The Incidence of Vasovagal Attack after
Abdulwahid Alqhtani1*, Waleed Alghamdi2, Mohammad Aqeel2, Khalid Alqhtani3 and Ahmad Etwadi3
1 Department of ORL-HNS, AFHSR, Southern of Saudi Arabia, Saudi Arabia
2 Department of ORL-HNS, Aseer Central Hospital Kingdom of Saudia Arabia, Saudi Arabia
3 Department of ORL-HNS, Khamis General Hospital, Southern of Saudi Arabia, Saudi Arabia
Submission:June 22, 2020; Published:July 08, 2020
*Corresponding author:Abdulwaheed Alqhtani, Department of ORL-HNS AFHSR, Southern of Saudi Arabia, Saudi Arabia
How to cite this article: Abdulwahid A, Waleed A, Mohammad A, Khalid A, Ahmed E. The Incidence of Vasovagal Attack after Septoplasty Surgery. Glob
J Oto, 2020; 22(5): 556098. DOI: 10.19080/GJO.2020.22.556098
Background: vasovagal syncope is referred to as neurocardiogenic syncope which is subtypes of neutrally mediated (reflex) syncope. VVS characterized by a transient loss of consciousness due to a neurologically induced drop in blood pressure. The vasovagal response (VVR) is a possible complication that may occur during rhinologic manipulation.
Aims/Objectives: To detect the incidence and correlates of vasovagal attack after septoplasty among patients in Khamis general hospital, Southern of Saudi Arabia.
Methodology: A retrospective record-based study was conducted including all patients with clinically diagnosed DNS and undergone surgical intervention at Khamis Mushayet General Hospital. Data extracted included patient’s demographic data, clinical signs and symptoms, history of post-operative vasovagal attacks.
Results:The study included a total sample of 94 patients, 46 (48.4%) patients had traumatic nasal deviation and 48 (51.6%) had no history of trauma. Sixty-seven (71.3%) of the patients aged less than 30 years and 56 (59.6%) were males. Nasal obstruction was the most recorded clinical complaint among the patients in total (96.8%) followed by snoring (65.6%). Vasovagal attacks were not commonly recorded among the included cases.
Conclusions & recommendations: In conclusion, the study revealed that vasovagal attack was not common among patients who undergone septoplasty. Also, experiencing post-surgical vasovagal attacks was nearly the same for all patients regardless their ages and gender
Vasovagal syncope (VVS) is commonly recorded postoperative attacks due to vagus nerve stimulation causing bradycardia [1,2]. Vasovagal syncope is referred to as neurocardiogenic syncope [3-5], which is subtypes of neurally mediated (reflex) syncope . VVS characterized by a transient loss of consciousness due to a neurologically induced drop in blood pressure . Sweating may precede the attack immediately with blurred vision or ringing in the ears . Occasionally the person may twitch when unconscious. Person with VVS may be injured from a fall.
Recently, otolaryngology instruments and surgical procedures have significantly improved, with a shift toward more minimally invasive procedures [9,10]. The vasovagal response (VVR) is a possible complication that may occur during rhinologic manipulation. A treatment algorithm for this phenomenon
has not been previously established in rhinology. Most types of septoplasty techniques include the use of nasal packing . First experiences with this packs show some postoperative adhesions and crusting . Complications related to pack insertion include pain, vasovagal attack, cardiovascular collapse, hypovolemic shock, vasovagal reflex and trauma to columella, nasal mucosa, and soft palate . The current study aimed to assess the incidence of vasovagal attacks post septoplasty and its relationship with patients’ characteristics.
A retrospective record-based approach was used targeting all patients with clinically diagnosed DNS and undergone surgical intervention at Khamis Mushayet General Hospital during the period from January 2017 to end of May 2019. All medical files
were reviewed, and clinical data were extracted using prestructured
data extraction sheet to minimize data extraction error.
Files with incomplete data were excluded if personal contact with
the patient failed. Data extracted included patient’s demographic
data, trauma related data, clinical signs and symptoms, besides
post-operative recorded complications, and occurrence of
After data were collected it was revised, coded, and fed to
statistical software IBM SPSS version 22. The given graphs were
constructed using Microsoft excel software. All statistical analysis
was done using two tailed tests and alpha error of 0.05. P value
less than or equal to 0.05 was statistically significant. Frequency
and percent were used to describe the frequency distribution of
the different collected variables including signs and symptoms
and post-operative complications and history of vasovagal attacks.
Cross tabulation was used to show the post-operative vasovagal
attack in relation to patient’s personal characteristics using chisquare
The study included a total sample of 94 patients, 46 (48.4%)
patients had traumatic nasal deviation and 48 (51.6%) had
no history of trauma. Sixty-seven (71.3%) of the patients aged
less than 30 years and 56 (59.6%) were males (Table 1). Nasal
obstruction was the most recorded clinical complaint among the
patients in total (96.8%) followed by snoring (65.6%), frontal
headache (51.6%), and nasal discharge (46.2%) while epistaxis
was recorded among 23.7% of the cases. As for post-operative
complications, Figure 1 demonstrates that 32% of the cases had
nasal obstruction followed by external nasal deformity (17%),
smell disturbance (11%), dental anaesthesia (10%), infection
(10%), septal perforation (6%), and nasal bleeding (5%) (Table
Figure 2 illustrates the incidence of post septoplasty vasovagal
attack. It was diagnosed among 11 patients (11.7%). Vasovagal
attack was insignificantly higher among patients aged above 30
years than those who were below the age of 30 (88.9% vs. 88.1%,
respectively; P=.910). Also, it was insignificantly more diagnosed
among male patients (91.1%) than female patients (84.2%)
Vasovagal syncope (VVS) is an alarming but benign condition
that may recorded postoperatively for the first time in even
healthy patients . Although VVS is associated with nasal
manipulation, no data have been found to quantify this incidence
with otolaryngology surgeries. In the current study researchers
aimed to find out the incidence and correlates of vasovagal
attack after septoplasty surgery. The study revealed that nasal
obstruction was the most recorded complain before surgery
and still post-surgery main complications. Vasovagal attack was
recorded among nearly 1 out of each 10 patients. Age and gender
were insignificantly associated with the higher incidence of
experiencing post-surgical vasovagal syncopal attacks.
Glossopharyngeal neuralgia was first recorded in 1910
which described by recurrent pain related to the visceral region
of Cranial Nerves IX and XII . The association of hypotensive
syncope was not reported until 1927 , and then again in 1942
. Syncope has been featured as an even less frequent among
patients with these cranial nerve neuralgias . The term
“vagoglosso pharyngeal neuralgia” was initiated to describe an
associated vagus nerve reflex as a possible etiology in “painless
cranial nerve neuralgias” with syncope .
In conclusion, the study revealed that vasovagal attack was
not common among patients who undergone septoplasty. Also,
experiencing post-surgical vasovagal attacks was nearly the
same for all patients regardless their ages and gender. A larger
scale study including more cases with more clinical assessment is
advised to be conducted to have more knowledge and explanations
for the findings.