The nasal cavity is divided into two halves by the nasal septum, the nasal septum has consisted of two parts (cartilaginous part and bony or osseous part) 1. Trauma, the environmental factors, and the genetic factors are the most common cause that leads to a deviated nasal septum 2. The deviated nasal septum with hypertrophied inferior turbinate will lead to nasal handicap to the patients 3.
The nose has an important role in the respiratory tract physiology. The study of the effect of nasal diseases on the pathogenesis of sleep-disorder breathing and the value of nasal problems management will be very important 4. All pathological disorders that cause nasal obstruction will lead to sleep-disorder breathing or make it worse, the causes of nasal obstruction may be divided into irreversible reasons like (septal deviation, hypertrophied inferior turbinate, nasal polyposis and inverted papilloma) and reversible reasons like(allergic rhinitis, non allergic rhinitis, and atrophic rhinitis) 5.
The septoplasty operation will include removing the deviated part of septal cartilage or bone and remodeling with replacing the cartilage in the midline, the turbinate reduction may be one by different techniques like laser, radiofrequency or electrocautery 6-7
Polysomnography is an accurate investigation that can detect the presence of obstructive sleep apnea and its severity, Polysomnography is a night laboratory test, several physiologic parameters are recorded continuously and simultaneously during the sleep, and the wake, these parameters include electromyography, electroencephalography and electro-oculography 8-9
The nasal breathing can help the respiratory system in warming and humidify the inspired air, deviated nasal septum and its pathological sequelae as hypertrophied inferior turbinate may lead to alteration of the respiratory mechanics and changes in the compositions of arterial blood, these changes in normal pulmonary functions may lead to malfunction of many body systems especially the respiratory system 10-11-12
There were many old studies which presented that the nasal obstruction would affect pulmonary function 11, there may be a relationship between improvement of nasal obstruction after the success of correction of nasal pathology by nasal operation and improvement of postoperative pulmonary function after the surgery 12.
Patients and methods
30 patients aged from 17 years to 35 years underwent Septoplasty with Turbinectomy due to nasal obstruction and sleep problems at benha University hospital, Faculty of Medicine, ENT department and pulmonary department at the period from Mars 2017 to Mars 2018 were included in this study. Institutional ethical committee approval and informed written consent from the patients were taken before the onset of the study. The mean age was 26.7±9.48 years, 13 of the patients were males and 17 were females, the investigations of this prospective study were conducted in the pulmonary department of benha University hospital, the operations were done by the same surgeon.
The study included 30 patients presented by severe nasal obstruction, shorting of breath, snoring and sleep problems because of the significant deviated nasal septum with hypertrophied inferior turbinates, these symptoms and classic physical examination finding confirmed by nasal endoscopy and computed tomography (CT) scan.
Patients who had one or more condition of these criteria would be excluded: nasal allergy, nasal polyps, smoking, any lung diseases ,allergic fungal sinusitis, previous nasal operations, pregnancy ,any systemic diseases (as heart failure, hypertension, diabetes), any lung diseases, large tonsil, long thick uvula, redundant palate, neurological disorders, obese patients (BMI >35), patients who were lost during follow up period.
Polysomnography and spirometry
Laboratory polysomnography (SOMNO screen™ plus PSG Tele, by SOMNOmedics GmbH), done for all patients 1 week before the surgery and then 6 weeks after it, all patient in this study underwent spirometry (MIR, spiro-doc, Italy) ; a simple non-invasive technique; all patients would be in a suitable sitting position without any restriction to the movements of chest (like heavy or tight clothes),The same physician observed all patients, the best trail out of 3 successful trials was taken as the best results or till 8 trials done by the patient, the forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), forced inspiratory flow at 50% of FVC (FIF50%) forced expiratory flow at 50% of FVC (FEF50%),All results ( pre-operative , post-operative) were recorded and compared.
The operation done under general anesthesia with use of endoscope to ensure adequate correction of the deviated nasal septum and excision of only part of the inferior turbinate (to prevent empty nose syndrome) and to make sure that the posterior end of the inferior turbinate would be reduced, nasal septal splint placed then merocel packs left in nose, patients kept 48 hours after the surgery for recovery .
Nasal packs removed 48 hours after the surgery and nasal septal splint 7 days after the surgery; Antibiotics prescribed with alkaline nasal douching for 10 days after the surgery, there were no complications could be detected during 2 months of postoperative follow up.
The clinical data were expressed as Mean and standard deviation for quantitative data, frequency, and distribution for qualitative data. Quantitative data were compared using: – Paired t-test and Wilcoxon test (Z test). All data were tabulated and analyzed using the computer program SPSS (Statistical package for social science) version 20. A P value 0.05 statistically insignificant. A P value