Clinical and Functional Outcomes of Conventional Septoplasty Versus Endoscopic Septoplasty in Patients with Symptomatic DNS

Abstract

Background: Deviated nasal septum (DNS) is a common cause of nasal obstruction and is associated with symptoms such as nasal blockage, recurrent sinusitis, epistaxis, and headache. Septoplasty is the definitive surgical treatment, with conventional septoplasty widely practiced and endoscopic septoplasty offering enhanced visualization and precision, particularly for posterior or complex deviations. Objective: This study aimed to compare the clinical and functional outcomes of conventional septoplasty versus endoscopic septoplasty in patients with symptomatic DNS. Methods: A prospective study was conducted at Malleus ENT Specialized Hospital Limited in Dhaka from June 2023 to June 2024. One hundred patients with symptomatic DNS were randomly allocated into two equal groups: conventional septoplasty (n=50) and endoscopic septoplasty (n=50). Preoperative evaluation included detailed history, anterior rhinoscopy, endoscopic assessment, and objective nasal airflow measurement using the Gertner-Podoshin plate. Postoperative outcomes were assessed subjectively (symptom relief) and objectively (nasal airflow) at multiple follow-ups. Complications were also recorded. Results: The majority of patients were young adults (11–30 years), with male predominance in both groups (72% conventional vs 80% endoscopic). Preoperatively, nasal obstruction was universal (100%), with additional symptoms including nasal discharge, headache, sneezing, hyposmia, and epistaxis. Anterior rhinoscopy and endoscopy revealed right-sided DNS in 36–40% and left-sided DNS in 32% of cases, with hypertrophied inferior turbinates in 44–48%. Preoperative objective airflow was moderate in most patients (60–68%). Postoperatively, significant symptomatic improvement was observed in both groups: nasal obstruction relief was achieved in 88% of conventional and 96% of endoscopic cases, while complete resolution of nasal discharge, hyposmia, and epistaxis occurred in all patients. Endoscopic septoplasty demonstrated superior objective airflow improvement, with 48% of patients achieving optimal airflow (6–9 cm) compared to 20% in the conventional group. Complication rates were lower in the endoscopic group, including reduced hemorrhage, mucosal tears, and absence of synechiae. Conclusion: Both conventional and endoscopic septoplasty are safe and effective for treating symptomatic DNS. Endoscopic septoplasty offers slightly better functional outcomes, improved nasal airflow, and fewer complications, making it particularly advantageous for precise correction of complex septal deviations, while conventional septoplasty remains a reliable option for standard cases.