Past Nasal Septum/Polyp Surgery

[griffinx]

Hi,

Previously I had difficulties with breathing from my right side of my nose. After visiting my ENT, he claimed that there was a polyp so he suggested that I remove it. While doing that he would correct a "slight" deviated septum toward the same side, which were the 2 causes of my problem. His diagnosis came without a CT Scan and suggested that I undergo surgery.

At that time, I was not aware of such a thing as a CT scan, so trusting on his diagnosis I underwent the surgery. Being a little smarter now, I would have insisted on a CT scan prior to undergoing any type of surgery.  Even having a tooth extracted requires an dental xray.

Well, the problem was that, after the surgery, I am having a slight difficulty breathing from my left nostril. Going back to the same Doctor, he claimed that my right is working so well that it makes it seem like the left is not. Well, I disagree to his explanation and it doesn't resolve my new breathing problem, but I have no CT scan to base on if something has been missed or erred. Needless to say I have no trust in this Doctor in what he's saying at this point.  

Is it appropriate to say that a CT scan should have been performed prior to surgery at the time (as a required procedure), and it is justifiable to report this doctor? It seems putting people under the knife without any type of visual seems careless or at best, rushed.  I would appreciate any professional medical opinion and what I should do.

Thanks

[hassaanwarsi]

Hi,

I recently underwent a septoplasty myself too. Actually, the total volume of your air remains the same, whether more is entering from your left or right side. Because the volume of air entering from your right side now has increased, it seems to you that you're having troubles breathing from your left side. But it might just be a psychological thing. I know for me, even though my septum hasn't completely straightened out, I no longer have the problems associated with deviated septum. A doctor cannot completely straighten your septum if the extent of deviation is severe because in reality, the nasal cartilage/bone needs to be chipped away to an extent exceeding which you risk nasal perforation which again needs corrective surgery.

However if you still feel the operation was less than satisfactory, you can always undergo  corrective surgery or take a second opinion. CT Scan is not a requirement to diagnose a deviated septum at most places, usually the doctor just examines the septum under light  himself.

[ENTMD]

Well, the question you ask is the same I ask -- what else CAN you do?  The only people qualified to diagnose and treat nasal/sinus disease (surgically, anyway) are Otolaryngologists (ENTs).  You really don't have many options here.  You are right in that you can never illustrate/prove to anyone how your nose looked or functioned before the procedure.  But here you are.  What matters now is how it functions now.  If you see several docs and they all same the same thing, then they may be on to something.  If they all say different things, then you are in a tougher situation as you now have to decide whom to believe.

I still would take issue with the policy you are proposing.  That would be a very expensive prospect, on the whole, and not a very good allocation of health care resources.  Sure, the CT may cost you a few hundred, or even nothing.  But the insurance company is paying more and ultimately, like all profitable insurance companies, that cost gets passed along to the consumer in one way or another.  Like I said, when it comes to polyps it depends a lot upon whether it's just a single polyp or a whole bunch of them.  When it comes to just a septum, getting a CT would be completely unnecessary and potentially harmful (finding false positives and then getting additional surgery or medications or tests).  Having a CT pre-operatively in nasal and simpler sinus cases (single polypectomy, for eg), has not been shown to improve outcomes or decrease risk.

Some ENT offices have scopes connected to video monitors that allow you to see exactly what the doc is seeing.  This may be useful to you.

[griffinx]

Hi ENTMD,

Appreciate your insightful reply.

Ok. so if there's no requirement, then I just wonder why not.   Anyone who's getting a surgical procedure on their nose to request a CT scan (Big word meaning Xray) from their doctor and do their homework.  CT scans allows the Doctor to explain in detail what he proposes to do and to explain it in an understandible way for the patient. It's a few hundred bucks vs, going through the surgery for a few thousand (all covered by insurance).  I just don't consider any surgical procedure minor.

But the dilemma is that I don't have any recourse to know what my nose was like before the surgery and then after he had performed the surgical procedure.  I just don't think that's fair.  

To go to another ENT now that you suggested, (which I have already done also) is starting all over again, who others have then recommended me to get a CT scan, endoscopy, etc, but after all that it's still unclear what was done prior or if it was truly diagnosed properly.  

Anyhow, thanks to listen to my part vent.  I still feel there must be something I should do here.   What else can I do to investigate?
  
Thanks again

[ENTMD]

Hello -  I am sorry to hear that you are frustrated following your procedure.  The simple answer to your question is that no, there is no requirement (legally, ethically, medically) to obtain a sinus CT scan before performing these procedures (septoplasty, polypectomy).  I think most ENT docs will get a CT before doing a polypectomy, but this typically refers to the removal of polyps from both sides and even some surgery in the sinuses themselves.  Removing a single, well-visualized polyp from one side, probably most wouldn't feel it was necessary.  Always a good option would be to seek the opinion of a different ENT doc if you don't trust the one who did your surgery.