The Impact of Middle Turbinate Concha Bullosa on the Severity of Inferior Turbinate Hypertrophy in Patients with a Deviated Nasal Septum

Background: Deviated nasal septum is a bodily disorder results in nasal obstruction. Many surgical procedures are available in correcting the disorder. The present study aimed to compare the surgical outcome of septoplasty alone and septoplasty with turbinectomy in patients with deviated nasal septum.Methods: This prospective study was done on 50 patients attending to the department of ENT of Dr. D. Y. Patil Medical College and Hospital, DPU with complaints of nasal obstruction due to inferior turbinate hypertrophy with deviated nasal septum. The severity of nasal obstruction was assessed by NOSE (nasal obstruction symptom evaluation) scale. Of them, 25 patients were managed with septoplasty alone and other 25 patients with septoplasty and turbinectomy. The outcome of both the procedures was assessed statistically by using NOSE scale. Results: Postoperative symptom improvement was seen in the both groups following surgery (p<0.05). When the NOSE scores are compared between two groups, statistically significant improvement in the symptoms (NOSE score) was seen in the group of patients treated with septoplasty and turbinectomy compared to septoplasty alone (p<0.05).Conclusions: This study re-iterates both septoplasty and concurrent turbinectomy are established mode of treatment in deviated nasal septum along with hypertrophy of inferior turbinates when the preoperative and postoperative symptoms are compared. However, the symptomatic outcomes and diagnostic nasal endoscopic findings are significantly better in patients who underwent septoplasty with concurrent resection of the inferior turbinate.

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Bilateral Antrochoanal Polyps: An Analysis from Four Cases

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1213 ◽

2016 ◽

Vol 50 (4) ◽

pp. 173-175

Author(s):

Prachi Jain ◽

Lokesh K Penubarthi ◽

Eshaan Kaushik

Keyword(s):

Nasal Septum ◽

Close Association ◽

Inferior Turbinate ◽

Sinus Surgery ◽

Easy Access ◽

Rare Entity ◽

Deviated Nasal Septum ◽

Turbinate Hypertrophy ◽

Inferior Turbinate Hypertrophy

ABSTRACT Bilateral antrochoanal polyps (ACPs) are a rare entity. We studied four cases of bilateral ACPs that presented to us. We found a close association of allergy (75%) and chronic rhinosinusitis (CRS) (50%) as etiological factors. The anatomical factors like deviated nasal septum (75%), inferior turbinate hypertrophy (50%), and concha bullosa (25%) are also commonly associated with bilateral ACPs. Endoscopic sinus surgery was performed in all the patients with special emphasis to correct the anatomical factors. Inferior meatal antrostomy was performed in two cases to allow easy access of the angled microdebrider blade for clearing the polyp from the anterolateral and anterosuperior limits of the antrum. After a mean follow-up period of 23 months, no recurrence was found. How to cite this article Virk RS, Penubarthi LK, Gupta AK, Jain P, Kaushik E. Bilateral Antrochoanal Polyps: An Analysis from Four Cases. J Postgrad Med Edu Res 2016;50(4):173-175.

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Association Between Deviated Nasal Septum With Inferior Turbinate Hypertrophy and the Risk of Male Infertility

American Journal of Rhinology and Allergy ◽

10.1177/1945892420932485 ◽

2020 ◽

Vol 35 (1) ◽

pp. 17-25

Author(s):

Hsin-Chien Chen ◽

Chi-Hsiang Chung ◽

Wu-Chien Chien

Keyword(s):

Male Infertility ◽

Incidence Rate ◽

Nasal Septum ◽

Inferior Turbinate ◽

Control Group ◽

Deviated Nasal Septum ◽

Turbinate Hypertrophy ◽

Obstructive Sleep ◽

Male Patients ◽

Inferior Turbinate Hypertrophy

Objectives Obstructive sleep apnea is associated with an increased risk of male infertility, and one of its causes is deviated nasal septum with inferior turbinate hypertrophy (DNS/ITH). However, the risk of male infertility associated with DNS/ITH remains unclear. Methods Using the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched cohort study to investigate the risk of infertility in male patients diagnosed with DNS/ITH (N = 61,761) from 2000 to 2015 in comparison with matched controls without DNS/ITH (N = 247,044). We further analyzed the effect of septoturbinoplasty (STP), including septoplasty and turbinoplasty, on the risk of male infertility in DNS/ITH patients. Results At the end of the follow-up period, 46 (0.07%, 46/61,761, incidence rate: 6.25 per 100,000 person-years) patients developed infertility in the DNS/ITH group versus 72 (0.03%, 72/247,044, incidence rate: 2.28 per 100,000 person-years) in the control group; the incidence rate was 2.740-fold higher in the DNS/ITH group (log-rank P < 0.001). Cox proportional hazards regression revealed that the risk of infertility increased in the DNS/ITH group [adjusted hazard ratio (HR): 1.080, 95% confidence interval (CI), 1.049–1.514, P = 0.001]. Compared with the control group, the risk of infertility was highest in the DNS/ITH group without STP (adjusted HR: 2.842, 95% CI, 1.715–4.082, P < 0.001), followed by the DNS/ITH group with STP (adjusted HR: 1.074, 95% CI, 1.035–1.488, P = 0.012). The intervention of STP reduced the risk of infertility in the DNS/ITH group by 45.1% compared with those without STP (P = 0.033). Conclusion Clinicians should be aware of the risk of infertility in male patients presenting with DNS/ITH. Improving the nasal airway by STP may decrease the risk of male infertility.

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COMPUTED TOMOGRAPHIC EVALUATION OF INFERIOR TURBINATE HYPERTROPHY IN ADULT INDO-DRAVIDIAN PATIENTS WITH DEVIATED NASAL SEPTUM

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i7.18083 ◽

2017 ◽

Vol 10 (7) ◽

pp. 342

Author(s):

Niranjan Sahu ◽

Satyasundar G Mohapatra ◽

Siba Narayan Rath ◽

Rabindra Nath Padhy

Keyword(s):

Nasal Septum ◽

Inferior Turbinate ◽

Septal Deviation ◽

Total Width ◽

Deviated Nasal Septum ◽

Maximum Width ◽

Turbinate Hypertrophy ◽

Group I ◽

Group Ii ◽

Inferior Turbinate Hypertrophy

Objective: Aim of the study was to evaluate the prevalence and significance of inferior turbinate hypertrophy (ITH) in adult indo-dravidian patients with deviated nasal septum (DNS). Methods: Analysis of sinonasal computerized tomography (CT) images of 86 patients having DNS was done during October 2015-December 2016 for evaluation of severity of the associated ITH. Values of maximum width of medial mucosa, bone and total width of the turbinate were measured. Patients with inflammatory or expansile sinonasal masses were excluded. Results: Total 86 patients with varying degrees of septal deviation with ages ranging from 18 to 72 years (mean age of 42.8 years) were distributed as: Group I, mild cases and Group II, moderate and severe DNS cases. Patients having ITH on the contralateral side of deviation were included in the study group. The dimensions of the ITH were evaluated. The medial mucosal component of the ITH underwent maximum hypertrophy as compared to bone and lateral mucosa components. The average medial mucosa, bone and total turbinate widths of the inferior nasal concha as well as lateral offset in Group II DNS cases were 5.21 mm, 1.76 mm, 9.96 mm and 8.74 mm, respectively. Total width and width of medial mucosa of ITH in relation to the severity of septal deviation was statistically significant (p=0.0001 and 0.0098). Conclusion: Present study evaluated the relationship between DNS and compensatory ITH. The findings support the decision to excise the inferior turbinate at the time of septoplasty, because of the significant mucosal expansion.

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Evaluation of inferior turbinate hypertrophy in patients with congenital and traumatic nasal septum deviation

The Journal of Laryngology & Otology ◽

10.1017/s0022215112001260 ◽

2012 ◽

Vol 126 (8) ◽

pp. 784-788 ◽

Cited By ~ 10

Author(s):

A Y Korkut ◽

F Islim ◽

S Gulseven Ciftci ◽

R Dogan ◽

O Gedikli ◽

...

Keyword(s):

Nasal Septum ◽

Group Versus ◽

Inferior Turbinate ◽

Septal Deviation ◽

Septum Deviation ◽

Turbinate Hypertrophy ◽

Nasal Septum Deviation ◽

Traumatic Group ◽

The Difference ◽

Inferior Turbinate Hypertrophy

AbstractObjective:To compare mucosal and bony measurements in patients with congenital and traumatic nasal septum deviation and compensatory inferior turbinate hypertrophy.Methods:The study examined 50 patients with nasal septum deviation (25 congenital and 25 traumatic) and compensatory inferior turbinate hypertrophy in the contralateral nasal cavity, confirmed by computed tomography.Results:The study compared inferior turbinate measurements on the concave and convex sides of the septum, in the congenital and traumatic groups. Measurements comprised: the shortest distance from the median line to the medial border of the conchal bone; the distances from the most medial part of the conchal mucosa and the conchal bone to the lateral line; the projection angle of the inferior turbinate; and the widest parts of the whole inferior turbinate and the inferior turbinate conchal bone. The differences between the concave and convex side measurements were compared in the congenital group versus the traumatic group; for three measurements, the difference between these two groups was statistically significant (p < 0.05).Conclusion:The present study findings suggest that the conchal bone has a marked influence on nasal patency in patients with congenital septal deviation. These findings supported the decision to excise the inferior turbinate bone at the time of septoplasty, especially when treating congenital septal deviation.

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Radiological significance of the sinonasal anatomical variants in recurrent acute rhinosinusitis patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172121 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2379

Author(s):

Niranjan Sahu ◽

Satya Sundar G. Mohapatra ◽

Siba N. Rath ◽

Rabindra N. Padhy

Keyword(s):

Nasal Septum ◽

Middle Turbinate ◽

Uncinate Process ◽

Sinus Surgery ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Anatomical Variants ◽

Acute Rhinosinusitis ◽

Computed Tomography Images ◽

Osteomeatal Complex

Background: Recurrent acute rhinosinusitis (RARS), a low form chronic rhinosinusitis is frequently under evaluated. The significance of sinonasal anatomical variants of osteomeatal complex (OMC) and spheno-ethmoidal (SE) recess regions in patients of RARS is assessed.Methods: Retrospective analysis of coronal sinonasal computed tomography images of 120 RARS patients presented with sinonasal anatomical variants during November 2013 to October 2016 was carried out. Patients with acute and expansile sinonasal lesions are excluded.Results: Sinonasal anatomical variants in the regions of OMC and SE recess are responsible for obstruction of normal mucociliary drainage of corresponding paranasal sinuses in presence of inflammation predisposing to RARS. Anatomical variants of nasal septum were, deviated nasal septum (DNS) in 86 (72%) and septal spur in 58 (48%) patients. Anatomical variants in OMC region were, pneumatized middle turbinate (concha bullosa) in 50 (48%), paradoxical middle turbinate in 38 (28%), giant ethmoid bulla in 35 (32%), agger nasi cell in 29 (38%), Haller cell in 23 (15%), pneumatised uncinate process in 20 (18%), medialized uncinate process in 18 (22%) and septated maxillary sinus in 5 (4%) patients. Anatomical variants in SE recess were superior concha bullosa in 14 (12%) and septal bullosa in 11 (9%) patients.Conclusions: OMC pattern of recurrent rhinosinusitis is often prevalent in patients of RARS due to abundance of anatomical variants in the OMC region. DNS or ethmoid bulla when gets associated with concha bullosa increased the incidence of RARS. Present analysis would help surgeons to evaluate RARS patients for selective endoscopic sinus surgery.

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Anatomical variations in patients with chronic sinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180702 ◽

2018 ◽

Vol 4 (2) ◽

pp. 428 ◽

Cited By ~ 1

Author(s):

Pragadeeswaran Kumarasekaran ◽

Rajprakash Dharmapuri Yadhava krishnan ◽

Gurumani Sriraman

Keyword(s):

Nasal Septum ◽

Chronic Sinusitis ◽

Anatomical Variation ◽

Middle Turbinate ◽

Anatomical Variations ◽

Uncinate Process ◽

Sinus Surgery ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Anatomical Variant

Background: Chronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. Methods: Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. Results: In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. Conclusions: In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process. Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.

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CT Evaluation of Anatomical Variations in Osteomeatal Complex in Patients with Deviated Nasal Septum

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v21i2.27646 ◽

2016 ◽

Vol 21 (2) ◽

pp. 90-93

Author(s):

Mirza Aneesa ◽

Sajad Majid Qazi ◽

Aijazul Haq

Keyword(s):

Paranasal Sinuses ◽

Nasal Septum ◽

Complex Disease ◽

Anatomical Variation ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Anatomical Variations ◽

Lateral Nasal Wall ◽

Deviated Nasal Septum ◽

Osteomeatal Complex

Background:The presence of septal deviation has been positively associated with sinus disease, especially osteomeatal complex disease and anterior and posterior ethmoid disease.Computerized tomographic imaging (CT) of the paranasal sinuses has become a widely accepted tool for assessing the paranasal sinuses (PNS) and providing a detailed anatomy of the lateral nasal wall.Objective:The objective of the study was to identify the anatomical variations of lateral nasal wall and paranasal sinuses in patients with Deviated nasal septum.Methods:Computerized tomographic (CT) examination was carried out using the bone algorithm in the coronal plane in 40 patients who met the inclusion criteriain the Postgraduate Department of Otorhinolaryngology and Head and Neck Surgery, SMHS Hospital an associated Hospital of Government Medical College, Srinagar from March 2011 to May 2012.Results:In our study, CT Nose and PNS revealed Deviated nasal septum in 40 (100%) patients, Hypertrophied Inferior turbinate in 11 (27.50%) patients, Concha bullosa in 5 (12.50%) patients, Paradoxical Middle turbinate in 8 (20%) patients, Everted Hypertrophied Uncinate in 2 (5%) patients, Aggernasi cells in 4 (10%) patients, Haller cells in 3 (7.50%) patients and Onodi cells in 2 (5%) patients.Conclusion:The most common anatomical variation associated with deviated nasal septum was Hypertrophied Inferior turbinate and the least encountered variation was Everted Hypertrophied Uncinate and Onodi cells. The CT scan provides supplementary clinical data to the history and endoscopic examination and assists in directing surgical treatment to the affected areas.Bangladesh J Otorhinolaryngol; October 2015; 21(2): 90-93

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STUDY THE CLINICAL CHARACTERISTICS , COMPUTERIZED TOMOGRAPHY IMAGES AND SURGICAL OUTCOMES OF PATIENTS WITH CONCHA BULLOSA

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.1.12 ◽

2016 ◽

pp. 94-100

Author(s):

Nguyen Nguyen ◽

Van Dung Phan ◽

Thanh Thai Le

Keyword(s):

Computerized Tomography ◽

Nasal Septum ◽

Clinical Characteristics ◽

Nasal Congestion ◽

Postoperative Bleeding ◽

Middle Turbinate ◽

Concha Bullosa ◽

Deviated Nasal Septum ◽

Before And After ◽

Grade 3

Background: This study aims to describe clinical characteristics, computerized tomography image of concha bullosa and evaluate the results of surgical patients with concha bullosa. Patients and method: 37 patients with 51 concha bullosa surgeried to partially outside, by the method described cross, from October 2012 to June 2014. Result: Main symptoms of patients with CB is headache (89.2 %) and nasal congestion (67.6 %). In patients with CB often changes the anatomy and pathology with particularly crooked nasal septum (75.7 %). Patients with bilateral CB accounted for 62.2 % of patients had unbiliteral CB is 37.8 %. Location CB: 88.2 % the previous section, the following 2 %, both before and after 9.8 %. Ventilation position of CB: 68.7 % lamellar type, type bulbous 7.8%, and type extensive 23.5 %. The size of CB as assigned Thomas: highest grade 3 (31.1 %) followed by grade 2 (27 %) and grade 4 (6.7 %) was the last grade 1 (4.1%). The size of CB according classified Nadas: highest level 1 (59.5 %), followed by the 0 (31.1 %) and grade 3 (8.1%), and finally grade 4 (1.3 %). Complications of surgery: tear the lining of the septum (18.9 %), multiple intraoperative bleeding (representing 8.1%), mucosal abrasions middle turbinate (accounting for 2.7 %). The incidence of post-operative Art: meche withdrawal bleeding after surgery (13.5 %), bleeding early before 6 hours (5.4 %); Roll stick after surgery (representing 2.7 %), postoperative bleeding before 24 hours. Functional impairment in patients after surgery: After 3 months of headaches decreased 84.8 %, stuffy nose fell 92 %, 90.9 % of reduction talks flow, Itchy nose, sneezing decreased 42.9 %. Middle turbinate endoscopic nasal after surgery: 100 % middle turbinate slim nose. Conclusion: The combined clinical and endoscopic sinus CT will improve the efficiency of diagnosis and treatment concha bullosa. Key words: concha bullosa, deviated nasal septum, rhinosinusal computerized tomographic scanner.

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