Illustration of a deviated septum obstructing sinus drainage.

Stuffy Nose After Sinus Surgery? What You Need to Know About Septal Deviation

Lena Voss in Health & Wellness December 2025 • 4 min read.

"Discover how a seemingly minor nasal issue can impact the success of your sinus surgery and what it means for your breathing."

Endoscopic sinus surgery (ESS) has become a game-changer for those battling chronic rhinosinusitis (CRS) that doesn't respond to medication. While ESS boasts impressive success rates, some individuals find themselves needing a second surgery because their sinus issues return or persist.

A number of factors can contribute to the recurrence of CRS after surgery, including everything from environmental irritants and allergies to the presence of highly inflammatory cells in the sinuses. One often-overlooked factor is a deviated nasal septum (DNS). This is where the wall inside your nose is crooked, potentially blocking airflow and impacting sinus drainage.

This article will explore new research that highlights how a DNS left unaddressed during sinus surgery can affect the severity and recurrence of CRS. We will break down the key findings of the study, explain why a DNS matters, and offer insights into managing this common issue for better sinus health.

The Hidden Impact of a Deviated Septum on Sinus Surgery Success

Illustration of a deviated septum obstructing sinus drainage.

Researchers at a tertiary academic center conducted a retrospective review of 489 patients who underwent revision ESS for CRS. They compared patients who had a septoplasty (surgery to correct a DNS) along with their revision ESS to those who had revision ESS alone. The study matched patients based on age and sex to ensure a fair comparison.

The results revealed some significant differences between the two groups:

Higher Disease Severity: The septoplasty group had significantly higher Lund-Mackay scores (LMS), a measure of sinus disease severity seen on CT scans.
Increased Obstruction: They also had a greater rate of obstruction in the ostiomeatal complex (OMC), a critical area for sinus drainage.
Specific Sinus Involvement: The septoplasty group showed higher opacification scores (meaning more cloudiness or blockage) specifically in the maxillary and posterior ethmoid sinuses.

Most importantly, multivariable analysis confirmed that DNS was an independent predictor of both higher LMS scores and OMC obstruction. This means that even when considering other factors, the presence of a DNS significantly contributed to more severe sinus disease.

What Does This Mean for Your Sinus Health?

This research provides valuable insights into why some sinus surgeries are less successful than others. An untreated DNS can create a perfect storm of mechanical obstruction, impaired airflow, and reduced access for both surgery and post-operative care, potentially leading to persistent or recurrent CRS.

If you are considering sinus surgery, or are facing a revision surgery, it's crucial to discuss the possibility of a DNS with your ENT (ear, nose, and throat) surgeon. A thorough evaluation, including a review of your CT scans, can help determine if a septoplasty is needed in conjunction with your ESS to optimize your outcome.

Don't hesitate to advocate for a comprehensive approach to your sinus health. Addressing all contributing factors, including a DNS, can significantly improve your chances of long-term relief and better breathing.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1177/0194599818815106, Alternate LINK

Title: Impact Of Septal Deviation On Recurrent Chronic Rhinosinusitis After Primary Surgery: A Matched Case-Control Study

Subject: Otorhinolaryngology

Journal: Otolaryngology–Head and Neck Surgery

Publisher: SAGE Publications

Authors: Terence Fu, Daniel Lee, Jonathan Yip, Alisha Jamal, John M. Lee

Published: 2018-11-27

Everything You Need To Know

What is a Deviated Nasal Septum and how does it impact sinus health?

A Deviated Nasal Septum (DNS) refers to a crooked wall inside your nose. This can block airflow and hinder proper sinus drainage. If left untreated during Endoscopic Sinus Surgery (ESS), it can lead to persistent or recurring Chronic Rhinosinusitis (CRS). The study showed a DNS is an independent predictor of more severe sinus disease, increasing Lund-Mackay scores (LMS) and obstruction in the ostiomeatal complex (OMC).

What is revision Endoscopic Sinus Surgery (ESS), and what were the key findings regarding its success?

Revision Endoscopic Sinus Surgery (ESS) is performed when previous sinus surgery has not fully resolved the Chronic Rhinosinusitis (CRS) or when symptoms return. The study compared two groups: patients who had septoplasty (surgery to correct a Deviated Nasal Septum or DNS) alongside revision ESS, and those who had revision ESS alone. The first group showed higher Lund-Mackay scores (LMS), increased obstruction in the ostiomeatal complex (OMC), and more opacification (blockage) in the maxillary and posterior ethmoid sinuses.

How are Lund-Mackay scores used to assess sinus disease severity?

Lund-Mackay scores (LMS) are used to measure the severity of sinus disease based on CT scans. The study showed that patients with a Deviated Nasal Septum (DNS) who underwent revision Endoscopic Sinus Surgery (ESS) had higher LMS scores compared to those who had revision ESS alone. This indicates that the presence of a DNS is associated with more severe sinus disease, even after surgery.

Why is the ostiomeatal complex important in the context of sinus health?

The ostiomeatal complex (OMC) is a critical area for sinus drainage. The research indicates that a Deviated Nasal Septum (DNS) can obstruct the OMC, impairing proper sinus drainage and potentially leading to recurrent sinus issues. This obstruction can create a perfect storm of mechanical issues and reduced airflow, affecting the success of sinus surgery.

What does it mean that a Deviated Nasal Septum is an independent predictor of sinus disease?

The research found that a Deviated Nasal Septum (DNS) is an independent predictor of more severe sinus disease, specifically higher Lund-Mackay scores (LMS) and obstruction in the ostiomeatal complex (OMC). This means that even when considering other factors, the presence of a DNS significantly contributes to more severe sinus disease. The study highlights the significance of addressing a DNS during Endoscopic Sinus Surgery (ESS) to improve outcomes and reduce the likelihood of recurring Chronic Rhinosinusitis (CRS).