A Review on Deviated Nasal Septum: Classification, Clinical Features and Management

The nasal septum separates the right and left part of the nasal cavity and columellar septum, membranous septum and septum proper are the parts of it. Deviation of nasal septum is a common case of nasal obstruction presented in a clinic. A lot of classifications have been developed to help ease the study of deviated nasal septum but none of them is used as a standard. Some of the classifications include the one given by Vidigal, Guyuron, Cerek, Mladina and Cottle’s. Apart from nasal obstruction other common clinical features involving deviated nasal septum are sinusitis especially in horizontal deviation type V. Pressure on lateral wall by spurs can also cause pressure headache. Due to increased air flow in the nasal cavity, dryness occurs causing epistaxis. Obstruction of nasal cavity causes mouth breathing in return either exaggerating or leading to obstructive sleep apnoea. Septal deviation also effects the choroidal thickness and choroidal blood supply. Histopathologically, lymphocytic infiltration and squamous metaplasia occurs in septal mucosa. These changes occur mostly due to change in the aerodynamic flow. There is decreased cilia movement and inferior turbinate hypertrophy. Thickness of inferior turbinate gains importance while septoplasty as, if thickened a lot, the inferior turbinate demands excision. The deviated nasal septum is associated with sinusitis, chronic suppurative otitis media and Eustachian tube dysfunction. Management involves sub mucus resection or septoplasty. Out of the two, septoplasty is preferred as it is a conservative surgery. Only symptomatic and cosmetically grossly disfigured cases require a surgical treatment while the asymptomatic cases are generally not indicated for surgery. This study tries to review the Classification, Clinical Features and Management of Deviated Nasal Septum.

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Prevalence and clinical features of nasal septum deviation: a study in an urban centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173670 ◽

2017 ◽

Vol 3 (4) ◽

pp. 842 ◽

Cited By ~ 2

Author(s):

Vinnakota Sriprakash

Keyword(s):

Nasal Cavity ◽

Nasal Obstruction ◽

Nasal Septum ◽

Critical Role ◽

Geographical Area ◽

Nasal Discharge ◽

Deviated Nasal Septum ◽

Septum Deviation ◽

Aesthetic Appearance ◽

Nasal Septum Deviation

Background: Considerably large nasal septum plays a critical role in the obstruction of the nasal cavity, leading to snoring, and other symptoms, aesthetic appearance of the nose, and increased nasal resistance. This study was performed with an aim to investigate the prevalence of nasal septum deviation in our geographical area.Methods: 446 patients who attended the ENT department in the study period were evaluated for the nasal septum deviation. General demographic details were obtained from all of them. Detailed physical exam was performed on all the patients. Disposable nasal speculum and otoscope was used to observe the interior of the nasal cavity. Results: Out of 446 patients visiting the ENT department of our hospital, 138 (30.9%) of them had DNS. The C shaped NSD was the most common type to be encountered in our study, with 57 patients showing this disorder. Nasal obstruction was the predominant symptom observed in 119 (86.2%) of the patients, followed by rhinitis and nasal discharge (34.8%).Conclusions: Deviated nasal septum is a very prevalent condition in our area, with severe symptoms such as nasal obstruction and rhinitis. Most of the patients had C shaped deviated septum.

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COMPARATIVE STUDY ON IMPROVEMENT OF NASAL SYMPTOMS FOLLOWING SEPTOPLASTY WITH PARTIAL INFERIOR TURBINECTOMY VS SEPTOPLASTY ALONE IN ADULTS WITH DEVIATED NASAL SEPTUM

10.36106/ujsr/5425585 ◽

2021 ◽

pp. 62-65

Author(s):

Subhadeep Chowdhury ◽

Tithi Debnath ◽

Sweta Verma

Keyword(s):

Comparative Study ◽

Nasal Obstruction ◽

Nasal Septum ◽

Tertiary Care ◽

Inferior Turbinate ◽

Deviated Nasal Septum ◽

Nose Scale ◽

Nasal Symptoms ◽

Group A ◽

Group B

BACKGROUND: Nasal obstruction is a common presenting symptom which otolaryngologists encounter in daily clinical practice. One of the most common cause of nasal obstruction is deviated nasal septum(DNS). DNS to one side is associated with overgrowth of inferior turbinate on the contralateral side. Septoplasty alone or septoplasty with inferior turbinate reduction is the mode of treatment but that depends upon the decision of the operative surgeon. In this study we aim to collect data and come to a conclusion as to which surgery is benecial for the patients. AIMS AND OBJECTIVES: (1) To compare the symptomatic improvement of nasal symptoms following septoplasty with partial inferior turbinectomy versus septoplasty alone by NOSE Scale. (2) To corroborate the subjective ndings of NOSE Scale by rhinomanometry and nasal endoscopy. METHODOLOGY: A prospective and comparative study was done on 60 patients over a period of 1 year in a tertiary care centre. Patients were alternatively divided into two surgical groups Group A- septoplasty with partial inferior turbinectomy and Group B- septoplasty alone. Nasal Obstruction Symptom Evaluation(NOSE) was used for subjective evaluation of nasal symptoms. Rhinomanometry was used as a tool for objective evaluation of symptoms. Data was analysed using tables, graph and percentage and test of signicance. Post operative improvement RESULTS: following both group A septoplasty with partial inferior turbinectomy and group B Septoplasty alone was signicant at post op 1,3 and 6 months respectively. When both groups were compared those undergoing partial inferior turbinectomy with septoplasty had highly signicant results by NOSE scale as well as rhinomanometry and endoscopy. This study showed tha CONCLUSION: t hypertrophied turbinate need to be addressed in chronic cases of nasal obstruction with deviated nasal symptom with contralateral turbinate hypertrophy. Thus we can conclude that partial inferior turbinectomy should be done in addition to septoplasty as it is a highly effective modality for treatment of nasal obstruction in patients of nasal obstruction in patients with deviated nasal septum.

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Comparing the outcome of septoplasty and septoplasty with turbinectomy in patients with deviated nasal septum

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193616 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1185

Author(s):

Nayanna Karodpati ◽

Mayur Ingale ◽

Sharad Rawat ◽

Vinayak Kuradagi

Keyword(s):

Nasal Obstruction ◽

Nasal Septum ◽

Inferior Turbinate ◽

Symptom Improvement ◽

Deviated Nasal Septum ◽

Medical College ◽

Turbinate Hypertrophy ◽

Symptom Evaluation ◽

Postoperative Symptoms ◽

Inferior Turbinate Hypertrophy

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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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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Grafting to denuded nasal cavity for prevention of recurrent nasal polyposis by endoscopic sinus surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183689 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1135

Author(s):

Hany Amin ◽

Yasser Mohammed Hassan Mandour ◽

Ahmed Elrefai

Keyword(s):

Nasal Cavity ◽

Nasal Obstruction ◽

Nasal Mucosa ◽

Endoscopic Sinus Surgery ◽

Nasal Septum ◽

Nasal Polyposis ◽

Inferior Turbinate ◽

Sinus Surgery ◽

Nasal Polypi ◽

Recurrent Nasal Polyposis

Background: The objective of the study was to avoid nasal polyposis occurrence after recurrent FEES.Methods: 87 patients undergoing recurrent FESS due to recurrent nasal polyposis, after completing all steps of FESS the placement of normal nasal mucosa from inferior turbinate or nasal septum instead of the mucosa of the fovea ethmoidalis and lamina papyracea was done. Results: There were nasal obstruction improvement in 79 patients (90.8%), but there were 8 patients (9.2%) had recurrent nasal polypi causing nasal obstruction. There was smell improvement in 38 patients (71.7%) out of 15 patients (28.3%).Conclusions: The nasal cavity grafting in FESS of recurrent nasal polyposis with nasal septal or inferior turbinate mucosa had promising results in prevention of nasal polyposis recurrence. These results made a recommendation of nasal cavity grafting during primary FESS of nasal polyposis.

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Role of CT Nose Paranasal Sinuses and Nasal Endoscopy for Decision Making in a Case of Deviated Nasal Septum

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i3.14 ◽

2019 ◽

Vol 27 (3) ◽

pp. 235-239

Author(s):

Sayan Hazra ◽

Ankit Choudhary ◽

Swapan Kumar Ghosh ◽

Subhradev Biswas ◽

Kaustuv Das Biswas

Keyword(s):

Ct Scan ◽

Nasal Obstruction ◽

Paranasal Sinuses ◽

Nasal Septum ◽

Pathological Condition ◽

Middle Turbinate ◽

Inferior Turbinate ◽

Nasal Endoscopy ◽

Deviated Nasal Septum ◽

Pathological Conditions

Introduction Deviated nasal septum (DNS) can be asymptomatic in an individual or may cause nasal obstruction. The condition is generally diagnosed clinically and based on clinical diagnosis it is managed Surgically by large without much heed to diagnostic procedure. Thus, often underlying other causes of Obstruction is missed. Thus, it becomes essential to evaluate every patient presenting with history of Nasal obstruction and clinically Deviated septum, with aid of Nasal Endoscopy and CT scan Nose Paranasal Sinuses (PNS) to rule out/diagnose other coexisting conditions. Methods and Methodology 100 patients who presented with nasal obstruction and clinically diagnosed to have Deviated Nasal Septum were then subjected to Nasal Endoscopy and CT scan Nose and PNS and findings were noted for analysis. Results and Analysis Of these 100 patients, 48 patients were found to have coexisting pathological conditions/anatomical variants. Various anatomical and pathological Conditions were found to coexist together. Inferior turbinate hypertrophy in 34% is the most common pathological condition found to be associated with DNS followed by of sinusitis in 25% patients apart from polyp, concha bullosa and paradoxical middle turbinate. Discussion Studies done so far shows there is a definite link of deviated nasal septum to various anatomical and pathological conditions of the nose. CT Scan Nose PNS and Nasal Endoscopy plays a vital role in diagnosing such anomalies. Conclusion Most of the patients, presenting with nasal obstruction and having Deviated Nasal Septum, undergo management without proper analysis and returns with recurrence of symptoms which could be analyzed properly if Nasal endoscopy and CT scan is employed during diagnosis of the condition, reducing risk of treatment failure.

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Role of Bilateral Inferior Turbinoplasty as an Adjunct to Septoplasty in Improving Nasal Obstruction and Subjective Performance in Patients With Deviated Nasal Septum Associated With Allergic Rhinitis: An Interventional, Prospective Study

Ear Nose & Throat Journal ◽

10.1177/01455613211015440 ◽

2021 ◽

pp. 014556132110154

Author(s):

Sanjoy Kumar Ghosh ◽

Mainak Dutta ◽

Dibakar Haldar

Keyword(s):

Allergic Rhinitis ◽

Prospective Study ◽

Nasal Obstruction ◽

Nasal Septum ◽

Inferior Turbinate ◽

Significant Benefit ◽

Rank Test ◽

Performance Parameters ◽

Deviated Nasal Septum

Background: Patients with nasal obstruction due to deviated nasal septum (DNS) often have allergic rhinitis (AR) as contributing factor. When optimal medical therapy for AR fails, septoplasty alone may not adequately treat nasal obstruction. Therefore, with bilateral inferior turbinate hypertrophy representing long-standing AR, adding bilateral inferior turbinoplasty (BIT) to septoplasty might be beneficial. Objective: To assess whether septoplasty with/without BIT alleviates nasal obstruction in the above patient cohort and whether adding BIT to septoplasty brings significant benefit. Methodology: In this interventional, prospective study, patients with nasal obstruction due to DNS and persistent, moderate-severe AR refractory to optimal medication were randomly allocated into group A (septoplasty alone) and group B (septoplasty with BIT). Nasal Obstruction and Symptom Evaluation (NOSE) score, along with Subjective Performance parameters (days-off/month; number of outdoor visits/month; overall satisfaction score [OSS]) were used to assess the symptom and quality of life, respectively, at follow-up. Results: Each group had 40 age/sex-matched patients. Friedman test, and subsequent pair-wise comparison within groups without Bonferroni correction, revealed that septoplasty with/without BIT elicited significant reduction in NOSE scores and in the Subjective Performance parameters (days-off/month; number of outdoor visits/month) at 3 and 6 months. Wilcoxon Signed Rank test revealed that the OSS within groups also improved significantly with time. Further, comparison between groups revealed significant improvement in NOSE scores at all levels of follow-up when BIT was included. However, there were no significant differences between groups in the Subjective Performance parameters at any level of follow-up. Improvement in OSS between groups was significant only at 3 months but not subsequently. Conclusion: Septoplasty with/without BIT is helpful in treating patients with DNS and refractory AR. However, although adding BIT brings significant benefit in decreasing nasal obstruction, it does not significantly improve the Subjective Performance parameters during follow-up, except for OSS at the third month.

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Morphological and histopathological study of hypertrophied inferior nasal turbinate in Egyptian patients: in clinical perspective

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-020-00024-2 ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Ashraf Ali El-Demerdash ◽

Essam Abdel Wanees Beheiry ◽

Sherif Maher El-Aini ◽

Asmaa Shams El-Dein Mohamed ◽

Ahmed Mohamed Ibrahim Khattab

Keyword(s):

Layer Thickness ◽

Nasal Septum ◽

Inferior Turbinate ◽

Military Hospital ◽

Deviated Nasal Septum ◽

Nasal Turbinate ◽

Egyptian Patients ◽

Mucosal Layer ◽

Group A ◽

Group B

Abstract Background The inferior nasal turbinates have important role in the maintenance of nasal breathing function by providing the nasal valve mechanism necessary for the regulation of air flow through the nose. Hypertrophied inferior nasal turbinates are the second most common cause of chronic nasal obstruction. Our aim of this study is to evaluate the morphological and histopathological features of hypertrophied inferior nasal turbinate in Egyptian patients. Methods Our descriptive comparative study was carried on 30 patients presented with hypertrophied inferior nasal turbinate by clinical and radiological assessment. Patients are divided into two groups according to CT scan and endoscopic examination as group A for patients with deviated nasal septum with compensatory hypertrophied inferior nasal turbinate and group B for patients with hypertrophied inferior nasal turbinate due to allergic rhinosinusitis. Both groups underwent the same operation which partial controlled posterior inferior turbinectomy. During the period from June 2018 till May 2019, patients were selected from out-patient’s clinic of Otorhinolaryngology Department at Menoufia University Hospital and Shebin El-Kom Teaching Hospital, and Military Hospital. Results By histopathological examination of the specimens, we found out that the bony layer thickness was more prominent in group A and the mucosal layer thickness was more prominent in group B. The prominent inflammatory cells were lymphocytes in group A and eosinophils plus mast cells in group B. Conclusion The bony layer thickness should be excised during the surgical treatment of cases presented with deviated nasal septum with hypertrophied inferior turbinate where in cases of allergic rhinitis with hypertrophied inferior turbinate, the mucosal layer is enough to be excised.

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An endoscopic approach to the deviated nasal septum – a preliminary study

The Journal of Laryngology & Otology ◽

10.1017/s0022215100142124 ◽

1998 ◽

Vol 112 (10) ◽

pp. 934-939 ◽

Cited By ~ 20

Author(s):

Dipak Ranjan Nayak ◽

R. Balakrishnan ◽

K. Deepak Murthy

Keyword(s):

Nasal Obstruction ◽

Nasal Septum ◽

Objective Assessment ◽

Subjective Assessment ◽

Endoscopic Approach ◽

Lateral Nasal Wall ◽

Combined Approach ◽

Deviated Nasal Septum ◽

Nasal Endoscope ◽

Preliminary Study

AbstractThe authors have used the nasal endoscope for the precise identification of pathological abnormalities of the nasal septum in relation to the lateral nasal wall including the osteo-meatal complex and in its ultraconservative management. The aim of the study was to compare the efficacies of endoscope-aided septoplasty (EAS) over traditional septoplasty (TS) in treating the pathological septum and turbinates, performed in 30 cases each. The subjective assessment was carried out by visual analogue scores and objective assessment by nasal endoscopy. This study demonstrates the superiority and limitations of the endoscopic approach in managing a deviated nasal septum and the turbinates. The endoscope-aided technique was found to be more effective in relieving the contact areas and nasal obstruction (p = ≤0.05). The authors advocate a combined approach – an endoscopic approach for inaccessible posterior deviation and the conservative traditional technique for accessible anterior deviation of the nasal septum.

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The Common Clinical Presentation of Patients Selected for Septoplasty in Northern Saudi Arabia

International Journal of Otolaryngology ◽

10.1155/2018/8536387 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Abdullah D. Alotaibi ◽

Bassam Ahmed Almutlaq ◽

Fahad Nashmi Alshammari ◽

Hussain Gadelkarim Ahmed

Keyword(s):

Saudi Arabia ◽

Nasal Obstruction ◽

Nasal Septum ◽

Clinical Presentation ◽

Critical Role ◽

Deviated Nasal Septum ◽

Clinical Presentations ◽

Common Clinical Presentation ◽

The Common ◽

Almost All

Background. Nasal septal deviation (NSD) plays a critical role in nasal obstruction symptoms, aesthetic look of the nose, increased nasal resistance, and occasionally snoring. Septoplasty is the most common method for correction of deviated nasal septum (DNS). Therefore, the aim of the present study was to assess the association between initial clinical presentations of patients selected for septoplasty and demographical characteristics in Northern Saudi Arabia.Methodology. Archives related to all patients selected for septoplasty between 2012 and 2017 were retrieved from ENT Department at King Khalid Hospital in Hail, Northern Saudi Arabia. Only adults over 18 years of age were included in this study.Results. With regard to the clinical presentations, almost all patients presented with variable degrees of nasal congestions, nasal blockages, breathing troubles, sleeping troubles, and exercise problems.Conclusion. Nasal obstruction is prevalent in Northern Saudi Arabia with peaks being in the years 2016 and 2014 with the most etiological factor being DNS.

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