Medical Necessity of Septoplasty and Turbinate Resection

Assessment of Medical Necessity

The American Academy of Allergy, Asthma, and Immunology recommends that septoplasty should only be considered medically necessary when there is septal deviation causing continuous nasal airway obstruction that has not responded to at least 4 weeks of appropriate medical therapy 1
Approximately 80% of the general population has an off-center nasal septum, but only about 26% have clinically significant deviation causing symptoms 1
The presence of OSA alone does not justify septoplasty without documented failure of medical management for nasal obstruction 1

A complete medical management trial should include regular use of intranasal corticosteroids, saline irrigations, appropriate antibiotics for bacterial sinusitis, treatment of any underlying allergic component, and mechanical treatments such as nasal dilators 1, 2

Not considering that nasal congestion may be due to other causes such as allergic rhinitis, which should be treated medically first 3

Surgical intervention for nasal obstruction should only be considered after failure of comprehensive medical management, as recommended by the American Academy of Allergy, Asthma, and Immunology, with a strength of evidence based on clinical guidelines 4, 5
Before considering septoplasty or turbinate surgery, turbinate hypertrophy that persists after medical management should be documented, according to the American Academy of Otolaryngology, with a moderate level of evidence 6

If nasal symptoms persist despite allergy immunotherapy, consider CT imaging if surgical intervention is being considered, as suggested by the American College of Radiology, with a high level of evidence 4, 5