What is Nasal Synechiae?

Nasal Synechiae, also known as nasal adhesion, is a condition involving scar tissue building up in the nasal cavities, usually between the turbinates and the septum. Unlike some other scars, synechiae of nose tissues form in strong bands that can join nasal structures which normally remain separate.

Although this nasal scarring isn’t necessarily painful, it can block the airways, causing breathing difficulties and sleep disorders, such as sleep apnoea. Many individuals may not realise that they are experiencing signs or symptoms of nasal scar tissue or may attribute it to conditions such as allergies or persistent sinusitis.

Depending on where in the nose the Nasal Synechiae has developed, it may be visible from the base of the nostrils. In some cases, it may be mistaken for other functional nasal conditions, so it is important to have your symptoms evaluated by a Consultant ENT Surgeon who can distinguish between the specific medical differences in these conditions and offer the appropriate treatment.

In the majority of cases, Nasal Synechiae removal is a straightforward procedure which can significantly improve comfort and overall quality of life for patients who may be avoiding certain activities due to difficulty breathing.

What Are the Symptoms of Nasal Scar Tissue?

Nasal Synechiae symptoms are typically functional and rarely affect the outward appearance of the nose.

If you are concerned about nose scar tissue, Nasal Synechiae symptoms to be aware of include:

• Difficulty breathing
• Snoring or sleep apnoea
• Reduced or altered sense of smell
• Recurrent sinus infections
• Stuffy nose
• Nasal dryness
• Headaches

Symptoms of scarring inside nose are very similar to those of other conditions, including a cyst, enlarged turbinates, or nasal valve collapse. If you are concerned about Nasal Synechiae, it is essential to speak with a qualified surgeon who has experience in treating nasal scar tissue to ensure you are given an accurate diagnosis and the most appropriate treatment options.

What Causes Synechiae in Nose Tissues?

As with scarring in other areas of the body, synechiae of nose structures are typically caused by a certain level of trauma. However, this can arise from a variety of causes, which may influence the treatment and management of the condition.

Nasal Synechiae causes may include:

Injury to the Nose

The prominent positioning and the somewhat fragile structures that make up the nose mean that it can be especially susceptible to injury.

Injuries within the nasal cavities can be caused by:

• Sports and physical activities
• Falls
• Accidents
• Chronic nose picking

Although a broken nose is often the result of these causes, injury to the nose may not result in a complete fracture. However, milder injuries may still lead to nose scar tissue forming.

Previous Nose Surgery

There are several reasons that surgery may be performed on the nose, and internal nasal scarring is a potential risk of many of these procedures. Nasal Synechia is most likely to occur following a procedure which specifically addresses the internal nasal structures:

• Septoplasty – A procedure which realigns the nose’s central cartilage to improve functional concerns without dramatically altering the external appearance of the nose
• Septorhinoplasty – A comprehensive Rhinoplasty procedure which involves repositioning external and internal nasal structures to improve function and aesthetics
• Turbinectomy – A procedure involving the reduction or removal of excess tissue around the nasal turbinates – internal structures within the nasal cavities which can become irritated and swollen

Nasal scarring is normal following any surgical procedure on the nose; however, Synechiae occur when these scars form abnormally during the healing process, becoming hardened and adhering between different nasal structures.

Recurrent Infections & Inflammation

Frequent or chronic infections and inflammation, such as sinusitis (sinus infections), rhinitis (inflammation of the nasal lining), or allergies, can result in lasting irritation and damage to the nasal cavities. The repeated cycle of damage and healing within the nose that this can cause increases the risk of abnormal scar formation.

Although conditions such as sinusitis and allergies do not typically cause serious nasal scarring concerns, in cases where the associated inflammation and damage is ongoing or recurrent, it is important to be aware of the risk.

There are a number of risk factors which increase the likelihood of synechiae in nose tissues from forming:

• Poor surgical technique – Unnecessary trauma to the nasal lining through inexperience or substandard execution
• Post-surgical dressings and splints – The type of internal dressings and splints, as well as the skill with which they are applied
• Recovery and aftercare – Not following surgical recovery and aftercare advice can result in poor healing outcomes
• Inadequately managed conditions – Ineffective or inconsistent management of allergies or nasal health to prevent recurrent infections and inflammation
• Age – Younger individuals may be at a higher risk due to overactive healing responses

Highly qualified and experienced surgeons will discuss any potential risks and complications that may affect your procedure during your consultation. If your consultant is concerned that you are at a higher risk of abnormal nasal scar tissue forming, they will ensure you understand the implications of this and the actions you may need to take.

Nasal Synechiae Treatment

There are several non-surgical and surgical treatments and remedies for nasal adhesion depending on the severity, cause and impact of your condition.

The best way to determine the most suitable Nasal Synechiae treatment for you is to speak with an experienced Consultant ENT Surgeon with experience in assessing and treating nose scar tissue.

Non-Surgical Nasal Synechiae Treatment

Consultants will often recommend trying non-surgical Nasal Synechiae treatment to manage or improve symptoms before suggesting surgery. Non-surgical treatments are often highly effective for mild or recently developed cases of nasal adhesion. But even for moderate to severe cases, they may offer improvement and relief, providing more time to consider other treatment options.

Steroid Injections

Steroid injections often provide a simple and effective option for nasal scar revision.

They work by directly calming down the overactivity in the immune system, which is causing the overdevelopment of scar tissue in the nose. This reduces inflammation and softens the hardened scar tissue, resulting in the reduction of the Nasal Synechiae.

In some cases, surgeons may use steroid injections as a preventative measure at the end of a Rhinoplasty procedure, to stop the abnormal scar tissue inside nose from forming in the first place. However, this isn’t suitable or necessary for all patients.

To effectively treat nasal scar tissue, steroid injections should typically be administered within 12 months of the scarring developing.

Nasal Steroid Sprays

Nasal sprays containing steroids work in a similar way to steroid injections, calming inflammation. However, as they are not injected into the tissues of the nose, they typically only prevent further scarring from developing, rather than softening and reducing existing scarring inside nose structures.

As a Nasal Synechiae treatment, nasal steroid sprays are suitable for mild cases which have been detected at a very early stage, to prevent scarring from worsening and causing more serious concerns.

The use of nasal steroid sprays must be closely supervised by a medical professional, as overuse can lead to concerns requiring further medical intervention, such as rebound congestion or septal perforation.

Saline Rinses

Also known as nasal irrigation, saline rinses are sprayed into the nasal passages in the same way as nasal steroid sprays, but do not contain steroids; they only contain distilled water and salt.

Using a saline rinse regularly maintains the correct moisture balance in the nasal passages and reduces irritation, which may contribute to inflammation that is causing abnormal scar tissue to develop.

Similar to nasal steroid sprays, saline rinses won’t address pre-existing nasal scarring, but they can prevent scarring from becoming more serious. In cases where a patient has been using a nasal steroid spray for the prescribed duration, a saline rinse may be recommended as a follow-up treatment to help prevent side effects.

Surgical Nasal Synechiae Treatment

In cases where non-surgical Nasal Synechiae treatment has either been unsuccessful or when nasal scarring is too severe to be treated with non-surgical options alone, a variety of surgical Nasal Synechiae treatment options are available.

It is essential to find a surgeon who has extensive experience performing surgery to address internal nose scar tissue, as if not carried out correctly, surgery could make the condition worse.

Nasal Synechiae Removal

Nasal Synechiae Removal is the primary surgical treatment option. Performed under general anaesthetic, the procedure involves the careful excision and removal of the bands of hardened scar tissue that have formed within the nasal passages. This clears the airways, restoring a steady airflow.

At the end of the procedure, refined internal nasal dressings are inserted with great precision and care to aid healing and support the structure of the nasal passages. This is typically removed 5-7 days after the procedure to allow healing and recovery to continue.

Nasal Splints

Alongside Nasal Synechiae Removal, nasal splints or spacers may be placed within the nose to prevent the newly separated tissues and structures from adhering back together during the initial healing phase. As with the dressings, it is crucial that these splints are precisely and expertly placed to prevent additional trauma or damage to the nose. The splints will be removed once the nasal tissues have healed sufficiently that they won’t readhere.

Other Nose Procedures

If other conditions or concerns are contributing to obstruction alongside nasal septum scar tissue, additional procedures may be performed in conjunction with Nasal Synechiae Removal to optimise the result. Whether this is suitable will depend on the severity of the condition, and whether your surgeon feels your nasal tissue is able to withstand the physical impact of the surgery without risking the scarring inside nose from recurring.

Procedures such as Septoplasty to straighten a deviated septum or Turbinectomy to address enlarged turbinates can both be performed in combination with Nasal Synechiae Removal. More involved procedures, such as Rhinoplasty or Septorhinoplasty, are less likely to be suitable as they are more extensive.

How to Prevent Nasal Synechiae

Although Nasal Synechiae treatment is highly effective, where possible, preventing nasal adhesion from forming in the first place is advisable.

It is important to acknowledge that this may not always be possible, for example, in cases of sudden injury.

• Avoid nasal irritation – Prevent irritating the nasal lining by not picking your nose or blowing it aggressively. If you are going to be exposed to irritants such as dust or smoke regularly or for an extended period of time, consider wearing a mask
• Manage ongoing conditions – If you are affected by chronic nasal conditions or allergies, ensure you have an effective and consistent treatment plan in place to prevent unnecessary inflammation or complications
• Finding a suitable surgeon – If you are considering a nose surgery, ensure your procedure is performed by a qualified Consultant Surgeon who has the correct knowledge and experience to address your concerns
• Surgical aftercare – If you have undergone any type of Rhinoplasty procedure, ensure you thoroughly follow your surgeon’s recovery and aftercare instructions, including the regular use of remedies such as saline rinses to aid healing

Where possible, preventing abnormal scarring inside nose structures and tissues from forming is likely to be better for your overall respiratory health, rather than relying on treatment options.

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