This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
This study compared nose surgery (septoplasty) with nasal sprays for people whose septum blocks their airways. After 6 months, compared with nasal sprays, people who had the surgery had:
- more improvement in symptoms
- better quality of life.
The researchers hope their findings will encourage more clinicians to offer surgery to people with severely blocked airways. People with moderate symptoms benefitted less from surgery but their symptoms improved over time with nasal sprays.
Some NHS hospitals provide good information on septoplasty.
UPDATE (29/04/2024): A cost-effectiveness analysis in the full report found that, although septoplasty is unlikely to be cost-effective at 12 months, it is highly likely to be cost-effective at 24 and 36 months (99 – 100% probability, at a £20,000 threshold for an additional quality-adjusted life-year).
What is the best option for people with nasal obstruction?
Left and right nostrils are separated by bone and cartilage (the nasal septum). A septum bent to one side (deviated septum) can make breathing through the nose difficult, and cause trouble sleeping.
People can be treated with nasal sprays to reduce inflammation, or with surgery to straighten the septum (septoplasty). Surgery is common; surgeons in England performed around 16,700 procedures between 2019 and 2020. But evidence to support septoplasty is lacking and some local guidelines recommend trying medical treatment before surgery.
This randomised controlled trial compared nasal sprays with surgery.
What’s new?
The study included 307 adults with moderate to severe nasal blockage due to a deviated septum. They were treated at 17 UK hospitals in all. Most participants were male (67%), white (88%) and had severe or extreme (84%) symptoms (the population most likely to be referred to secondary care). Fewer (16%) had moderate symptoms. Half (152) were assigned to surgery; half (155) to nasal spray.
Participants recorded their symptoms and quality of life before they started treatment, at 6 months and at 12 months. A 9-point difference in scores was considered meaningful.
At 6 months, people who had septoplasty:
- had improved symptoms, including thick mucus and the need to blow their nose (20 points) compared with those in the nasal spray group (40 points)
- had more improvements in both physical and mental quality of life than people in the nasal spray group (this was a secondary outcome).
People with the most severe symptoms before treatment showed most improvement. Those with moderate symptoms were less likely to benefit meaningfully from septoplasty, but they tended to improve over time with nasal sprays.
Breathing tests and symptom surveys continued to favour surgery over nasal sprays at 1 year but the difference was less. Symptoms in the septoplasty group remained the same (21 points) but were reduced in the nasal spray group (to 30 points). However, half those in the nasal spray group (37) had chosen to have surgery.
Serious adverse events were uncommon (14 in septoplasty group; 9 in nasal spray group). These included readmission to hospital because of bleeding, and infections that needed antibiotics.
Why is this important?
The study found that septoplasty led to more improvements in symptoms after 6 months than nasal sprays. At 1 year, the difference was less but still meaningful. The researchers suggest that septoplasty is an effective option for people with a deviated septum that causes severe symptoms, but with no other nasal or sinus disease.
People with extreme symptoms benefitted from surgery; those with moderate symptoms benefitted less. Therefore, the researchers suggest that clinicians and patients discuss the likely benefit of surgery (based on the severity of symptoms) before deciding on treatment.
What’s next?
The NHS England initiative ‘Getting it Right First Time,’ which presents a data-driven evidence base to support change and improve patient care, is exploring septoplasty. The procedure typically has a long NHS waiting list, the researchers say.
You may be interested to read
This is a summary of: Carrie S, and others. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. British Medical Journal 2023; 383: e075445.
Similar findings from a previous study in the Netherlands.
Funding: This study was funded by the NIHR Health Technology Assessment programme.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
