METHODS
This prospective study was conducted at the Otolaryngology Department of Health Sciences University, Sanliurfa Mehmet Akif Inan Training and Research Hospital between January 2017 and December 2019. The institutional ethical review board of the same hospital approved this study. All adult patients referred to the otolaryngology department with nasal septal deviation and underwent septoplasty were included. Patients with a previous history of nasal surgery, patients older than 45, and patients who required another nasal surgery such as rhinoplasty were excluded. Since the risk of septal perforation is inherently higher in more complicated septoplasty procedures, patients with excessive septal deviation were not included for homogeneity purposes.3Also, patients who changed their smoking habits during the one-year preceding surgery and those who were lost to follow-up after surgery were excluded. Written informed consent was obtained from all patients fulfilling the inclusion criteria.
Patients who give a social history of smoking at least 1 pack of (i.e. twenty) cigarettes and/or one hookah per day regularly during the last year before the surgery were defined as smokers. Study participants were divided into four groups based on their tobacco consumption status: Non-smokers, patients smoking cigarettes only, patients smoking hookah only, and patients smoking both cigarettes and hookah. The same experienced surgeon performed all surgical procedures using the same septoplasty technique. The surgeon was blinded to the group of the patients. Silicone nasal septal splints were placed internally and removed on the 3rd postoperative day. All patients underwent a complete examination, including nasal endoscopy daily after the surgery by a physician blinded to their tobacco consumption status. Healing was considered complete when there was no longer any intranasal crusting, granulation tissue, polyps, mucosal infection, adhesions, or synechiae at the surgical site, and the patient returned to daily activities without nasal blockage. The septal perforation diagnosis was based on a complete nasal examination, including anterior rhinoscopy and nasal endoscopy. All patients were followed until they completely healed; healing times and presence or absence of septal perforation were recorded for all study participants. The study groups were compared in terms of healing times and frequency of septal perforation.