My daughter is 12 years old and has been diagnosed with a severe deviated septum - a twist which is partially blocking the sinus opening. She began a series of severe sore throats last year, including numerous strep infections, and finally had her tonsils removed last April. This past November she again started with severe sore throats, and after many different medications, her ENT has recommended surgery to correct the deviated septum since he feels the post-nasal drip is responsible for the constant sore throats. My concern is that initially I had been told that this surgery is not done before a child is 16 or older since the face continues to grow and change up to then. He tells me that he feels there have been enough successful cases on children her age so that it will not be a problem, and that she will continue with the sore throats unless she receives the surgery. I have also made an appointment with an allergist since the ENT doctor feels some of the post-nasal drip may also be allergy related. How can I find out more about this surgery in younger children? She missed a lot of school this year and is very depressed about being sick all the time.
Reply: -------------------------------
It is true that septoplasty has been done in children younger than 16 or 17 years of age without affecting facial growth. It is considered a potential risk nevertheless and most otolaryngologists will defer a recommendation for septoplasty until later teenage years unless symptoms that are conclusively related to a deviated septum are severe and warrant earlier intervention. I would personally be hesitant to recommend a septoplasty in a 12 year old if recurrent sore throat were the primary symptom. The symptoms that in my opinion may warrant septoplasty in children under 16 or 17 are severe nasal airway obstruction and/or chronic sinusitis that cannot be alleviated with medication and/or allergy management. It is true that nasal airway blockage due to a deviated septum can result in chronic mouthbreathing which in turn can lead to frequent sore throats. This is due to a drying effect since one of the functions of the nose is to warm and humidify the air we breathe. But it should be fairly clear and easy to determine that the sore throats are due to nasal airflow obstruction. If post-nasal drainage were primarily responsible for sore throats and nasal airflow blockage was not a major problem, then I would suspect that non-surgical therapies would be available to eliminate the problem. It would be important to assess the sinuses, possibly with a CAT scan to make sure chronic sinusitis was not present. Septoplasty would not necessarily be considered appropriate primary management of chronic sinusitis although it might ultimately be recommended if other more appropriate initial treatment measures failed. I would strongly concur with an evaluation by an allergist.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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