Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study / Relação entre a morfologia do septo nasal e a gravidade dos sintomas de obstrução nasal: estudo de tomografia computadorizada

Abstract Introduction The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored. Objective This study aimed to investigate whether the morphology of the deviated nasal septum assessed by computed tomography may explain nasal obstruction severity. Methods The study included 386 patients who were referred to the computed tomography examination of the paranasal sinuses. Patient selection criteria were the absence of facial anomalies, facial trauma, nasal surgery, and sinonasal tumors. Computed tomography images were used to estimate deviated nasal septum prevalence, the prevalence of Mladina's seven types of deviated nasal septum, and to measure the deviated nasal septum angle. Nasal obstruction severity was assessed by the nasal obstruction symptom evaluation, NOSE scale. The relationship between NOSE score, deviated nasal septum morphology, and deviated nasal septum angle was performed by a statistical regression model on the reduced sample of 225 patients. Results The prevalence of deviated nasal septum was 92.7%. Type 7 deviated nasal septum was the most frequent (34.2%) followed by type 5 (26.2%) and type 3 (23.6%). The worst NOSE scores were recorded in the type 2 deviated nasal septum (45.00 ± 28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5° ± 3.24. NOSE scores were not significantly associated with deviated nasal septum types and angles. Conclusion Patients with different types of deviated nasal septum have different NOSE scores. Computed tomography morphology of the deviated nasal septum could not fully explain the severity of nasal obstruction.

Resumo Introdução O impacto da morfologia do septo nasal na gravidade dos sintomas obstrutivos nasais ainda não foi totalmente explorado. Objetivo Investigar se a morfologia do desvio do septo nasal avaliada pela tomografia computadorizada pode explicar a gravidade da obstrução nasal. Método O estudo incluiu 386 pacientes encaminhados para exame tomográfico de seios paranasais. Os critérios de seleção dos pacientes foram: ausência de anomalias faciais, trauma facial, cirurgia nasal e tumores nasossinusais. Imagens de tomografia computadorizada foram usadas para estimar a prevalência de desvios do septo nasal, a prevalência dos sete tipos de desvios do septo nasal de Mladina e para medir o ângulo do desvio septal. A gravidade da obstrução nasal foi avaliada pela escala Nasal Obstruction Symptom Evaluation, NOSE. A relação entre o escore da NOSE, a morfologia e o ângulo do desvio septal foi verificada por um modelo de regressão estatística em uma amostra reduzida de 225 pacientes. Resultados A prevalência de desvios do septo nasal foi de 92,7%. O desvio septal do tipo 7 foi o mais frequente (34,2%), seguido do tipo 5 (26,2%) e do tipo 3 (23,6%). Os piores escores da escala NOSE foram registrados nos desvios septais tipo 2 (45,00 ± 28,28). O ângulo médio do desvio em pacientes com obstrução nasal foi de 8,5° ± 3,24. Os escores da escala NOSE não foram significativamente associados aos tipos e ângulos do desvio septal. Conclusão Pacientes com tipos diferentes de desvios do septo nasal apresentam diferentes escores na escala NOSE. A morfologia do desvio septal à tomografia computadorizada não conseguiu explicar totalmente a gravidade da obstrução nasal.

Evaluation of choroidal thickness measurements in patients with marked nasal septal deviation / Avaliação das medidas da espessura da coroide em pacientes com acentuado desviode septo nasal

Abstract Introduction: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. Objective: To assess choroidal thickness measurements of patients with marked nasal septal deviation. Methods: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000 µm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. Results: In the study group, 52 eyes of 26 patients with a mean age of 26.34 ± 8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69 ± 7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p > 0.05). Conclusion: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.

Resumo Introdução: A obstrução crônica das vias aéreas superiores devido a acentuado desvio do septo nasal pode causar hipóxia crônica. Pode alterar o equilíbrio do sistema simpático-parassimpático e afetar o fluxo sanguíneo na coroide. Objetivo: Avaliar as medidas da espessura da coroide em pacientes com acentuado desvio de septo nasal. Método: Foram incluídos no estudo pacientes que apresentavam sintomas de obstrução nasal, com diagnóstico de acentuado desvio de septo realizado por rinoscopia anterior e endoscopia nasal, e com septoplastia programada. O grupo controle consistiu de indivíduos saudáveis pareados por idade, sexo e índice de massa corporal. As medidas da coroide na fóvea central e a 1.000 µm da fóvea nas regiões nasal e temporal foram feitas com tomografia de coerência óptica com imagem de profundidade melhorada. Resultados: No grupo de pacientes, 52 olhos de 26 pacientes com média de 26,34 ± 8,14 anos foram examinados. No grupo controle, 52 olhos de 28 indivíduos saudáveis com média de 26,69 ± 7,84 anos foram examinados. Não houve diferença estatisticamente significante em termos de medidas da espessura da coroide entre os grupos (p > 0,05). Conclusão: Nossos resultados sugerem que desvios do septo nasal acentuados podem não levar à hipóxia significativa e ativação simpática, resultar na deterioração do fluxo sanguíneo coroidal e consequente espessamento da coroide.

Nasal septal angle deviation: effect on lateral wall in nasal obstruction

Background: Deviation of the nasal septum (DNS) refers to the convexity of the septum to one side disturbing the nasal physiology with obstructed nasal breathing leading to lateral nasal wall abnormalities and paranasal sinuses (PNS) mucosal disease. Knowledge of nasal morphological parameters plays an important role in planning successful nasal surgery. Our aim was to evaluate the angle of septal deviation (ASD) on CT scan and study its influence on the lateral nasal wall abnormalities and PNS mucosal disease.Methods: A prospective cross-sectional observational study was conducted on 130 patients with clinical evidence of DNS and chronic sinusitis. The direction and severity of DNS was recorded on CT scan along with evaluation of lateral nasal wall and sinus mucosal abnormalities.Results: Increasing ASD had statistically significant correlation with the lateral nasal wall abnormalities, most commonly, contralateral middle and inferior turbinate hypertrophy (p-value <0.0001). No significant association was found with the incidence of ipsilateral or contralateral osteomeatal complex (OMC) obstruction and sinus mucosal disease.Conclusions: The direction and severity of septal deviation has significant impact on contralateral middle and inferior turbinate hypertrophy. The analysis of these ancillary pathologies can be of great help to the surgeon in better management of patients with nasal obstruction.

Relation between Nasal Septal Deviation and Pneumatization of Mastoid Air Cells – A Computerised Tomographic Study

Introduction: The environment of middle ear cavity gets regulated mostly by pneumatized mastoid air cell system (MACS). Many theories exist that details the process of pneumatization of this MACS. The nasal septal deviation (NSD) has been shown to be instrumental in influencing pneumatization of paranasal sinuses to varied degrees. The effect of NSD on the pneumatization of MACS remains questionable due to limited literature available. And so this study was done to find the relation between the side of NSD and extent of Pneumatization of MACS on that side by computerized tomographs of Paranasal sinus region. Subjects and Methods: 120 CT images of paranasal region from archives of radiology department were studied for NSD. The NSD was classified according to the nasal septal angle. The extent of pneumatization of mastoid region was studied and classified. The relation between severe NSD and extent of mastoid pneumatization was noted. Results: NSD was found to be right sided in 90% cases studied and 20, 45, 55 were seen belonging to group I, II and III NSD respectively. The mean NSA was found to be 13.5o. Mastoid region was observed to be hypo pneumatized in the side of NSD in 42 cases of group III NSD. Conclusion: The findings of the study puts forth the need for assessment of NSD and planning possible correction of NSD prior to middle ear and mastoid surgeries for successful results.

Effect of Septoplasty on Mean Platelet Volume in Patients of Deviated Nasal Septum.

Background: Mean platelet volume corresponds to average size of platelets and studies proved that large platelets are enzymatically and metabolically more active and have prothrombotic potential. Chronic upper airway like marked nasal septal deviation leads to higher Mean platelet volume and vice versa septoplasty operation lowers the volume of the platelets over a period of time and hence reduces other associated comorbidities. Objectives: This study was done with an aim to analyze the effect of Septoplasty on Mean Platelet Volume Levels in patients with Marked Nasal Septal Deviation. Methods: A prospective study was done in a total of 50 patients who were selected from ENT OPD and ENT Ward of Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh after proper history and examination. Results: Data obtained from preoperative and postoperative blood investigation were analysed using paired t-test and it was statistically proved that after Septoplasty, Mean Platelet Volume was significantly lowered in patients who had Marked Nasal Septal Deviation. Conclusion: Septoplasty plays an important role in reducing the MPV value in cases with Marked nasal septal deviation and thus other comorbid conditions can be prevented by doing septoplasty in these patients.

Radiological Examinations of Inferior Turbinate in Patients with or without Deviated Nasal Septum by Using Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to analyse the radiological anatomic dimensions of the inferior turbinate in patients without deviated nasal septum and compare it to those in the patients with deviated nasal septum using computed tomography. SUBJECTS AND METHOD: The OMU CTs of 98 patients, 196 nostrils with or without deviated nasal septum were evaluated (control group: 42 patients, deviated septum group: 56 patients). The analysis of the CT scans contained the mucosal and bony length, mucosal width of the turbinate and the anterior and posterior mucosal overlay. And also evaluated the cross-sectional area and the type of inferior turbinate bone. RESULTS: All subjects were divided into three groups: the concave, convex, and control groups. The correlations of fifteen measuring points such as anterior, middle and posterior medial mucosal thickness, total width, bone width, medial mucosa width of inferior turbinate, and area of inferior turbinate bone were significantly different among the groups (concave side>con-trol group>convex side). Of the demographic factors, age was negatively correlated with mucosa and bone length. Types of inferior turbinate bone were as follows: lamella type (38%), combined type (37%), compact type (25%). CONCLUSION: There were statistical differences in some measured anatomical points among the concave, convex, and control groups. Greater septum deviation was correlated with greater degree of hypertrophysm of the inferior turbinate. The age of patients showed negative correlation with inferior turbinate length. Most frequent type of inferior turbinate was lamella type. The results of this study may provide important information when considering turbinate surgery.

The Characteristics of Sinonasal and Psychological Symptoms and Quality of Life in Rhinologic Patients and the Role of Surgical Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic diseases of the nose and sinuses have been shown to influence patients, not only physically but also psychologically affecting the overall well-being. We evaluated the quality of life of rhinologic patients, and the effect of surgery on them. In addition, we assessed the correlation between the symptom scores and objective findings. SUBJECTS AND METHOD: From November 2009 to January 2011, a total of 194 patients haveing nasal and sinus surgery were enrolled. They were divided into nasal cavity disease (NCD) group (n=103) and chronic rhinosinusitis (CRS) group (n=91). These patients had to fill out a questionnaire at different points, at 1 day, 1 month, 3 and 6 months prior to surgery. The normal control group (n=30) also had to fill out four questionnaires: our questionnaires were Sinonasal Outcome Test-20 (SNOT-20), Rhinosinusitis Disability Index (RSDI), Version 2 of Short-Form 36 item Health Survey (SF-36v2(TM)), Symptom Checklist-90-Revised (SCL-90-R). For the CRS group, Lund-Mackay score was calculated using CT scans. RESULTS: Both experimental groups showed more severe scores than the control group. The CRS group exhibited more severe symptoms than the NCD group. Both experimental groups achieved significant improvements after surgery. CRS group showed more significant improvement than the NCD group in SNOT-20. The Lund-Mackay score showed no significant correlation with the subjective symptom scores. CONCLUSION: Chronic rhinologic diseases affect the quality of life. CRS patients show more severe scores than the NCD patients. CRS patients have more improved effectiveness than NCD patients after surgical treatment. Objective conditions and subjective symptoms may be correlated inconsistently, and the evaluation for the overall quality of life is important to reflect on the therapeutic effect.

Correction of bent cartilaginous vault / 中华医学美学美容杂志

Objective To seek a method to correct the bent cartilaginous vault.Methods This study included 18 patients (12 women,6 men,aged 18-45 years) suffering from the bent cartilaginous vault with the various degrees of nasal obstruction from January 2005 to December 2009.A open surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the dorsum or nasal tip.The approach depended on full mobilization of deviated cartilage,removal of the deviated part of the quadrangular cartilage,followed by straightening of a caudal septal extension graft and its fixation in the corrected position.Rhinoplasty was performed to correct bent cartilaginous vault.Results A satisfactory result was gained in all clinical cases,except a septum still to remain light tilt (not affect the breathing function).Follwing-up for 3-24 months,all cases dorsum of nose was straighten and nasal septum situated mediately.All patients indicated cosmetic satisfaction of nasal dorsum and tip and improvement in nasal obstruction.No nasal deformity and septum tresis was found in all patients.Conclusions ()pen rhinoplasty is a helpful technique in the treatment of the bent cartilaginous vault.Septal surgery is necessary in the patients with cartilage framework,not only to improve breathing but also to achieve a straight,symmetrical and external nose as well.

Nasal Obstruction in Patients with Deviated Nose

BACKGROUND AND OBJECTIVES: The objectives of the study are to investigate the incidence and characteristics of nasal obstruction and their association with the types and direction of external deviation among patients with a deviated nose. MATERIALS AND METHODS: Eighty-eight patients with a deviated nose without mucosal diseases in the nose from January 2004 to July 2005 were retrospectively reviewed. The overall incidences of nasal obstruction were assessed. Incidences of nasal obstruction by the types and direction of deviation in the external nose and by the direction of the septal deviation were also assessed. RESULTS: Seventy-two patients (81.8%) were found to suffer from various degrees of nasal obstruction. Left sided obstruction was more dominant irrespective of the direction of external nose. There was no relationship between the dominant sides of nasal obstruction and the type and the direction of the deviation of external nose. Among patients with a linear shaped deviated nose, the septum tends to deviate to the opposite side of the direction of the external nose. CONCLUSION: Nasal obstruction is commonly found among patients with a deviated nose. But not all patients suffer from nasal obstruction. To attain good aesthetic and functional results, a rhinoplastic surgeon should pay particular attention to this common findings among patients with deviated nose.

New Description Method and Classification System for Septal Deviation

BACKGROUND AND OBJECTIVES: The purpose of this study is to develop an efficient method of description and a new classification system for septal deviations (SD) and to study the applicability of the new description method and classification system to a clinical setting. MATERIALS AND METHODS: Sixty-five patients with nasal obstruction (symptomatic group) and thirty-five patients without nasal obstruction (asymptomatic group) were included in this prospective study. The characteristics of SD were analyzed according to the new description method based on the morphology, site, severity, and its influence on the external nose. Based on these observations, four classification categories of SD were introduced: localized deviation (type I), curved/angulated deviation (type II), curved/angulated deviation combined with type I (type III), and curved/angulated deviation with associated dorsal nasal deviation (type IV). The incidence of each type of SD was calculated. RESULTS: In both groups, all pathologies of the SD could be precisely described using the new description method. In both groups, the curved deviation (type II) was the most common pathology. Anterior/mid was the most common site of deviation. In the symptomatic group, moderate was the most common form of severity while mild was the most common form in the asymptomatic group. In both groups, type II was the most common. Types III and IV were significantly more common in the symptomatic group while type I was predominant in the asymptomatic group (p<0.05). CONCLUSION: The new description method provides a precise descriptive term for SD. The proposed classification system is suitable for documentation and determination of the severity of SD.

Correction of Caudal Septal Deformity via Open Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Caudal septal deformities are surgically challenging disorders. A number of corrective programs have been described with variable success. Causes of frequent failure in correction of the caudal deformities have been conservatism and unrealistic dependence on incisional method such as cross hatching, and limited comprehension of the extrinsic and intrinsic forces causing caudal deformities. We reviewed and evaluated the surgical techniques for correction of the caudal septal deformities performed at our institution. SUBJECTS AND METHOD: A retrospective study was performed on 24 patients who underwent septal surgeries for severe caudal septal deformities between Feb 2001 to May 2004. With open approach, all deforming forces around the caudal septum were released and definite intraoperative correction was possible. RESULTS: All 24 patients showed definite improvement in terms of functional and anesthetic outcomes. Potential complications related with structural instability as well as other inherent complications of nasal surgery have not been encountered. CONCLUSION: For successful correction of the caudal septal deformities, completed exposure and releasing all the extrinsic forces around the caudal deformities via open rhinoplasty approach is desirable to avoid frequent recurrences.

Histologic difference of the nasal mucosa of both nasal cavities in patients with nasal septal deviation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Patients with nasal septal deviation usually manifest compensatory hypertrophy of the mucosa of unilateral nasal cavity. However, the histologic difference of the bilateral septal mucosa of both nasal cavities in patients with nasal septal deviation has not been extensively studied. Thus we tried to investigate histologic difference of both the septal mucosa of both sides in patients with nasal septal deviation. MATERIALS AND MEHTODS: Nasal mucosae taken from 15 patients with nasal septal deviation were studied. About 0.5 x 0.5 cm sized piece of septal mucosae were obtained from the corresponding site of both nasal cavities at 2 cm from the nostril and 2 cm inferior to the nasal dorsum. After staining by hematoxylin-eosin, the histologic differences of the bilateral nasal mucosa were examined under a light microscope. RESULTS: Surface epithelia of both nasal cavities showed squamous metaplasia or epithelial exfoliation. Inflammatory cell infiltration was more severe in the concave side compared with the convex side. The number of nasal gland were significantly higher in the convex side than in the concave side. CONCLUSIONS: The result of this study indicated that the concave and convex nasal mucosae in patients with nasal septal deviation have different histologic features in terms of inflammatory cell infiltration, and number of nasal glands.

Overcorrected Septums as a Complication of Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Overcorrection is defined as obvious deviation of the septum to the opposite direction after septoplasty and it is not infrequently developed in young patients. We investigated the rate of its incidence, especially in relation to age. MATERIALS AND METHODS: We retrospectively studied 1,124 patients undergoing septoplasty operation for septal deviation between 1994 and 1999. The operations and postoperative observation were performed by a single surgeon. We reviewed the medical records for age, sex, symptoms, combined operations, direction of deviation before and after septoplasty. RESULTS: Out of 1,124 patients, 22 (2.0%) had their septum overcorrected after septoplasty and 21 (95%) complained of nasal obstruction of the newly deviated side. The incidence of overcorrection was 7.3% (16/218) in teens, 1.7% (5/294) in twenties, 0.4% (1/250) in thirties, and 0% in older ages. The incidence in teens and early twenties was 5%. Patients of teenagers revealed significantly higher incidence as compared to other age groups (p<0.05). CONCLUSION: Overcorrected septum as a complication of septoplasty develops at the incidence rate of 5% in patients of teens and early twenties. Authors suggest that the depth of cross-hatching incision on the cartilage should be superficial or half-thickness to avoid overcorrection in young patients. And the possibility of overcorrection or revision septoplasty should be informed preoperatively.

Significance of acoustic rhinometry and rhinomanometry in the evaluation of surgical treatment of nasal septal deviation / 解放军医学杂志

Objective To discuss the significance of acoustic rhinometry(AR) and rhinomanometry(RM) in the evaluation of surgical treatment of nasal septal deviation.Methods Fifty-one patients of nasal septal deviation were recruited,and seventy-two nasal cavities were tested(twenty-one patients with narrowing of double sides).Visual analogue scale(VAS) was used to estimate the degree of nasal obstruction.AR and RM were used to obtain the data of nasal airway resistance(NAR),nasal cavity 0-5cm volume(NCV0-5) and nasal minimal cross-sectional area(NMCA).The data were used to assess the airflow function of nasal cavity.Each patient was tested at the time both before surgery and 12 weeks after surgery.The pre-and post operative data were used to calculate paired t-test by SPSS 16.0,and to disclose the correlation among ?NCV,?NMCA,?NAR and ?VAS.Results The preoperative data showed that NCV0-5 was 4.07?0.91cm3,NMCA 0.33?0.08cm2,NAR 1.14?0.34kPa?s?L-1,and VAS 7.36?1.23;and the postoperative data showed that NCV0-5 was 7.29?0.68cm3,NMCA 0.56?0.08cm2,NAR 0.35?0.12kPa?s?L-1,and VAS 1.14?0.91.Significant differences existed in NCV0-5,NMCA,NAR and VAS(P