IF A PERSON HAS BEEN DIAGNOSED WITH DEVIATED SEPTUM AND ENLARGED TURBINES... FOR WHATEVER THAT MEANS, IF HE CAN'T BREATHE DAY IN AND DAY OUT, LIVES ON DECONGESTANTS AND PAIN RELIEVERS AND BECONAISE...WHY WOULD THE HMO, DENY HIS PROCEDURE?? WHAT CAN HE RECOMMEND TO HIS PRIMARY PHYSICIAN THAT WILL GET HIM SOME LASTING HELP ON HIS CONDITION?
Answer:
Nasal airway obstruction is commonly caused by deviations or abnormalities of the nasal septum. Additionally, enlargement of the nasal turbinates can either be a primary cause or a contributory factor in nasal airway blockage.
When either or both conditions are present, symptomatic patients are occasionally satisfactorily improved by topical nasal steroids and oral decongestant medications. These medicines successfully improve the airway by shrinking reversible swelling of the lining of the turbinates.
If the turbinate mucosa (lining) becomes irreversibly swollen, or if the predominate cause of symptoms is related to a deviation of the septum, medication typically will not relieve symptoms. When symptoms are not alleviated with such medications, the only alternative treatment is surgery.
Deviations of the nasal septum are corrected by an operation known as a septoplasty - an outpatient procedure commonly done under local anesthesia with sedation. There is little to no external bruising or swelling, and recovery is generally fairly quick (return to work 2-7 days; return to normal physical activities within 1-2 weeks).
When turbinates need to be addressed surgically, I prefer to either trim them or shrink them using a laser. This typically results in a short period (1-3 weeks) of nasal crusting requiring the use of nasal emollients or salt water irrigations during the recovery period.
As to the question regarding an HMO denying the procedure, I can think of little justification to deny a relatively minor operative procedure that has a high success rate and offers a strong liklihood of freedom from chronic symptoms without dependency on medication. Many HMO's cover the cost of prescription medication to some extent. Interestingly, if you consider the typical cost of the commonly used medications required to successfully control nasal obstruction; and if you consider the typical clinical scenario that such medications, should they be successful, will be required on a regular basis since they don't "cure" the problem, only temporarily relieve symptoms, it would seem to make more sense for an HMO to approve a minor surgical procedure that has a high success rate and great likelihood of relieving symptoms in a single step.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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