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Zhenpeng Liao,1,* Wei Liao,1,* Kai Sen Tan,2,* Yueqi Sun,3 Aiqing Peng,1 Yingxian Zhu,4 Haixin He,1 Shuowei Yang,1 Guangfu Xu,1 Rongfei Su,1 Jinyu Yao,3 Yunping Fan,1 Qintai Yang,5 Haiyu Hong1 1Department of Otolaryngology, Allergy Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China; 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore; 3Department of Otolaryngology, Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 4Department of Anesthesiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China; 5Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China *These authors contributed equally tothiswork Objective: Septoplasty has been the definitive treatment for nasal septum deviation, but its postoperative procedure may affect patients’ quality of life. While new procedures in general surgery, such as enhanced recovery after surgery (ERAS), can speed up postoperative rehabilitations to improve quality of life, it is rarely applied in the ear–nose–throat field. This study therefore aims to evaluate the application of ERAS in patients with nasal septum deviation as a means of improving perioperative outcomes. Materials and methods: Fifty patients with nasal septum deviation undergoing septoplasty were randomized as ERAS or control group (25 patients in both groups). Patients were investigated for outcomes including length of stay, operating time, bleeding volume, total cost, complications, and Self-Rating Anxiety Scale (SAS) and visual analog symptom score of nasal obstruction, sleep disturbance, and head facial pain. Results: The preoperative anxiety in ERAS group (SAS 35.4±6.2) was lower than the control group (SAS 43.6±8.6). The anxiety levels in ERAS group (SAS 31.6±5.4) was also reduced compared to the control group (SAS 38.1±10.4) in the 3 days postsurgery, but showed no significant difference thereafter at 7 days postsurgery. In addition, the length of stay and total cost were significantly lower for the ERAS group as well. The visual analog symptom score of nasal obstruction, sleep disturbance, and head facial pain in ERAS group were all also found to be lower than the control group. The only outcomes with no significant differences were the operation time, blood volume, and complications between the groups. Conclusion: Our study indicated ERAS application can reduce hospital charges and postoperative pain in septoplasty, thereby improving patient quality of life and hospital expenses at the same time. Keywords: enhanced recovery after surgery, hospital charges, nasal septum deviation, postoperative pain, septoplasty