Does Sinus and/or Nasal Surgery Help with Sleep Apnea?

Bluntly, the answer is not really... Although it may make sense that improving nasal airflow should help with obstructive sleep apnea, the reality is that it does not make a profound difference. Indeed, there was a study in 2014 that looked into this question.

In this study, 3 groups of patients were looked at divided into patients with mild, moderate, or severe obstructive sleep apnea (OSA). These patients underwent sinus surgery, septoplasty, and turbinate reduction.

What was found was that patients with severe OSA with a mean AHI of 52 would go down to 43 (normal being less than 5) after surgery. Moderate OSA with a mean AHI of 22 down to 20. Patients with mild OSA did not have any significant changes to AHI at all.

In other words, for patients with moderate or severe OSA, although the AHI does decrease somewhat, it does not decrease enough that it really makes any clinical difference. Patients with moderate or severe OSA still had OSA... and still would need to use a CPAP or equivalent machine after surgery to correct their sleep apnea.

Although at first blush, these results may not make sense, it actually does make sense when you consider sleep apnea to be a multi-level disorder affecting not just the nose, but the throat as well.

For example, the back of the tongue may fall backwards obstructing the airway causing sleep apnea. Correcting nasal factors would have absolutely ZERO impact on tongue factors of OSA.

In order to determine where these other anatomic factors may be that may contribute to OSA, a sedated or sleep endoscopy is often performed. Watch the video below.

Granted, patients may STILL wish to pursue sino-nasal surgery due to discomfort with their sinuses and nasal breathing... but patients need to be aware that their OSA may still remain essentially unchanged!

Sino-nasal surgery may also help with CPAP compliance as lower pressures may be required to address OSA compared to before surgery. Why? Because the nasal passages are more open after surgery so it is easier to push air into lungs when using CPAP.

Reference:
Effects of Endoscopic Sinus Surgery and Nasal Surgery in Patients with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg. 2014 Mar 31;151(1):171-175. [Epub ahead of print]

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Why Is a Nosejob Sometimes Necessary to Resolve Nasal Obstruction?

A very common complaint for a patient to see an ENT surgeon is to resolve nasal obstruction. The most common surgeries to resolve nasal obstruction include septoplasty, adenoidectomy, and turbinate reduction. All of theses procedure are performed within the nasal cavity and does not affect appearance.

However, sometimes in order to resolve nasal obstruction, the appearance of the nose MUST change especially if the nostril openings are very narrow. By looking at these example pictures of the nostril openings, it's pretty obvious that breathing would be an issue. So even though a nosejob is typically performed for cosmetic reasons, it may also be recommended for medical reasons should nasal breathing be inadequate.

For both these patients, the nasal columella is crooked to one side resulting in one nostril opening being larger than the other which causes nasal obstruction on the more narrow side.

Correction of this crooked nasal columella into a straight and midline appearance would result in improved nasal breathing as well as a change in appearance.

Sometimes the nasal columella may be straight, but the nostril openings are both too narrow leading to nasal obstruction. Correction would require enlarging the nasal opening by use of alar batten and spreader grafts which would result in not only improved nasal breathing, but also a wider nasal appearance overall.

The explanation for why the nasal appearance does not change especially after septoplasty which requires cartilage and bones removal is actually quite simple. The analogy would be a house where the appearance on the outside would not change even though you may knock down a wall between two rooms inside the home.

SO... Here is a side view of the septum. The blue arrow is pointing to the nostril opening and the red arrow is pointing to the lip.

In this picture below, the septum has been removed.

As you can see, the outside appearance of the nose remains unchanged as the rim of the nose is kept intact as shown by the red arrows here:

So that in a nutshell is the explanation for why deviated septum surgery does not change the outside nasal appearance.

Read more about the septoplasty surgery here.

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Actress Jennifer Aniston Underwent Septoplasty Twice

Though not entirely recent news, actress Jennifer Aniston reportedly underwent septoplasty nasal surgery not just once, but twice. The first was done in 1994 and a revision septoplasty was performed in January 2007. [link] [wiki]

This type of surgery is performed to help improve nasal breathing, an issue that Jennifer Aniston apparently had.

Septoplasty, unlike rhinoplasty or nosejob, does NOT change the outside appearance of the nose. All the work is done internally. (Watch video here).

The explanation for why the nasal appearance does not change after septoplasty is actually quite simple. The analogy would be a house where the appearance on the outside would not change even though you may knock down a wall between two rooms inside the home.

SO... Here is a side view of the septum. The blue arrow is pointing to the nostril opening and the red arrow is pointing to the lip.

In this picture below, the septum has been removed.

As you can see, the outside appearance of the nose remains unchanged as the rim of the nose is kept intact as shown by the red arrows here:

So that in a nutshell is the explanation for why deviated septum surgery does not change the outside nasal appearance.

The way the deviated septum itself is removed can be more simply understood looking at the nose from a different vantage point.

Step 1: A small incision is made inside the nose and the mucosal lining carefully lifted away from the septum on one side. It is during this stage of the procedure that one of the complications of the procedure, septal perforation, may occur. This complication occurs when the lining gets torn resulting in a hole as the mucosa is lifted away from the septum.
Step 2: The septum is incised immediately in front of the deviation and the nasal mucosal lining is lifted away from the septum on the opposite side.
Step 3: The deviated septum is now physically removed. One removes the deviated septum completely instead of forcing it into a midline position. Why? Because just like a young tree sapling, the nasal septum has "memory" and bending or forcing it into a certain position will last only temporarily before it springs back into its original position.
Step 4: The nasal mucosal lining is reapproximated in the midline. There are several methods how this last step is performed. One method is to suture the lining back together like a quilt (NO nasal packing or septal splints are used). Occasionally, the nose is packed with septal splints or nasal packing material. Both methods are used in our practice depending on the physician and the condition of the septum itself.

Read more about the septoplasty surgery here or watch a video!

Source:
The one where Jennifer Aniston Fixes Botched Surgery. PopSugar 6/7/10

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