Post-Surgery Nasal Congestion: Seeking Relief After Turbinate Surgery

My rhinitis—this surgery was unnecessary?

I recently underwent surgery for nasal polypectomy and septoplasty less than two months ago, but my nose is congested again.
I looked in the mirror and can see that some of the tissue has indeed been removed, but there is still swollen tissue further inside that is blocking my airway.
What can I do to achieve relief? I hope I don't have to undergo another surgery.
Initially, I was told that this would resolve the issue completely.
My congestion worsens when I encounter cold air; it was even worse before the surgery.

Please advise me on how to achieve relief.
I am open to another surgery if necessary, as long as I can breathe freely.
I am unsure if this is a postoperative complication or something else.
The surgery was performed under local anesthesia, and when the needle was injected, I experienced excruciating pain in the back of my head that made me cry.
Even after the surgery, the pain persisted and continues to this day.
I wake up with headaches in the morning, and sometimes the pain lasts all day.
It feels like a throbbing pain in the same spot at the back of my head, and I am very worried about the possibility of a stroke.
I had experienced similar pain before the surgery, but it was infrequent.
I hope the doctor can help me.

nikegg, 20~29 year old female. Ask Date: 2005/03/05

Dr. Ye Dawei reply Otolaryngology

Sir, your issue requires a clinical examination for a clear understanding of the problem.
Please visit the outpatient clinic.
My clinic hours are Monday, Wednesday, Thursday, and Friday mornings.
Here is a reference document for you:
┌─── 　■ Dr.
Da-Wei Yeh's ENT Clinic Medical Education ■　 ───
2000/02/20
The leading dizziness specialist in the Zhuliu area, a pioneer in online medicine in Taiwan
└─ Dr.
Da-Wei Yeh's ENT website: http://www.csie.nctu.edu.tw/~yehdawei
─┘
This article will be organized later on the 【Dr.
Da-Wei Yeh's ENT website/Health Education】.
Articles on this website are welcome to be cited, but please indicate the source.
-----------------------------------------------------------
【The 'Cure-All for Nasal Diseases' That Makes One's Nose Tingle】
In the outpatient clinic of an ENT specialist, symptoms such as cough, headache, dizziness, and nasal congestion are very common.
However, due to their complex causes, treatment can be challenging, leading patients to flock to exaggerated advertisements promising "cures" and "guaranteed treatments." In the past two years, I have treated many patients who underwent the so-called "five-minute nasal disease cure," resulting in issues like nasal mucosa adhesion, nasal vestibule inflammation, nasal passage narrowing, and nasal septum perforation—truly a distressing situation.

The causes of nasal congestion generally include "infection," "structural abnormalities of the nose," "allergic rhinitis," and "vasomotor rhinitis," each with its own pathogenic mechanisms and treatment approaches.
Of course, each condition has its limits in efficacy, which has allowed these alternative practitioners to thrive.
Below, I will briefly introduce each condition based on this classification.
◎ Infection: The most common cause of nasal congestion is the common cold.
Once the cold resolves, the nasal congestion typically improves.
Bacterial infections leading to sinusitis are more severe, often accompanied by post-nasal drip, headaches, difficulty concentrating, and chronic nighttime cough.
In children, this can significantly affect sleep quality and academic performance.
If conservative treatments such as medication and nasal irrigation are ineffective, surgery may be recommended.
The traditional Luc's procedure, which involved incising the lip to remove the entire sinus mucosa, has now been completely replaced by endoscopic sinus surgery.
This technique allows for selective removal of obstructive mucosal tissue under good visualization, restoring normal sinus function.
◎ Structural Abnormalities of the Nose: Deviated septum and chronic hypertrophic rhinitis.
A deviated septum can occur naturally at birth or due to trauma causing cartilage distortion.
The degree of deviation does not always correlate with nasal congestion, and the decision to correct it surgically can depend on the patient's subjective experience.
Chronic hypertrophic rhinitis refers to the thickening of normal turbinate tissue, which can cause nasal congestion.
The turbinates, also known as nasal conchae, are normal physiological structures located on the lateral wall of the nasal cavity, and patients can often see them when examining their own nasal cavities.
Sometimes, patients are misinformed that these are nasal polyps and undergo inappropriate cauterization.
◎ Allergic Rhinitis: Currently, there is no definitive cure for allergic rhinitis in medicine.
It is a disease caused by a specific predisposition, leading to edema of the nasal mucosa and resulting in nasal congestion.
Treatment can be tailored based on the severity of symptoms, utilizing oral medications, nasal sprays, or even surgery to alleviate nasal congestion.
◎ Vasomotor Rhinitis: Various factors can trigger vasomotor rhinitis, including work stress, hormonal changes during pregnancy, certain antihypertensive medications, and irritants such as perfumes, temperature, humidity changes, or cooking fumes.
These factors can cause dilation and congestion of the blood vessels in the nasal mucosa, leading to symptoms of nasal congestion.
Treatment options for chronic hypertrophic rhinitis, allergic rhinitis, or vasomotor rhinitis include conservative oral medications, nasal sprays, traditional inferior turbinate resection, and advanced laser surgery.
There is also a technique using thermal probes placed submucosally in the turbinates, where radiofrequency generates low heat to cause protein coagulation in the submucosal tissue, leading to fibrosis and reduction of the hypertrophied turbinates.
Nasal congestion is not classified as a disease, but it is a very bothersome symptom.
It not only makes breathing difficult but can also easily lead to dizziness, headaches, difficulty concentrating, snoring, insomnia, or sleep apnea.
Consulting a professional ENT specialist to identify the true cause of nasal congestion and selecting appropriate symptomatic treatment is the right approach.
I sincerely hope to no longer see so-called "cure-alls for nasal diseases" in the outpatient clinic.

Reply Date: 2005/03/05

More Info

Post-surgery nasal congestion, especially after procedures like turbinate reduction and septoplasty, can be a frustrating experience. It’s not uncommon for patients to feel that their nasal passages are still congested even after surgery, and this can lead to concerns about whether the surgery was effective or if further intervention is needed.

Firstly, it’s important to understand that the healing process after nasal surgery can take time. While some swelling is expected immediately after the procedure, it can persist for several weeks or even months. The turbinate tissues, which are responsible for humidifying and filtering the air we breathe, can also swell in response to environmental factors such as cold air, allergens, or irritants. This means that even if some of the turbinate tissue was removed during surgery, the remaining tissue can still react and cause congestion.

In your case, you mentioned that you are experiencing nasal congestion again, and upon inspection, you noticed that some tissue remains swollen. This could be due to several factors:
1. Post-operative Swelling: After surgery, the nasal tissues can remain swollen for an extended period. This swelling can contribute to feelings of congestion, even if the surgery was technically successful.

2. Nasal Mucosa Reaction: The nasal mucosa can react to changes in the environment, leading to swelling. If you are experiencing congestion primarily in response to cold air, it may indicate that your nasal passages are sensitive to temperature changes.

3. Possible Inflammation or Infection: If there is persistent pain or discomfort, it could indicate inflammation or even a secondary infection. This is something that should be evaluated by your surgeon or an ENT specialist.

4. Nasal Polyps or Residual Turbinate Tissue: In some cases, if there is residual turbinate tissue or the development of nasal polyps, this can lead to ongoing congestion.
To address your concerns and seek relief, consider the following steps:
- Follow-Up Appointment: Schedule a follow-up appointment with your ENT specialist. They can perform a thorough examination, possibly using nasal endoscopy, to assess the condition of your nasal passages and determine if there are any issues that need to be addressed.

- Nasal Irrigation: Using saline nasal sprays or performing nasal irrigation can help keep the nasal passages moist and clear out any irritants or mucus that may be contributing to your congestion.

- Avoid Irritants: Try to avoid exposure to known irritants, such as smoke, strong odors, or allergens, which can exacerbate nasal congestion.

- Medication: Discuss with your doctor the possibility of using nasal corticosteroids or antihistamines to help reduce inflammation and manage symptoms.

- Pain Management: For the headaches you are experiencing, it’s important to discuss this with your doctor as well. They can help determine if the headaches are related to the surgery or if there is another underlying issue.

- Consider Further Evaluation: If symptoms persist despite conservative management, further evaluation may be necessary. This could include imaging studies or even a discussion about the possibility of revision surgery if deemed appropriate.

In conclusion, while it can be disheartening to experience congestion after surgery, it’s important to remember that healing takes time. Open communication with your healthcare provider is crucial in managing your symptoms and ensuring that you receive the appropriate care. Don’t hesitate to reach out to your doctor with any concerns, as they can provide the best guidance tailored to your specific situation.

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