Printer Friendly

The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery.

Byline: Seyyed Abdollah Madani, Seyyed Abbas Hashemi and Mostafa Modanluo

Abstract

Objective: To investigate the correlation of nasal septal deviations and chronic rhinosinusitis.

Methods: The study was conducted at Department of Otolaryngology, Head and Neck Surgery, Boali Hospital, Sari, Iran from January 2012 to September 2014 and comprised subjects aged from 5 to 68 years who had undergone elective functional endoscopic sinus surgery for chronic rhinosinusitis. SPSS 17 was used for statistical analysis. Results: Of the 60 subjects in the study, 41(68.3%) were males and 19(31.7%) females with overall median age of 27. Nasal septal deviation was found in 49(81.7%) subjects; 11(18.3%) had it in both right and left sides, 16(26.7%) in right alone and 22(36.7%) in the left side. The commonest type of septal deviations in the left side were posteroinferior 10(16.66%) and anteroinferior 7(11.7%). In the right side, the corresponding numbers were 9(15%) and 7(11.7%).

Conclusion: Nasal septal deviations are of particular interest in majority of patients with chronic rhinosinusitis.

Keywords: Chronic rhinosinusitis, Functional endoscopic sinus surgery, Septal deviation, Variation. (JPMA 65: 612; 2015)

Introduction

Chronic rhinosinusitis (CRS) is a common disease which decreases the quality of life and affects up to two per cent of the world population.1-5 According to an analysis of the 2008 National Health Interview Survey information, rhinosinusitis affected nearly 1 in 7 adults.6

Several researches have investigated the correlation of sinonasal anatomic variants and the incidence of CRS.7-10

Two anatomic variants have been recognised, including the middle turbinate concha bullosa and nasal septal deviation. The incidence of positive reports of computed tomography (CT) for concha bullosa has been elucidated from 14% to 53% and the correlation of concha bullosa and septal deviation with paranasal sinus diseases were subject of different studies.11,12 Congenital and normal anatomical variants in this site can be important as cause of hard operation and development of chronic inflammation.13 In this regard, there is not enough data and information in the literature about the possible role of these variations in CRS.

Therefore, the current study was planned to examine the variations in septal deviations in patients suffering from CRS who underwent functional endoscopic sinus surgery (FESS).

Patients and Methods

The study was conducted at Department of Otolaryngology, Head and Neck Surgery, Boali Hospital, Sari, Iran from January 2012 to September 2014 after approval from the ethics committee of the Mazandaran University of Medical Sciences, Sari, Iran,. It comprised subjects whose age ranged from 5 to 68 years and who underwent elective FESS for CRS. Those below 5 years of age, with history of coronary artery disease (CAD), bleeding disorders and those using anti-hypertensive medications were excluded. All patients were selected according to criteria for CRS as described by the Sinus and Allergy Health Partnership.1

Statistical analysis was performed with SPSS 17. Results were expressed as median, mean and standard deviation. Chi square, student t test and Fischer exact test were used for data analysis. P value less than 0.05 was considered statistically significant.

Results

There were 60 patients in the study; 41(68.3%) males and 19(31.7%) females with a mean age of 29.1315.21 years (Table-1). There were 13(21.6%) patients in the 15-20 years age group followed by 8(13.3%) each in the 25-30 and 30-35 years groups.

Among the subjects, 49(81.7%) had anatomical variation and septal deviation was not observed in 11(18.3%). Overall, 11 (18.3%) patients had septal deviation in both right and left sides, 16(26.7%) had in the right side and 22(36.7%) had in the left side (Table-2).

Table-1: Demographic data.

N###Age (Years) Duration of chronic rhinosinusitis(month)

Mean###29.13###53.53

Standard deviation###15.21###55.35

Median###27###36

Range###5-68###176

Minimum###5###4

Maximum###68###180

Table-2: Distribution of left and right septal deviation.

Variation###Left septal deviation###Right septal deviation

###Number (%)###Number (%)

Posterosuperior###4(6.7%)###2(3.3%)

Posteroinferior###10(16.66%)###9(15%)

Anterosuperior###4(6.7%)###1(1.7%)

Anteroinferior###7(11.7%)###7(11.7%)

Medioanterior###1(1.7%)###3(5%)

Mediosuperior###1(1.7%)###1(1.7%)

Medioposterior###1(1.7%)###0

Medioinferior###2(3.3%)###1(1.7%)

Mediomedial###0###2(3.3%)

Caudal end of septum nasi###3(5.0%)###1(1.7%)

Septal deviation(total)###33(55%)###27(45%)

Table-3: Clinical information and other features.

Septal deviation###Urban###Rural###Total

Yes###27(55.1%)###22(44.9%)###49(100%)

No###8(72.7%)###3(27.3%)###11(100%)

Total###35(58.3%)###25(41.7%)###60(100%)

Septal deviation###Male###Female###Total

Yes###35(71.4%)###14(28.6%)###49(100%)

No###6(54.5%)###5(45.5%)###11(100%)

Total###41(68.3%)###19(31.7%)###60(100%)

Septal deviation###Allergy (yes)###Allergy(no)###Total

Yes###15(30.6%)###34(69.4%)###49(100%)

No###4(36.4%)###7(63.6%)###11(100%)

Total###19(31.7%)###41(68.3%)###60(100%)

Septal deviation###Polyp(yes)###Polyp(no)###Total

Yes###8(16.3%)###41(83.7%)###49(100%)

No###3(27.3%)###8(72.7%)###11(100%)

Total###11(18.3%)###49(81.7%)###60(100%)

Septal deviation###Cyst(yes)###Cyst(no)###Total

Yes###5(10.2%)###44(89.8%)###49(100%)

No###1(9.1%)###10(90.9%)###11(100%)

Total###6(10%)###54(90%)###60(100%)

Septal deviation###Tumour(yes)###Tumour(no)###Total

Yes###2(4.1%)###47(95.9%)###49(100%)

No###1(9.1%)###10(90.9%)###11(100%)

Total###3(5%)###57(95%)###60(100%)

The commonest type of septal deviations in the left side were posteroinferior 10(16.66%) and anteroinferior were 9(15%) and 7(11.7%). Posteroinferior septal deviation was a significant variation in the right side (p=0.003) and left side (p=0.021).

There was no significant change in the age of patients with septal deviation in comparison to patients without deviation (p=0.44). Likewise, no significant alteration was found neither in the duration of the disease in the two groups nor on the basis of rural or urban, cyst, polyp and tumour (pgreater than 0.05 each) (Table-3).

Discussion

There is great interest among otorhinolaryngologists and researchers in the exploration of paranasal region's anatomy, its variations and correlation of these variants with CRS.14

Advances in operational methods have resulted in better findings with less complication in the paranasal sinus area. We made use of FESS to determine these variants and interpret the probable association between nasal septal deviations and CRS.

Some studies have reported nasal septal deviation in 20-31% of the community and also revealed that severe deviation predisposed the individuals to rhinosinusitis.

In this regard, one study indicated that there is a probable association between concha bullosa or septal deviation and rhinosinusitis.18 In contrast, another study showed there was no significant relationship between septal deviation and rhinosinusitis.19

One study20 reported that 73% subjects with concha bullosa suffered from paranasal sinus inflammatory disease; but 78% subjects without concha bullosa also indicated some forms of inflammatory disease.

One set of researchers21 studied the CT scans of 63 patients who underwent revision FESS. It reported 15.9% subjects had significant deviation of the nasal septum.

One study22 examined 65 children with CRS and revealed no correlation between anatomical variants in the nose and paranasal sinuses with CRS in children on sinus CT scanning.

In our series, 49(81.7%) subjects had anatomical variants and septal deviation was not reported in 11(18.3%). Eleven (18.3%) participants had septal deviation in both right and left sides, 16(26.7%) patients had it in the right side and 22(36.7%) in the left side. In our study, the most particular types of septal deviation in left side were posteroinferior (16.66%) and anteroinferior (11.7%). In the right side, the most common types were posteroinferior (15%) and anteroinferior (11.7%).

In contrast to earlier investigations, our study had the most prevalence of septal deviation in CRS patients and revealed there a strong association between nasal septal deviation and CRS.

It has been supposed that nasal septal deviations predispose patients to development of CRS but there are few published studies to support this notion.9,23-25

Conclusion

Nasal septal deviations were common variants in patients with CRS. Characterisation of anatomic variants in CRS needs further studies.

Acknowledgment

We are grateful to Ms Nilofar Motamed for statistical assistance.

References

1. Meltzer EO, Hamilos DL, Hadley JA ,Lanza DC, Marple BF, Nicklas RA, et al, editors. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004; 114:155-212.

2. Fokkens W, Lund VJ, Bachert C,Clement P,Hellings P,Holmstorm M, et al. EPOS document EAACI: position paper on rhinosinusitis and nasal polyposis. Rhinology .2005 ; 43 ((Suppl 18):1-88.

3. Shashy RG, Moore EJ,Weaver A. Prevalence of the chronic sinusitis diagnosis in Olmsted County.Minnesota. Arch Otolaryngol Head Neck Surg. 2004 ; 130:320-3.

4. Madani SA, Hashemi S A,Gebraili E.The Correlation of Nasal Mucosal and Systemic Eosinophilia with Chronic Rhinosinusitis.J Mazand Univ Med Sci 2012; 22: 91-96 (Persian).

5. Hashemi SA, Abediankenari S, Madani SA, Akbari M. Comparison of salivary IgA, tear IgA and serum IgE in patients suffering from chronic rhinosinusitis. Int J Med Invest 2012;1:31-7.

6. Pleis JR, Lucas JW, Ward BW. Summary health statistics for U.S. adults: National Health Interview Survey, 2008. Vital Health Stat 2009;10:1-157.

7. Stackpole SA, Edelstein DR. The anatomic relevance of the Haller cell in sinusitis. Am J Rhinol 1997;11:219-23.

8. Zinreich S, Albayram S, Benson M, Oliverio P. The ostiomeatal complex and functional endoscopic surgery. In: Som P, ed. Head and neck imaging. 4th ed. St Louis: Mosby; 2003;149-73.

9. Bolger W, Butzin C, Parsons D. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 1991;101:56-64.

10. Arslan H, Aydnloglu A , Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 1999;26:39-48.

11. Lloyd GA. CT of the paranasal sinuses: study of a control series in relation to endoscopic sinus surgery. J Laryngol Otol 1990;104:477-81.

12. Lloyd G, Lund V, Scadding G. CT of the paranasal sinuses and functional endoscopic surgery: a critical analysis of 100 symptomatic patients. J Laryngol Otol 1991;105:181-5.

13. Mecit K, Karasen M , Alper F , Onbas O , Okur A, Karaman A. Remarkable anatomic variations in paranasal sinus regionand their clinical importance. Eur J Radiol 2004;50:296-302.

14. Zinreich SJ, Kennedy DW, Rosenbaum AE, Gayler BW, Kumar AJ, Stammberger H. Paranasal sinuses: CT imaging requirements for endoscopic surgery. Radiology 1987;163:769-75.

15. Shin HS. Clinical significance of unilateral sinusitis. J Korean Med Sci 1986;1:69-74.

16. Lebowitz RA, Brunner E, Jacobs JB. The agger nasi cell: radiolog- ical evaluation and endoscopic management in chronic frontal sinusitis. Operative techniques. Otolaryngol Head Neck Surg 1995;6:171-75.

17. Wanamaker H. Role of Haller's cell in headache and sinus disease: a case report. Otolaryngol Head Neck Surg 1996;114:324-7.

18. Calhoun KH, Waggenspack GA, Simpson CB, Hokanson JA, Bailey BJ. CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngol Head Neck Surg 1991;104:480-3.

19. Hamdan AL, Bizri AR, Jaber M, Hammoud D, Baino T, Fuleihan N. Nasoseptal variation in relation to sinusitis: a computerized tomographic evaluation. J Med Liban 2001;49:2-5.

20. Stallman JS, Lobo JN, Som PM. The Incidence of Concha Bullosa and Its Relationship to Nasal Septal Deviation and Paranasal Sinus Disease. AJNR Am J Neuroradiol 2004;25:1613-8.

21. Khalil HS, Eweiss AZ, Clifton N. Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study. BMC Ear Nose Throat Disorders 2011, 11:4.

22. Al-Qudah M. The relationship between anatomical variations of the sino-nasal region and chronic sinusitis extension in children. Int J Pediatr Otorhinolaryngol 2008; 72, 817-21.

23. Lusk RP, McAlister B, el Fouley A. Anatomic variation in pediatric chronic sinusitis: a CT study. Otolaryngol Clin North Am 1996;29:75-91.

24. Jones NS, Strobl A, Holland I. A study of the CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol Allied Sci 1997;22:47-51.

25. Danese M, Duvoisin B, Agrifoglio A, Cherpillod J, Krayenbuhl M. Influence of naso-sinusal anatomic variants on recurrent, persistent or chronic sinusitis. X-ray computed tomographic evaluation in 112 patients. J Radiol 1997; 78:651-7.
COPYRIGHT 2015 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2015 Gale, Cengage Learning. All rights reserved.

 
Article Details
Printer friendly Cite/link Email Feedback
Publication:Journal of Pakistan Medical Association
Date:Jun 30, 2015
Words:2110
Previous Article:Comparing neonatal respiratory morbidity in neonates delivered at term by elective Caesarean section with and without dexamethasone: retrospective...
Next Article:Students perception of mentoring at Bahria University Medical and Dental College, Karachi.
Topics:

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters