Recurrence of Nasal Blockage After Surgical Intervention
Recurrence of nasal blockage after surgical intervention is common, with studies showing that 78.9% of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) experience recurrence over a 12-year period, and 36.8% require revision surgery. 1
Rates of Recurrence
Recurrence rates vary based on the underlying condition and surgical technique, ranging from an estimated <10% recurrence rate for surgical artery ligation or arterial embolization to 50% recurrence for nasal packing in patients with epistaxis. 2
For patients who have undergone septoplasty, approximately 10% experience some form of nasal obstruction postoperatively. 3
In patients with CRSwNP, long-term follow-up shows that despite initial improvement, the probability of substantial relief gradually decreases with time. 4
A 12-year prospective cohort study of patients with CRSwNP who underwent endoscopic sinus surgery found that 30 out of 38 patients (78.9%) developed recurrent nasal polyps. 1
Factors Contributing to Recurrence
Anatomical Factors
- Unaddressed anatomical issues during primary surgery are common causes of persistent or recurrent nasal obstruction, including:
Iatrogenic Factors
- Surgical complications can lead to persistent nasal blockage:
Inflammatory Factors
- Revascularization of the nasal mucosa 2
- Persistent digital trauma 2
- Bacterial colonization 2
- Incomplete resolution of inflammatory disease 6
Specific Conditions and Their Recurrence Patterns
Chronic Rhinosinusitis with Nasal Polyps
CRSwNP has a particularly high recurrence rate, with significant predictors for revision surgery including:
Despite significant improvement in symptoms after surgery, the probability of substantial relief gradually decreases with time. 4
Post-Septoplasty Recurrence
The probability of having at least a 50% reduction in blockage decreases from 73% at 3 months to 27% at 2½ years after septoplasty and turbinate surgery. 4
Obstructive, vasomotor type of rhinitis often ensues after rhinoplasty, which can usually be treated with corticosteroid injections into the turbinates. 3
Prevention and Management of Recurrence
Medical Management
Corticosteroid delivered via nasal irrigation is superior to simple nasal spray in post-surgical patients with chronic rhinosinusitis, showing greater improvement in:
For patients with allergic factors contributing to recurrence, management should include:
Surgical Considerations
Careful surgical follow-up in the immediate postoperative period will minimize synechiae formation. 2
Preservation of as much turbinate tissue as possible is now considered an important part of surgical management to prevent symptoms of nasal dryness or blockage. 2
For recirculation of mucus (when mucus draining through a sinus ostium re-enters the maxillary sinus through a different ostium), revision surgery may be needed to create a single ostium. 2
Follow-up Recommendations
Documenting outcomes after treatment for nasal blockage may improve individual patient care and provide research opportunities for studying the effectiveness of various treatment modalities. 2
Routine follow-up is recommended for patients who have undergone invasive treatments for epistaxis. 2
Patients should be educated about secondary symptoms that may require additional follow-up, such as persistent nasal blockage, pain, and/or severe crusting. 2
Common Pitfalls to Avoid
Performing revision sinus surgery too soon after initial surgery without adequate trial of medical therapy. 6
Recommending septoplasty when CT imaging shows no significant septal deviation. 6
Not considering that symptoms may be due to post-surgical changes rather than ongoing anatomical issues requiring revision. 6
Prolonged use of intranasal decongestant sprays, which can worsen symptoms and lead to rhinitis medicamentosa (rebound congestion). 8