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Clinical Consensus Statement Clarifies Role of Septoplasty

AAO-HNSF has developed a clinical consensus statement on septoplasty because a lack of evidence hindered the development of a clinical guideline. The statement was reviewed Sunday in the Miniseminar “Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction.”

The objectives of the clinical consensus statement are to promote appropriate care, reduce inappropriate variations in care, and educate clinicians regarding multiple aspects of the medical and surgical management of nasal obstruction employing septoplasty with or without inferior turbinate reduction, according to statement literature.

The clinical consensus statement was developed by an expert panel, which produced a series of statements as part of the clinical consensus statement, including:

  • A CT scan may not accurately demonstrate the degree of septal deviation
  • Septoplasty can assist delivery of intranasal medications to the nasal cavity
  • An endoscope can be used to improve visualization of posterior-based septal deviation during septoplasty
  • Quilting sutures can obviate the need for nasal packing after septoplasty

The statement also defines septoplasty with or without inferior turbinate reduction and offers additional statements addressing diagnosis and medical management prior to septoplasty, and surgical considerations. Additional statements also were released on the appropriate role of perioperative, postoperative, and adjuvant procedures.

Nasal septoplasty and inferior turbinate reduction procedures can improve the nasal airway in the treatment of nasal obstruction, which often is caused by a deviated septum, with or without hypertrophic inferior turbinates.

Although septoplasty has been used for a long time, there are significant differences of opinion regarding the appropriate methods for diagnosis and treatment of nasal obstruction secondary to septal deviation and turbinate hypertrophy, according to literature released with the clinical consensus statement.

“The roles of nasal endoscopy, imaging, photo documentation, and tests such as acoustic rhinometry/rhinomanometry in the diagnosis of nasal obstruction are unclear,” it states. “Payers have imposed requirements for using some of these methodologies prior to approving payment for septal surgery in the absence of appropriate evidence-based literature to support the requirements. Similarly, requirements for extended medical therapy prior to authorization for septoplasty and/or inferior turbinate reduction surgery have been imposed by a number of payers without clear evidence of benefit.”

The desire to improve the quality of care and educate clinicians on the topic led the AAO-HNSF Rhinology and Paranasal Sinus Committee to submit it to the AAO-HNSF Guidelines Task Force. That led to the development of the clinical consensus statement because limited evidence did not support the development of a guideline.