Nasal Synechiae: Causes, Symptoms and Treatment

A nasal synechia is a band of scar tissue inside the nose that bridges two surfaces which should never be joined — most often the septum to a turbinate. The plural is synechiae, and the term comes from the Greek for “continuity”, meaning tissues that have grown together. In the nose it is also called a nasal adhesion, and it does one thing: it blocks the airway with a physical bar that no spray, decongestant or antihistamine will shift.

Almost every nasal synechia is a consequence of something — surgery, injury, or prolonged inflammation. The great majority follow septoplasty, turbinate reduction, sinus surgery or rhinoplasty. That is uncomfortable for a surgical clinic to state plainly, and it is the single most useful fact on this page, because it means synechiae are largely preventable and the prevention happens in the first operation.

The other useful fact is this: most people who think they have a synechia in the first three months after nasal surgery have swelling instead. The two feel identical and are treated completely differently. There is a section below on telling them apart.

What Is a Nasal Synechia?

The inside of the nose is lined with mucosa, and the airway is the gap between those lined surfaces. When mucosa is injured on two facing surfaces at once and those surfaces touch while healing, the body does what it does with any wound edges in contact — it joins them.

The result is a band of fibrous tissue spanning the airway. It may be a thin thread barely visible on endoscopy, or a broad sheet obliterating most of one side. Both matter, because the nasal airway is already the narrowest part of the respiratory tract, and even a slim band creates turbulence and resistance out of proportion to its size.

Synechia or synechiae? Synechia is singular, synechiae plural. Both pronunciations are in use — roughly “sin-EE-kee-ah” is the common one. You may also see them called nasal adhesions, intranasal adhesions or nasal scar bands; all describe the same thing.

How They Form

Three things have to happen together, which is why prevention works.

1. Two facing surfaces are injured. Damage to one side alone almost never causes a synechia — there is nothing for it to stick to.
2. Swelling brings them into contact. Post-operative oedema narrows the airway and pushes the raw surfaces together, often for days.
3. They stay in contact while healing. Fibrin bridges the gap within days, and fibroblasts convert it to permanent collagen over the following weeks.

Interrupt any one of those and no adhesion forms. That is the entire rationale for the splints, spacers and dressings placed after nasal surgery — they are not there for comfort but to keep the surfaces physically apart during the window in which fusion happens.

Where They Form

• Septum to inferior turbinate — the commonest site by a wide margin, because these two surfaces sit closest together and both are frequently operated on in the same procedure. This is why combining septoplasty with turbinate reduction carries a higher adhesion risk than either alone, and why splinting matters most in that combination.
• Septum to middle turbinate — typically after endoscopic sinus surgery. Adhesions here can also block the drainage pathway of the sinuses, causing recurrent sinusitis as well as obstruction.
• Turbinate to lateral wall — less common, and often follows turbinate surgery where the outer wall was also instrumented.

Causes

Previous nasal surgery

The dominant cause. Reported rates after septoplasty with turbinate surgery vary widely between series, and the variation is largely explained by whether splints were used and how carefully mucosa was preserved rather than by anything about the patient.

Risk rises with: operating on both facing surfaces in one procedure; mucosal tearing during septal work; aggressive turbinate reduction that removes lining rather than reducing volume beneath it; heavy post-operative bleeding or clot; and omission of splints where both surfaces were instrumented.

Nasal trauma

A fracture or laceration that tears the lining on both sides of the airway. See broken nose surgery. An untreated septal haematoma can also produce adhesions alongside the more serious risk of saddle nose deformity.

Chronic inflammation

Poorly controlled allergic rhinitis, nasal polyps, recurrent infection and granulomatous conditions all damage mucosa over time. Adhesions from inflammation tend to form slowly and are often noticed only when the airway has narrowed considerably.

Other causes

Nasal cautery for recurrent nosebleeds, particularly when performed on both sides at one sitting. Retained foreign bodies, mainly in children. Prolonged nasal packing. Radiotherapy to the head and neck. Recreational drug use, which damages mucosa and can cause both adhesions and septal perforation.

Symptoms

• Nasal blockage that sprays do not touch. The defining feature. A steroid spray reduces mucosal swelling; it cannot dissolve scar. If six weeks of correct spray use has changed nothing, the obstruction is structural.
• Fixed, one-sided blockage that does not swap sides with the normal nasal cycle — unlike turbinate swelling, which typically alternates.
• Crusting and dryness, because the adhesion disturbs the airflow pattern that normally humidifies inspired air.
• Recurrent nosebleeds from the crusted, dried surface.
• Reduced sense of smell, as less air reaches the olfactory area high in the nose. See can rhinoplasty affect smell or taste.
• Whistling on breathing where the band divides the airflow.
• Mouth breathing, dry mouth, snoring and disturbed sleep. See snoring and sleep apnoea.
• Facial pressure or recurrent sinusitis where the adhesion obstructs sinus drainage.

Synechia or Swelling? Telling Them Apart

This is the question most people arrive with, and getting it wrong in either direction causes problems — unnecessary worry on one side, unnecessary delay on the other.

Points toward swelling: you are within three months of surgery; the blockage fluctuates through the day or with position; it changes sides; it improves at least partly with a decongestant or steroid spray; it is gradually getting better week on week.

Points toward a synechia: you are beyond three to six months post-surgery; the blockage is fixed and unchanging; it does not respond to any spray; it affects one side consistently; it appeared after an initial period of good breathing, then plateaued; you have crusting or whistling on the blocked side.

The distinction cannot be made reliably by looking up the nostril with a torch. It requires nasal endoscopy, which takes a few minutes in clinic and settles the question immediately.

The practical rule: post-operative swelling should be steadily improving by three months. Breathing that is no better at three months than at six weeks, or that got better and then stopped, is worth having looked at rather than waited out.

Diagnosis

Assessment begins with the history — what surgery or injury preceded it, when the blockage started, whether it has ever improved, and what treatments have been tried.

Nasal endoscopy is the definitive test. A fine rigid or flexible endoscope shows the adhesion directly, its site, whether it is thin and filmy or broad and mature, and how much airway remains. It also identifies what else is contributing — because a synechia frequently coexists with residual septal deviation, turbinate hypertrophy or nasal valve collapse, and dividing the band while leaving the others untreated produces a disappointed patient.

CT imaging is added where sinus disease is suspected or where revision surgery is being planned.

Treatment

Why medication does not work

Steroid sprays, antihistamines, decongestants and saline all act on mucosa. A synechia is mature collagen with no inflammatory component, so none of them will alter it. They may help coexisting swelling, which is worth treating in its own right, but they will not open the adhesion.

Division of the adhesion

The band is divided endoscopically with fine scissors, a blade or a microdebrider. A thin filmy adhesion in an accessible position can sometimes be divided under local anaesthetic in clinic in a few minutes. Broader, more mature bands, adhesions high in the nose, and bilateral cases are done as a day case under TIVA.

Division itself is straightforward. The difficulty is that the operation recreates exactly the conditions that caused the problem — two raw surfaces facing each other in a swollen nose. Everything that follows exists to stop it happening again.

Preventing it reforming

• Silicone splints or spacers placed between the divided surfaces and left for one to two weeks. This is the single most effective measure.
• Treating what caused the contact — reducing a hypertrophied turbinate or correcting residual septal deviation at the same time, so the surfaces are not pressed together after the splints come out.
• Absorbable spacers or dressings where splints are not tolerated.
• Saline irrigation from the day after surgery, high volume and regular, to clear crust before it organises.
• Endoscopic review at around two and six weeks, so an early re-adhesion can be divided while still filmy rather than after it has matured.

Recovery

Congestion and crusting for one to two weeks, worse while splints are in. Splints removed in clinic at one to two weeks — uncomfortable for a few seconds rather than painful. Most people return to work within a few days of a local anaesthetic procedure, or within a week after TIVA. Breathing usually improves noticeably once splints are out, and continues to settle over four to six weeks.

Recurrence: the honest position

Recurrence is the main risk, and it is not rare. Published rates vary considerably depending on the site, how mature the adhesion was, whether splints were used and what else was treated at the same time.

Broad adhesions, adhesions high in the nose near the middle turbinate, cases where the underlying cause of surface contact was not addressed, and revision cases all carry higher recurrence risk. Anyone quoting you a single reassuring figure without knowing which of those applies is guessing.

Where it does recur, further division is possible, though the tissue is more scarred and the outcome less predictable each time. This is why the first attempt should be done properly with splinting and follow-up rather than as a quick division alone.

Can They Be Prevented?

Largely, yes — and this is worth reading before nasal surgery rather than after.

• Preserve mucosa. Modern turbinate reduction removes volume beneath the lining rather than removing the lining itself. Techniques that strip mucosa carry a materially higher adhesion risk.
• Repair mucosal tears during septal surgery rather than leaving them.
• Use splints where both facing surfaces have been instrumented, particularly septoplasty combined with turbinate reduction.
• Control bleeding, since clot organising between two raw surfaces is a scaffold for adhesion.
• Irrigate early and often after surgery.
• Attend post-operative endoscopy. An early adhesion caught at two weeks can be separated in seconds; the same adhesion at three months needs an operation.

If you are consenting for septoplasty with turbinate reduction, asking whether splints will be used and when you will be scoped afterwards is a reasonable and revealing question.

Cost

Cost depends on whether division can be done under local anaesthetic in clinic or requires day-case surgery under TIVA, whether both sides are involved, and whether other work — septal correction, turbinate reduction — is needed at the same time to stop the surfaces re-contacting.

Your exact cost is confirmed in writing after in-person consultation and endoscopy. Finance is available through Chrysalis Finance, subject to status — see our finance options.

Nasal synechiae cause functional obstruction rather than a cosmetic concern, so treatment is available on the NHS, and where the adhesion followed NHS surgery it should be reviewed by the original team. Your GP is the route to referral. Waiting times vary by area.

Nasal Synechiae FAQs

Nasal Airway Assessment at Centre for Surgery

Assessment for suspected nasal synechiae starts with endoscopy, because the question of whether an adhesion is present cannot be answered any other way.

Where you are still early after surgery and what you have is swelling, we will tell you that and advise waiting rather than operating. Where an adhesion is present, assessment covers not only the band itself but the septum, turbinates and nasal valve — because dividing an adhesion without correcting what pushed those surfaces together in the first place invites it straight back.

Our ENT surgeon and rhinologist leads nasal airway assessment, including patients who had their original surgery elsewhere.

All surgery is performed by GMC-registered surgeons at our own day-surgery facility at 95–97 Baker Street, Marylebone. We are regulated by the Care Quality Commission and rated Good overall. We recommend a two-week cooling-off period before any surgery is booked.

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Related Reading

• Nasal turbinates: why they swell and how they are treated
• Turbinate reduction surgery
• Septoplasty (deviated septum surgery)
• What is a deviated septum?
• Nasal valve collapse
• Saddle nose deformity
• Septorhinoplasty
• Revision rhinoplasty
• Broken nose surgery
• How septoplasty and turbinate reduction help you breathe better
• Can rhinoplasty affect smell or taste?
• Snoring and sleep apnoea