Published: November 4, 2015

AAO-HNSF CLINICAL CONSENSUS STATEMENTSeptoplasty with or without inferior turbinate reduction

Nasal obstruction is a highly prevalent problem in the United States that can negatively impact quality of life. One of the common causes of nasal obstruction is a deviated septum, with or without hypertrophic inferior turbinates. In the presence of such nasal obstruction, nasal septoplasty and inferior turbinate reduction procedures can improve the nasal airway.

By Joseph K. Han, MD, Scott P. Stringer, MD, Richard M. Rosenfeld, MD, MPH, Timothy S. Lian, MD

Yanigisawa Image Library: Telescopic view (4mm, 0˚) shows a perforation of the nasal septum in its anterior inferior portion.

Despite a long history of septoplasty as a procedure, there are significant differences of opinion regarding the appropriate methods for diagnosis and treatment of nasal obstruction secondary to septal deviation and turbinate hypertrophy. The roles of nasal endoscopy, imaging, photodocumentation, and tests such as acoustic rhinometry/rhinomanometry in the diagnosis of nasal obstruction are unclear. 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.

During the development stage of the clinical consensus statement, a complete definition of septoplasty with or without inferior turbinate reduction was established. Additional statements addressing the diagnosis, medical management prior to septoplasty, and surgical considerations, as well as the appropriate role of perioperative, postoperative, and adjuvant procedures, in addition to outcomes, were subsequently produced and evaluated. The end result produced a series of clinical statements, developed by an expert panel, such as CT scan may not accurately demonstrate the degree of septal deviation; septoplasty can assist delivery of intranasal medications to the nasal cavity; endoscope can be used to improve visualization of posterior based septal deviation during septoplasty; and quilting sutures can obviate the need for nasal packing after septoplasty.

The desire to improve quality of care, promote appropriate care, decrease variations in the care of septoplasty patients, and educate clinicians, led the Rhinology and Paranasal Sinus Committee of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) to submit the topic of septoplasty to the AAO-HNSF Guidelines Task Force. Due to the limited evidence to support a guideline in this regard, the topic of septoplasty was selected for clinical consensus statement (CCS) development. The objectives 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. A Miniseminar during the AAO-HNSF 2015 Annual Meeting & OTO EXPO^SM presented the result of this process, and focuses on diagnosis, medical therapy, and surgical interventions.

More from November 2015 - Vol. 34, No. 10

Development of a professional code of conduct in an academic otolaryngology departmentExpanded from the print edition

Otolaryngology departments are increasingly becoming aware of the critical importance of professionalism in the academic medical setting.1 Growing evidence is showing that lack of civility in the workplace harms patient safety, employee satisfaction, and the broader institutional mission. Literature from other medical departments and from fields outside medicine suggests that a formalized written code of conduct is an effective method of clearly codifying the culture for all members of the organization, and of improving professional behavior.2

There is an ‘I’ in team

At the heart of the word committee, both literally and figuratively, is the word commit. As former basketball coach Pat Riley said, “There are only two options regarding commitment. You’re either in or you’re out. There is no such thing as life in-between.” Ditto for a successful committee.

Legislative Advocacy highlights from Annual Meeting

Another successful Annual Meeting & OTO EXPO(SM) has come and gone. In case you were unable to join us in Dallas, below is a brief overview of what you missed.

Gaining public trust

Imagine that you are dependent on a system that you have been familiar with most of your life to provide preventative and life-saving care for you and your family. That system is now undergoing monumental, fast-moving changes that not even the architects or participants of the successor structure can define or explain to those who will be using it or making it work. Will you still have insurance coverage for you and your family? Will you be able to pay for the coverage and the dramatic increase in out-of-pocket costs you will be expected to pay? Well, this scenario does not require any imagination. This is what American patients are facing and will continue to face over the next three to five years.

Those who can do more, volunteer

Most of us are used to a very specific type of work. Whether we are working in a clinic, a hospital, or an operating room, we are used to applying certain otolaryngologic skills every day. We learned those skills in medical school and in training, and keep them fresh with CME activities. We advance our careers because we become great at these skills. As a group, we are self-motivated and highly capable learners. Otolaryngology residency applicant personality types1 show us to be primarily extroverted, thinking, and judging. We become, and stay, busy in our practices and in our families.