Intended for healthcare professionals


Septoplasty for nasal obstruction

BMJ 2023; 383 doi: (Published 18 October 2023) Cite this as: BMJ 2023;383:p2341

Linked Research

Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction

  1. Annakan V Navaratnam, consultant rhinologist, facial plastic and ENT surgeon,
  2. Alfonso Luca Pendolino, senior clinical rhinology fellow
  1. Department of Ear, Nose and Throat, Royal National ENT and Eastman Dental Hospitals, London WC1E 6DG, UK
  1. Correspondence to: A V Navaratnam annakan.navaratnam{at}

New trial paves the way for evidence based guidelines

Health resources everywhere are stretched in this post-pandemic era. The pursuit of effectiveness has led policy makers and health insurance companies to pay close attention to the value of common procedures, and otorhinolaryngology is not spared.12 In common with other surgical techniques developed before evidence based medicine, there is a paucity of high quality evidence evaluating septoplasty and therefore no clear guidelines for its use. Consequently, clinicians have varying opinions about when, or even if, septal surgery can benefit patients with nasal obstruction.

In the linked paper, Carrie and colleagues (doi:10.1136/bmj-2023-075445) enrolled 378 adults with septal deviation and at least moderate symptoms of nasal obstruction into a randomised controlled trial: the Nasal Airways Obstruction Study (NAIROS).3 Participants were randomised 1:1 to receive either septoplasty (with or without unilateral inferior turbinate surgery at the surgeon’s discretion) or defined medical management (nasal steroid and saline spray for six months). The authors observed a statistically significant improvement at both six and 12 months in reported …

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