Is It Common for a Septum to Redeviate? My Journey with ENT Issues
**A Brief Background** In October 2003, at the age of 15, I faced multiple surgeries simultaneously, which included: double jaw osteotomies, the extraction of wisdom teeth, a myringotomy, septoplasty, and turbinate reduction. The recovery period wasn’t very memorable for me, given the extent and number of procedures performed at once. **Fast Forward to Recent Years** Years later, I noticed that my upper teeth were shifting inward from the sides, resulting in a significant crossbite. I didn’t realize the severity of the issue until I sought braces again a couple of years ago. However, I remain uncertain about whether this dental shifting was influenced by my jaw or nose or if it was just an independent occurrence. It's rather perplexing, especially considering the various plates and screws placed in my jaw. A few years post-shift, my left ear, which has been problematic in the past, began to feel congested again. This re-introduced symptoms of tinnitus and dizziness, and I found myself unable to breathe through my nose, relegating me to mouth breathing, which was incredibly uncomfortable. **Back to Medical Attention in 2013** I returned to the ENT specialist who had performed the initial surgery on that side. He is a well-regarded, board-certified surgeon, highly recommended by friends and family. This procedure closely resembled the previous one, with the exception of any jaw work. For a span of several years, everything seemed manageable, but over the last six years, I feel I’ve reverted to my original state. My left nostril completely collapses when I inhale, preventing any airflow. The frustrations of my ear’s condition weigh heavily on me. I frequently find myself actively forcing air through my nose while pinching it just to achieve a fleeting sense of relief. Occasionally, I experience a brief moment when my ear opens on its own, allowing me to relish the bliss for a mere 15 seconds—an exhilarating experience that is both rare and fleeting. Yet, the dizziness, relentless tinnitus, and constant headaches have made life difficult, severely limiting my activities. Recently, I began monitoring my nighttime oxygen levels, which have been plummeting into the 70s quite regularly. I consulted two different ENT specialists, including the same surgeon from before and another reputable doctor. Unfortunately, both of my appointments ended in dismissal of my concerns. That was about two years ago now. They prescribed an ear ointment, nasal spray, and even an off-label antidepressant to help alleviate the tinnitus, but nothing seems to work. I've arranged to meet with a new double board-certified ENT and facial plastic surgeon. However, that consultation won’t happen for another month, and I’m feeling a mix of anticipation and anxiety about it. **Questions Arising** Given this background, I’m wondering if it’s typical for a septum to redeviate over time? Can you experience ear and nasal issues as if they’ve returned to how they were two decades ago? I was still quite young during my first operation, but my second surgery happened when I was more aware of my body. I haven’t grown much since I was 15—my height has remained the same—but I realize that growth involves more complexities beyond mere height increases. The dismissive attitude of some doctors has compounded my feelings of being unwell. While I struggled to articulate the extent of my suffering during those visits, I am reaching a breaking point and it has overshadowed many aspects of my life. Is there a chance that a revision surgery could adjust things? I would willingly consent to cartilage grafting or any necessary procedures to restore my quality of life, even though I’m unclear on what my normal would look like anymore. **Surgical History Summary** To provide context regarding my surgeries: **First Surgery Report (Excluding Jaw Work):** 1. Septoplasty for a deviated septum 2. Inferior turbinate reduction via cautery 3. Left myringotomy with fluid evacuation **Second Surgery Report:** 1. Septoplasty for a severely deviated septum 2. Bilateral inferior turbinate resection 3. Endoscopic resection of left middle turbinate concha bullosa 4. Left myringotomy with a tube placement 5. Right debridement of an unexpected nasal polyp that had not shown up in tests and was never discussed with me—this was news to me today. The surgical notes indicated it was inadvertently removed without being sent for pathology but appeared benign. I’m baffled as to why, despite undergoing a nearly identical surgical procedure the second time around, I still find myself in distress. Any suggestions or supportive messages would mean the world to me. **In Summary:** I'm about to embark on what seems to be a potential journey toward another surgical intervention for my deviated septum and ear concerns. Is this something that others have experienced?
Answers (1)
8/15/2025, 1:11:05 AM
OpenHealth AI
Summary: It is not uncommon for a septum to redeviate over time, particularly after multiple surgeries. Your ongoing nasal congestion, ear issues, and symptoms like tinnitus, dizziness, and headaches are understandably distressing. Considerations for revision surgery may be appropriate, especially given the impact on your quality of life. Here’s what you can do next.
Explanation: The nasal septum, which is the structure separating the two nostrils, can indeed redeviate for a variety of reasons, including the healing process and changes in facial structure over time. After your extensive surgeries, it's possible that shifts in the jaw, nasal passages or even internal healing responses led to renewed symptoms.
Nasal and ear issues can frequently overlap, particularly if the nasal passages are obstructed, which can affect pressure regulation in the ears, leading to eustachian tube dysfunction. Your experience of temporary relief hints at the potential for successful interventions, but they require careful assessment by specialists.
Your symptoms of dizziness, tinnitus, and headaches are significant and warrant closer investigation to rule out underlying issues, such as sleep apnea, especially if your nighttime oxygen levels are dropping significantly. Consulting with multiple ENT specialists can sometimes lead to frustrations, but it's crucial to find someone who will actively address your concerns.
Next Steps:
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Prepare for Your Upcoming Consultation:
- Write down all your symptoms, including their frequency and intensity.
- Note how these symptoms impact your daily life.
- Bring a list of questions and any relevant previous medical reports to your appointment.
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Monitor Your Symptoms:
- Keep a journal of your nasal congestion, ear pressure, dizziness, and other symptoms, including any triggers or patterns.
- Document your nighttime oxygen levels as this will be important for your doctor to assess.
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Consider Remedial Practices:
- Use saline nasal sprays or neti pots to help maintain nasal hygiene and moisture, potentially easing some symptoms.
- Practice breathing exercises to help retrain nasal airflow and reduce mouth breathing.
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Discuss Surgical Options:
- In your upcoming consultation, express your willingness to consider revision surgery and ask about the potential for cartilage grafting or other interventions.
- Ask about the risks and benefits of revision surgery, as well as what the expected outcomes could be.
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Seek Support:
- Engage in support groups, either locally or online, where others with similar experiences share their journeys and coping strategies.
It's completely understandable to feel anxious about your journey ahead, but focusing on clear, actionable steps can help you feel more in control. You deserve to find solutions that enhance your quality of life, and I wish you the best as you navigate this process.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - Urea: 1.80 mmol/L (normal) - Creatinine: 33.4 μmol/L (normal) - **ALT: >1000 IU/mL** (EXTREMELY HIGH - severe liver dysfunction) --- ## FOLLOW-UP IMAGING (December 16, 2025 - 5.5 Months Old) ### Liver Ultrasound: **RESULTS:** - Right lobe: 64 mm, left lobe: 43 mm - Liver capsule appears irregular and vague - **Parenchyma: heterogeneous, showing 7 hypo-isoechoic nodules** (sizes range from 11.5×10.7 mm to 17.6×15.4 mm) - Capsule features uneven contours - Blood flow noted during Doppler examination - No dilation in intrahepatic bile ducts - **Portal vein: 3.9 mm** (decreased from 6.1 mm - indicating improvement) - Common bile duct: 1.4 mm - Gallbladder: measures 43.7×9.2 mm (pear-shaped, wall thickness 2.0 mm, homogeneous, free of stones) **ULTRASOUND ASSESSMENT:** "Presence of liver volumetric formations (specifically liver hemangiomas)." --- ## LATEST MSCT (February 6, 2026 - 7 Months Old) ### MSCT with 3-Phase Contrast: **FINDINGS:** - Liver remains normal in size, but shows heterogeneous structure with uneven contrast enhancement - **Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.