ENT - patient / doctor trust - Deviated septum - Scanner necessity - Arbitration in how much to cut

ENT - patient / doctor trust - Deviated septum - Scanner necessity - Arbitration in how much to cut - around Paris

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Christopher Mann - 15 Dec 2004 09:11 GMT

Hello,

I have an severe s-shaped deviated septum, turbinate hypertrophy and a
very weak ala. I will get surgery (septoplasty or SMR).

A young doctor just opened an ENT section in a clinic near where I live.
He suggests correcting the septum and reinforcing the nasal walls (the
collapsing ala).

At the same time, he suggested not having surgery with an older French
ENT. He believes (as far as I can remember from our conversation) that
the the frenzy of nasal correction in the past and the subsequent
results showed that the previous surgical training of French ENTs was
insufficient.

Needless to say, one ENT distrusting another scares me. I then saw
another ENT, and one ENT pair.

The second ENT in a different clinic said to go with the septum and
turbinate surgery.

The ENT pair is one who works in a hospital and the other who has an
office. The office ENT handles the patients and the hospital ENT does
the surgery. They were highly recommended.

After seeing the office ENT, the hospital ENT refuses to operate on me
because he doesn't have confidence in me. He thinks I fear the surgery.
I asked too many questions out of my fear from the first ENT. He
refuses the Collapsing Ala (and is probably right). His idea, which
seems right to me too, is that I cannot trust him and thus he cannot
trust me (fear of malpractice, probably also due to my accent). He is
right.

When an ENT does deviated septum and turbinate surgery, I have the
feeling that there may be choices he/she has to make in order maximize
breathing but minimize the chances of a pierced septum. Is this true ?

As a secondary question, does a scanner significantly help in the
surgical stage ? The hospital ENT prescribed it, but the other two
didn't mention this at all. Am I right in taking this to be a more
professional way to go about preparation for the surgery ?

Of course, other than my two questions, any comments or questions you
may have about this story/dilemma are welcome.

Many thanks

Chris Mann

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CanDo - 15 Dec 2004 16:04 GMT

Another place to ask questions about sinus surgery is the "nose board".
There are many there who have had surgery, especially to their turbinates,
and who might also be able to answer your quesions. The link to the "nose
board" is:

http://members.boardhost.com/shouser144/index.html?1071149361

> Hello,
>
[quoted text clipped - 44 lines]
>
> Chris Mann

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Don Brady - 15 Dec 2004 17:47 GMT

>Hello,
>
[quoted text clipped - 16 lines]
>The second ENT in a different clinic said to go with the septum and
>turbinate surgery.

In other words he thinks the Ala surgery is unnecessary?

>The ENT pair is one who works in a hospital and the other who has an
>office. The office ENT handles the patients and the hospital ENT does
[quoted text clipped - 4 lines]
> I asked too many questions out of my fear from the first ENT. He
>refuses the Collapsing Ala (and is probably right).

You may recall that I have suggested people be careful about the Ala diagnosis.
It can be perfectly valid but sometimes there seems to be disagreement about
whether the condition exists. I had one ENT say I had it but no others ever
did so I ignored it.

>His idea, which
>seems right to me too, is that I cannot trust him and thus he cannot
>trust me (fear of malpractice, probably also due to my accent). He is
>right.

If he does not want to do it, do not press him to do so. You can see him
for more information though.

You need to research who are the experts and get more opinions intil *you* are
satisfied *you* know what to do and who to have do it. At least, that is the
approach I took and it worked out well.

Then go to the person you want to actually have do it and don't give him (or
her) too hard a time.

>When an ENT does deviated septum and turbinate surgery, I have the
>feeling that there may be choices he/she has to make in order maximize
>breathing but minimize the chances of a pierced septum. Is this true ?

There are indeed different approachers ans philosophies and techniques.....

>As a secondary question, does a scanner significantly help in the
>surgical stage ? The hospital ENT prescribed it, but the other two
>didn't mention this at all. Am I right in taking this to be a more
>professional way to go about preparation for the surgery ?

You should have a CT scan for diagnostic purposes.

If you mean *during* the surgery, i.e. "image guided surgery", it is a risk
reduction measure. Quite a few very experienced surgeons prefer not to use
it (they don't need it). Others love it.

>Of course, other than my two questions, any comments or questions you
>may have about this story/dilemma are welcome.

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