, and bleeding and infection are also common complications. Prior to surgery, patients should have a frank discussion with their surgeon about these concerns31. After surgery, it is normal to experience some discomfort and oedema, but both should subside within a few weeks. He32 found that septoplasty may be performed using either an open or closed approach. The method utilised will be determined by the degree of septal deviation and the surgeon’s individual preference. In open septoplasty, the columella (the fleshy portion between the nostrils) is incised to expose the entire nasal septum. According to33, this method has a success rate of 94% in cases of severe septal deviation, making it the method of choice for complicated or severe septal deviations.

Material and Methods

The formulation of this CCS included a methodical breakdown into several phases. The first phase of the investigation included evaluating the suitability of septoplasty, either as an independent intervention or in conjunction with inferior turbinate reduction, as a feasible subject for the Comprehensive Clinical Study (CCS). Extensive literature study was undertaken to establish precise definitions of septoplasty and inferior turbinoplasty, as well as to determine the exact scope of practise and target group, in order to produce our consensus statement. Furthermore, a comprehensive analysis was conducted, and subsequently, the resultant data was subsequently furnished.

A comprehensive review of relevant academic literature was undertaken to ascertain the present and dependable understanding about the diagnosis and treatment of septoplasty, with or without inferior turbinate reduction, using both medical and surgical methodologies. In November 2014, the assistance of a proficient database search consultant was sought to aid in conducting literature searches for clinical practise guidelines and systematic reviews. Following this, in January 2015, the aforementioned consultant participated in the execution of searches for randomised controlled trials. A thorough inquiry was conducted to gather data. The research investigated a range of scholarly evaluations, including meta-analyses, clinical practise recommendations, and other relevant Clinical Care Standards (CCSs) that were available in the English language.

Search strategy process

Clinical practice guidelines

A comprehensive review of the existing literature resulted in the identification of a total of 34 pertinent suggestions that were published between the years 2004 and the present. Each guideline’s whole text was independently evaluated by two members of the guideline update committee in order to assess its pertinence and calibre. To ensure compliance with the criteria for inclusion, the guideline must fulfil the following prerequisites: a well-defined scope and objective, involvement of stakeholders from diverse disciplines, a thorough assessment of pertinent literature, and a transparent mechanism for establishing the link between evidence and recommendations. The reviewers concluded that three suggestions were relevant to septoplasty, regardless of whether surgery was done with or without inferior turbinate reduction, and therefore met the necessary criteria.

Systematic reviews

During the first stage of the literature review, an exhaustive search was conducted, resulting in the identification of a total of 132 potential systematic reviews that were published from 2010 forward. In order to assess the pertinence and calibre of each whole text, two individuals from the CCS panel conducted separate examinations. In order to satisfy the criteria for inclusion, the systematic review was required to fulfil the following prerequisites: the reviewers were anticipated to possess a welldefined objective and specified methodology, provide a comprehensive account of the search technique used, and assure precise extraction of data. In accordance with established guidelines, it was determined that a minimum of two independent researchers should be involved in the process of extracting data from the source journals. The methodology above was used in order to mitigate the potential impact of any inherent biases. The researchers identified a total of nineteen systematic assessments that met the specified criteria and centred on the topic of septoplasty, either with or without inferior turbinate reduction.

Results

Definition and diagnosis

Table 1 displays the consensus reached on three statements within this particular category. The collective elucidated that nasal septoplasty is a surgical procedure designed to rectify a deviated nasal septum with the objective of improving nasal function and aesthetic appeal. According to34, medical professionals typically determine the suitability of a patient for septoplasty based on an assessment of their symptoms and a comprehensive physical examination. The panellists reached an agreement that the assessment of septal deviation before doing septoplasty may be effectively achieved by using either anterior rhinoscopy, nasal endoscopy, or a combination of both techniques.

Table 1: Definition and Diagnosis Statements.

Table 2: Imaging Studies

Furthermore, it was collectively agreed upon that nasal endoscopy may provide valuable insights before undergoing septoplasty, such as identifying other potential causes of nasal blockage, even if the presence of septal deviation has already been confirmed by anterior rhinoscopy. As per the findings of 35, a consensus among the panellists was not reached regarding the necessity of conducting nasal endoscopy for the evaluation of the nasal cavity in all patients who qualify for septoplasty. The expert panel was unable to reach a consensus on the potential utility of either acoustic rhinometry or rhinomanometry for patients presenting with primary complaints of nasal obstruction. Nevertheless, it is not mandatory to conduct these tests for the purpose of diagnosing septal deviation. He36 found that the consensus among the panel members is that the acquisition of photographic evidence is deemed unnecessary in verifying the existence of a deviated nasal septum prior to the implementation of septoplasty.

Imaging studies

Participant 1, who had expertise in the domain of education, was included as one of the thirteen individuals comprising the sample for this research. The person had symptoms of nasal obstruction and allergic rhinitis, which ultimately led to the diagnosis of Deviated Nasal Septum (DNS) as the root cause. The provided case study serves as an illustration of a consistent trajectory of advancements that has resulted in the present state of affairs, which is both favourable and beneficial. A substantial improvement was indicated by the patient’s response to the therapeutic intervention, which was rated as 7 on a scale of 1 to 10. Even after the passage of one month, the patient continued to exhibit signs of improvement. The current case study provides evidence that the medication effectively managed the patient’s symptoms associated with allergies and nasal obstruction. In the second patient, both the clinical manifestation and the diagnosis of bilateral inferior turbinate hypertrophy were indicative of sleep apnea.

It is noteworthy to mention that the second patient has achieved significant progress in the classroom. The patient’s condition significantly improved upon initiation of treatment, as evidenced by the rating of 8 out of 10, which signifies a considerable level of recuperation. As previously delineated, the implementation of the intervention to address the patient’s sleep apnea and bilateral inferior turbinate hypertrophy resulted in a substantial enhancement of the patient’s quality of life. Later, a college student in their early twenties sought medical attention. In this patient, nasal obstruction was identified due to the presence of HIT and DNS. Based on his self-assessed rating of eight on a scale of zero to ten, it can be concluded that his health has improved substantially since the intervention was implemented. His nasal obstruction and overall health significantly improved following the intervention, as shown by the results.

An adolescent who presented with nasal obstruction as evidenced by a DNS and HIT was identified as the fourth individual. A remarkable nine out of ten points indicates that the patient’s health improved substantially after therapeutic intervention was concluded. Considerable advancement was identified in this assessment. The study’s results provide substantiation for the effectiveness of the intervention in diminishing symptoms associated with nasal blockage and enhancing the individual’s overall quality of life.

Furthermore, the fifth individual in the research was recognised as an undergraduate student. The patient in question presented with indications of nasal blockage, which were ascribed to the simultaneous presence of two medical conditions: DNS and HIT. After the successful implementation of the prescribed therapeutic intervention, the person exhibited significant improvements, as shown by a positive evaluation of 7 out of 10, indicating remarkable development. The approach that was executed effectively focused on his DNS (nasal airway) and HIT (hyperventilation-induced turbulence), resulting in enhanced nasal ventilation and overall improvement of his condition. The prospective ramifications of this finding are significant, as it can significantly augment the daily operations and educational achievements of university pupils.

The sixth patient, who coincidentally had a profession in education, presented with nasal obstruction attributed to DNS and HIT. After the implementation of the prescribed intervention, the person demonstrated notable progress, as shown by a noteworthy score of 8 out of 10, indicating considerable improvement. The result above demonstrated the effectiveness of the intervention in the treatment of DNS and HIT, hence enhancing nasal functionality. The seventh participant in the trial, who was identified as a student, exhibited nasal obstruction resulting from DNS and HIT. Following the conclusion of treatment, there was a significant improvement in the patient’s health, as shown by the attainment of a score of 8 out of 10, indicating a strong level of recovery. This research study presents empirical data supporting the effectiveness of the intervention in mitigating symptoms related to DNS (Deviated Nasal Septum) and HIT (Hypertrophy of Inferior Turbinates), resulting in improved nasal airflow and enhanced quality of life for a student actively involved in academic endeavours. The eighth assistance member who presented with nasal obstruction was diagnosed with HIT and a DNS. These conditions were found to be the underlying causes of the obstruction. A clinical state of the patient exhibits a moderate degree of improvement subsequent to medication administration, as evidenced by a score of 4 out of 10. Following correction of a deviated nasal septum and hypertrophy of the inferior turbinates, nasal obstruction may persist; in such cases, the treatment may not have been as effective as initially anticipated. An additional individual, referred to as patient number nine, experienced nasal obstruction as a result of Hypertrophy of the Inferior Turbinates (HIT) and a DNS. The patient’s health advanced substantially following the conclusion of treatment, as evidenced by the score of seven out of ten, which signifies a substantial improvement. The results of this study lend support to the effectiveness of the intervention in decreasing DNS and HIT. The student reported a substantial enhancement in both academic achievement and overall well-being due to the enhanced ventilation through their nasal passages. The nasal blockage seen in both the domestic assistant and the tenth patient was determined to be the result of a combination of DNS and hypertrophy of the nasal turbinates, which was induced by hypersensitivity to environmental irritants (HIT). Following the administration of medicine, a discernible amelioration in her health was seen. The observed enhancement was discernible based on a positive assessment of 6 out of 10, signifying advancement. The proficient administration of her DNS and HIT led to increased nasal airflow and greater overall well-being in her professional capacity.

Both the university employee and the eleventh patient encountered nasal obstruction resulting from DNS and HIT. After undergoing the prescribed therapy intervention, the person exhibited significant improvement, achieving a respectable score of eight out of 10, therefore showing considerable progress. The methodology effectively targeted the DNS and HIT, leading to enhanced nasal functionality. The twelfth individual, who coincidentally had a profession in education, exhibited symptoms of nasal obstruction. The blockage was found to be caused by inflammation of the nasal mucosa and a DNS resulting from hypersensitivity. Following the successful implementation of the prescribed therapeutic intervention, there was a notable improvement in the individual’s condition, as shown by a noteworthy rating of 9 out of 10. The patient saw a significant improvement in her nasal functionality after the successful treatment of her hypersensitivity to HIT as well as her deviated nasal septum (DNS). The twelfth and last patient, who was a student, was diagnosed with nasal obstruction. The diagnosis revealed DNS and hypertrophy of the inferior turbinates. As a direct result of the intervention, his academic performance shown significant improvement, leading to a notable increase in his grade from a failing two to a passing eight. The method effectively treated the student’s DNS and HIT, resulting in enhanced nasal function.

Discussion

Septoplasty was performed on thirteen patients with nasal disorders, including DNS or HIT. The results of this study provided valuable information regarding the efficacy of this surgical intervention. Given the diversity of patient demographics, preoperative conditions, and surgical encounters, this study engages in a thorough discussion of the outcomes of septoplasty with and without inferior turbinectomy. Students, professors, university employees, soldiers, and housewives were included in the research study’s diverse group of participants. As a primary observation, this aspect carries considerable weight. According to37, the diversity of the population affected by nasal obstruction is illustrated by this extensive array. Numerous professions actively pursued septoplasty, demonstrating the widespread prevalence of the underlying problem and the shared aspiration for improved nasal functionality and quality of life.

Due to their impaired nasal respiration, everyone underwent septoplasty. They38 stated that aligned with the shared objective of septoplasty, and this surgical procedure helps patients suffering from nasal obstruction due to conditions such as DNS and HIT to experience enhanced respiration and decreased irritation. The examples demonstrated the need for a comprehensive diagnostic evaluation to precisely diagnose the causes of nasal obstruction, which may stem from a variety of sources. On the other hand39, patient outcomes following septoplasty are essential for determining the efficacy of the procedure. While the majority of patients did exhibit significant improvement, the degree of improvement varies widely. Patients rated their postoperative health on a 10-point scale from 4 to 9. It is conceivable that preexisting conditions, the type of septoplasty procedure (open versus closed), and individual healing periods all contribute to this variation.

This research gains valuable insight by contrasting and comparing the outcomes. The twelfth patient, a schoolteacher, and the eleventh patient, an employee at a university, are just two examples of those who have reported significant improvement after treatment. This demonstrated that septoplasty effectively corrected the nasal obstructions induced by their DNS and HIT. Other patients, such as the seventh patient, had only a slight improvement (rated 4/10). He40 demonstrated the need for individualised treatment protocols, as septoplasty may not be equally advantageous in all cases. Even if some patients assigned themselves lower ratings of improvement (e.g, 6/10), this indicated a significant improvement in their health.

Similarly41, found that despite the possibility of variable outcomes, this suggested that septoplasty has the potential to improve nasal function and overall quality of life for a substantial proportion of individuals. In addition, the necessity of exceeding patients’ expectations is emphasised. He42 found that a sizeable proportion of patients who rated their improvement as “very good” or “excellent” were pleased with the final result. Individuals who saw a diminished degree of change may have harboured distinct expectations or may still be encountering unresolved issues.

Conclusion

In conclusion, patients with nasal obstruction owing to disorders such as DNS or HIT may benefit greatly from septoplasty with or without inferior turbinectomy, according to recent research. Nasal blockage was discovered to impact people from many walks of life, including college students, teachers, soldiers, and housewives. In this research, nasal obstruction was the predominant reason for septoplasty, which is in line with the normal clinical presentation of septoplasty. All patients pursued septoplasty to alleviate the discomfort and difficulty inhaling through the nostrils brought on by their disorders. The instances highlighted the need for exhaustive diagnostic investigation to determine the true causes of nasal obstruction. After surgery, patients reported varying degrees of disease improvement, assigning results ranging from 4 to 9 on a 10-point scale. Patients’ ratings of postoperative improvement may be influenced by variables such as the severity of pre-existing problems, surgical approach (open versus closed septoplasty), and individual recovery responses. Septoplasty consistently produced dramatic improvements in nasal function and quality of life when compared to other procedures. Patients with high satisfaction ratings, such as the eleventh and twelfth patients, indicated that the surgery was effective in treating DNS and HIT. Some patients, however, made less progress than others; this demonstrates the need to modify interventions to the unique requirements of each patient and to encourage reasonable recovery objectives.