@mastro99- I will speak to my experience and what I have learned. 80% of the population has a deviated septum. It is very very common. These surgeries are presented as “normal and routine”. Routine, because it is one of the most common findings that an ENT will point out to any patient that they see with one and tell them they can “fix” it. But what exactly are they “fixing”. Something that doesn’t look “normal”. Do not fall into the trap of abnormalities. ENTs are surgeons, first and foremost. They will spend more time focusing on things they can present to you that need to be cut or removed. They spend very little time discussing how the nose actually works. The nose is a complete organ system. I works entirely in a finite pattern. This organ is not like the liver or kidney that can still function with less than.
Swelling in the nasal passages is caused my many many different things that need to be addressed first. Many people will get septal surgery thinking it will solve breathing issues. But if the underlying issue has not been addressed, you will still have the same issues. Allergies, in door/outdoor can cause swelling. Hormonal changes, Diet, Stress as well. When we sleep, the nasal mucosa lining and turbinate structure naturally enlarge due to increased blood flow to that area while laying on our backs. This is why a lot of people have to prop head on pillow to breathe better and they are fine. There are many REAL risks that occur with Septum surgery that are not “rare”. Septal perforations are very common. This is one of the most difficult revisions to perform. If this occurs you are often referred to one of the very few ENTs who can perform this correctly. Some ENTs will remove too much cartilage, causing a weakening in the entire septum structure. There is a saying in ENT world “As goes the septum, so goes the nose”. The risk of dryness is common. When the structure is altered if it is done conservatively it can leaves a too open pathway on one or both sides then you will have a sensation of too much air which causes extreme uncomfortability. The lining of the septum is richly innervated with nerve endings. It is very common for these nerves to get damaged, stretched and altered causing constant pain. Neurologists see many patients after all kinds of nasal type surgeries.
Airflow is a very subjective feeling that only you can explain or feel. Only you know what feels normal to you. When an ENT sees you in your original state, he is looking for something objective to match your subjective feeling. ENTs can not “see” airflow. So most of the time it is a guess as to your cause of complaint. If something structurally is altered and you return with a subjective feeling. There is not much they can do at this point as they have already offered their objective findings which they have removed/altered and can not be replaced or put back in. You can bring up everything I just mentioned to your ENT and if he/she denies it or seems caught off guard then then I would move on to a different ENT. I would explore every alternative first. Address the allergies. Use humidifier, nasal irritation moisture before sleep. Assess your diet, exercise and over all lifestyle. Any type of nasal surgery is difficult to ask others, because these surgeries are all performed so different and for different reasons and half the time ENTs don’t even know why they really work.
There are risks with every surgery regardless of how it’s presented. “Simple routine outpatient procedure. You are in and out and probably only need a week off work”. Nasal surgeries also have some of the highest failure rates. This is because this is one of the most delicate, open areas on your body that you still need immediately after surgery. It’s not a knee or shoulder that can be put in a boot or sling.
I know I have provided a lot here. Only because of the way the procedures are presented to patients. Ask yourself if what you are dealing with now, is a minor annoyance that you can control with other modalities rather than running the risk of completely altering your breathing pattern.
Sit with yourself without other opinions or surgical opinions and let your intuition guide you on this. Hope my honesty was helpful.

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