Small Subset of Patients With Fibromyalgia Improved After Septoplasty

Nurce Cilesizoglu Yavuz, MD

Credit: Giresun University

New research has found that fibromyalgia (FM) symptoms improved after septoplasty surgery to correct nasal septum deviation (NSD).¹

“Beyond correcting structural deformities that impede nasal breathing, septoplasty offers surgical solutions for recurrent epistaxis, sinusitis, obstructive sleep apnea, and facial pain stemming from septal spurs touching the lateral nasal wall (Sluder syndrome). Considering that septum deviation, which is frequently accompanied by sleep disorders and psychiatric findings, may predispose to FM, we asked the question whether FM findings could improve after septoplasty, and this study was designed to seek the answer to this question,” investigators Nurce Cilesizoglu Yavuz, MD, Department of Physical Medicine and Rehabilitation, and Yonca Coluk, MD, Department of Otolaryngology, Giresun University, Turkey, wrote.¹

Cilesizoglu Yavuz and Coluk conducted a study of 35 adult patients, 21 male (60.0%) and 14 female (40.0%), with NSD indicated for septoplasty at the Giresun University Giresun Training and Research Hospital Physical Medicine and Rehabilitation Outpatient Clinic and Otolaryngology Department between January 2024 and June 2024. Patients had an average age of 27.69 (standard deviation, 7.96). Nine patients (25.95%), 5 women (55.6%) and 4 men (44.3%), had FM at baseline.¹

Investigators evaluated widespread pain and symptom severity scores byhaving patients fill out The Revised Fibromyalgia Impact Questionnaire (FIQR) at baseline and after septoplasty at 3 months. They also used the Pittsburgh Sleep Quality Index (PSQI)to assess the sleep quality of patients. At baseline, there was a slight correlation between PSQI and symptom severity scale (R = 0.335, P = .049) and a moderate correlationbetween PSQI and FIQR scores of the patients (R = 0.699, P < .001).¹

The investigators found that of the 9 patients that had FM at baseline, none met FM criteria after the surgery. After septoplasty, patients experienced statistically significant decreases in widespread pain index (P = .006), symptom severity scale (P = .004), and Revised Fibromyalgia Impact Questionnaire scores (P < .001). They also experienced decreases in total score and Pittsburgh Sleep Quality Index, although these were not statistically significant (P = .028 and P = .014, respectively).¹

“Although septoplasty alone cannot eradicate FM, it can be incorporated into a comprehensive treatment plan to potentially alleviate FM symptoms, improve nasal breathing, and thereby elevate patients’ quality of life,” Cilesizoglu Yavuz and Coluk concluded.¹ “However, further research with larger, well-designed trials is warranted to confirm these findings, elucidate the underlying mechanisms, and establish septoplasty as a potential treatment option for this patient population. The precise mechanisms by which septoplasty might improve FM-related symptoms remain unclear. Future research should explore potential pathways such as improved sleep quality due to better breathing, reduced inflammatory responses, or modulations to the central nervous system.”

Of note, the study only included 9 of 35 participants with FM and the authors acknowledged this as a serious limitation of its findings. They also noted that the majority of participants with FM were male, unlike its prevalence in the general population. Furthermore, the follow-up time of 3 months is short, and the study also applied FIQR to patients without FM.¹

One possible link between septoplasty and FM may be sleep quality, which is impacted by NSD and implicated in FM pathology.²

“One of the core abnormalities of FM is this nonrestorative sleep, this seems to be one of the prominent features of FM,” Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP, told our sister site, Educated Patient.² “There is evidence based on EEG that patients [with FM] never get into that restorative phase of sleep...one of the first things i treat is sleep. I am a firm believer that sleep is essential. It’s essential for any disease state, but people with chronic diseases who don't sleep, don’t get better.”

REFERENCES

1. Cilesizoglu Yavuz N, Coluk Y. Fibromyalgia symptoms before and after septoplasty: A cross-sectional study. Medicine 103(35):p e39473, August 30, 2024. | DOI: 10.1097/MD.0000000000039473
2. Wright W. Sleep and Cognitive Symptoms in Fibromyalgia. Video.Educated Patient. September 5, 2024. https://www.theeducatedpatient.com/view/sleep-and-cognitive-symptoms-in-fibromyalgia