Correlation Study Between Nasal Septal Deviation and Rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) is a major cause of concern worldwide. Nasal septal deviation (NSD) may either cause osteomeatal obstruction or may interfere with proper airflow and potentially predispose to sinusitis. Due to the lack of a universally accepted classification on NSD it has not been established whether NSD influences the development of sinusitis or not. Mladina in 1987 proposed a classification in which he classified NSD into seven different categories. The aims and objectives of this study are to observe the correlation between NSD and CRS and to study the relation of different grades of NSD with sinusitis as per Mladina's classification. Patients above 18 years of age presenting to ENT OPD with complaint of nasal obstruction, nasal discharge and headache were subjected to CT scan (nose and paranasal sinuses) coronal section with contiguous 5 mm thickness slice perpendicular to the hard palate in prone position. Presence of NSD and sinusitis was observed. 120 cases were studied. The mean age was 28.7 ± 9.37 years with age range 18-58 years. There were 92 (76.6 %) males and 28 (23.3 %) females with a M:F ratio of 3:1. Out of 120 cases, 114 (95 %) cases had NSD. Sinusitis was present in 63 (52.5 %) cases on CT scan. Out of 57 (50.0 %) cases with NSD and sinusitis, 13 (11.4 %) cases had sinusitis on the same side of NSD, 14 (12.28 %) cases had sinusitis on the side opposite to NSD and 30 (26.31 %) cases had sinusitis on both sides of NSD. There was no statistically significant relationship between NSD and sinusitis. As per Mladina's classification vertical deviations accounted for majority of patient's septal deviations with 31 (27.1 %) cases of type II NSD and 24 (21.1 %) cases of type I NSD. The maximum number of cases with sinusitis had vertical deviations with type I NSD in 17 (27.0 %) cases and type II NSD in 18 (28.5 %) cases. The present study reveals that there is no correlation between NSD and sinusitis. Vertical deviations type I and type II are more prone to sinusitis as they involve the nasal valve area.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…They concluded that sinonasal anatomical variation did not increase the possibility of developing CRS and/or increase the severity of preexisting CRS. Prasad et al 478 similarly found no significant relationship between NSD and CRS.…”

Nasal Septal Deviations: A Systematic Review of Classification Systems

“…Additional searches applied to all the databases produced a grand total of 952 articles, and after reviewing the titles and the abstracts a total of 907 articles were excluded. Full texts were downloaded for 45 articles [ 2 – 46 ]. After retrieval and reviewing the references of those articles, an additional five articles were downloaded [ 19 , 47 – 50 ].…”

“…After retrieval and reviewing the references of those articles, an additional five articles were downloaded [ 19 , 47 – 50 ]. Of the 50 articles reviewed in their entirety, the following are reasons for exclusion: two were letters to the editor [ 13 , 49 ], one classified nasal defects based on subunits and corrective surgeries [ 24 ], one study correlated previously described systems in their patients [ 37 ], one used a previously published classification system [ 46 ], one described trauma and surgical techniques [ 2 ], two referenced their own previously described classification system [ 21 , 28 ], one was a questions and answers article [ 17 ], two articles focused on the external nasal deformities [ 15 , 39 ], fourteen articles focused on operative techniques [ 4 , 18 – 20 , 29 – 32 , 35 , 36 , 38 , 40 , 47 , 50 ], and ten articles failed to meet criteria as classification systems [ 5 , 7 , 9 – 12 , 14 , 22 , 34 , 42 ]. A total of fifteen articles met inclusion criteria for describing internal nasal septal deviation classification systems [ 3 , 6 , 8 , 16 , 23 , 25 – 27 , 33 , 41 , 43 , 44 , 48 , 51 ].…”

High incidence of posterior nasal cavity obstruction in obstructive sleep apnea patients

“…deviated nasal septum, enlarged turbinates and nasal valve collapse) or by inflammatory mucosal disease (rhinitis, chronic rhinosinusitis with or without nasal polyps) (Lee et al 2013;Prasad et al 2013). Correction of nasal obstruction is unquestionably a priority in the management of OSA patients, regardless of whether it leads to an improvement in OSA severity based on objective polysomnography respiratory parameters.…”