Clinical Study on Deviated Nasal Sep

tum and Its Associated Pathology

Tutor :
dr. Tris Sudyartono,
Sp. THT-KL
dr. Agus Sudarwi, Sp.
THT-KL
Presented dr. Afif Zjauhari, Sp.
Feny Chandra Dewi
by:
THT-KL
406138045

Vivi Anggelia 406138108

REVIEW

Here is it.

Nasal Septum Deviation

Ta daaa

Deviation of cartilage and or bony

framework of the nasal septum from
midline associated with nasal
symptoms

Etiology

Trauma

Developmental

Racial factor

Abnormal
intrauterine posture

Type of DNS

Spur

C shaped

Anterior

S shaped

Septal
thickening

Mladinas
Classification

Type VI
shows a unilateral sulcus running through the
caudal-ventral part of the septum, while on the
other side there is a ridge and accompanying
asymmetry of the nasal cavity.

Type I
is described as a unilateral crest which does not
Type
IV the function of the nasal valve. It is
disturb
type II
defines two crests one at thesituated
level ofinthe
head
of
the area
of the valve.
disturbance
the middle nasal concha, and
the otherofonthe
thevalve function is caused by the
unilateral
crest.
opposite side in the valve area,
disturbing
thePositive
valve Cottles symptom can be
functions.observed after raise of the nostril, which gives a
subjective and objective improvement in the nose
patency.

Type V
III while on
is a unilateral ridge on the base of the Type
septum,
one unilateral
at the
level of the head of the middle
the other
side the crest
septum
is straight.
nasal concha.

Clinical Symptoms

Nasal block

Headacache

Epistaxis

Hyposmia

External nasal
deformity

Sinusitis

Differential Diagnosis

Polyp
Septal haematoma

Hypertrophied
turbinates

JOURNAL READING

Clinical Study on Deviated Nasal Se

ptum and Its Associated Pathology

Prayaga N. Srinivas M
oorthy, Srikanth Kolloj
u,
Srivalli Madhira,
Ali Behman Jowkar1

Abstract
Deviated nasal septum is a frequently occurring condition that can cause nasal ob
struction in an individual. It may result in permanent changes in the nasal and
sinus mucosa because of altered ventilation of the nasal cavity. The present study m
akes an attempt to review its incidence and its associated pathology.

Our study involves two groups of patients wit

h 100 patients in each group.
-The first group consists of patients who
are having nasal obstruction as a chief complaint
and have deviated nasal septum.
-The second group consists of patients with either
ear or throat complaints without any nasal sy
mptoms, but were noted to have deviation of
nasal septum on examination.

An analysis was made to determin

e whether any particular type of d
eviation is more prone to develop
pathology than other types.

Our study shows that an S s

haped deviation is more prone
to be associated with ear, nose a
nd throat pathology.

Introduction
Bony parts

cartilaginous
parts

Nasal
septum

Right and left nasal cavity

 Racial factors,
birth molding of septum
during parturition,
trauma and
developmental
deformities of septum

Throat, ear and surgery

of septum and sinuses
is indicated in such a
situation

Asymptomatic in an
individual
nasal obstruction
rhinosinusitis like nasal
discharge, facial pain,
epistaxis, disturbance of
smell

Various reasons
have been
attributed to
occurrence of
deviated nasal
septum (DNS)

Deviated nasal
septum (DNS)
can

Pathology in
sinonasal cavity
can also affect
the functioning

To analyze the
prevalence of
various types of
deviated nasal
septum and their
associated ear,
nose and throat
pathology.

Material and MethodsChildren < 5 years

of age are excluded

from the study.

A thorough clinical
examination and diagnostic
nasal endoscopy is done to
evaluate the nasal cavity and
nasal septum in all the
patients.

Classified the
observed DNS
clinically into
varioud type:
Anterior deviation

Posterior deviation

Caudal dislocation

Patients in
Group I

Patients in
Group II

Were subjected
Computerized
Tomography scan of
paranasal sinuses (CT
PNS).

Were advised X-Ray

of Paranasal sinuses
initially

C shaped
S shaped deviation
(either in cephalo-caudal
or antero-posterior
direction)
Spur impinging on
lateral nasal wall,
thickened septum

They were subjected

to CT PNS if the X-ray
PNS showed any
sinus pathology.

Material and Methods

The aim of the study is to
determine whether any
particular type of septal
deviation is more prone
to be associated with
the ear, nose and throat
pathology than other
types, irrespective of it
being symptomatic or
not.

Result

It is similar to the study of

Rodney P Lusk
where the incidence of
septal deviation in
pediatric age group is
10.4%

Results
More number of males even in Group II and
patients between 16 - 25 years were more
common.
The absence of nasal symptoms (group II ) could
not be explained by our study
But its possible that the patients have ignored
subtle nasal symptoms in presence of more
distressing ear and throat complaints of their
disease.

Various types of deviated nasal septum found in both the

groups.

Group I

patients the associated

anatomical variants on lateral
nasal wall as diagnosed by CT
Scan were Concha bullosa
(CB), and Paradoxical middle
turbinate (PMT)

Group II
Interestingly none of these 35
patients were complaining any
nasal symptoms of which 20
patients were having tubotympanic
type of CSOM and 10 were having
chronic pharyngitis.

patients there were no

nasal polyp seen but
significant sinus
involvement as noted in
CT scan

A patient of left CSOM

(Group II) showing disease
in left middle ear and
mastoid having a C
shaped DNS to- wards
right, left Concha bullosa
and sinusitis involving left
maxillary and ethmoid
sinuses without any nasal
symptoms.

 200 113 (Significant sinonasal)

49 (S shaped DNS in anteropsterior
direction and all)
8 (having sinonasal disease)
The association between sinus disease and
presence of other types of DNS (other than
S shaped) is not statistically significant in our
study.

CONCLUSION

Deviated nasal septum can be associated with

significant sinonasal disease even in absence of any
nasal symptoms, especially an S shaped DNS which
showed statistically significant correlation with sinus
disease in our study.

Larger multi-centre studies are required to confirm our

study findings before we can propose that a preventive
Septoplasty can be contemplated for an S shaped
septum without nasal symptoms to curtail
development of possible ear, nose and throat pathology

ANY Q?