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Deviated Nasal Septum

Nasal Septum Deviation

A deviated nasal septum is quite common in the general population and is often asymptomatic, but some individuals can develop chronic nasal obstruction, recurrent epistaxis and are predisposed to chronic sinusitis. The diagnosis can be made during physical examination and through imaging procedures.


Presentation

More than 60% of the adult population is estimated to suffer from a deviated nasal septum according to certain reports [1], but the clinical presentation varies depending on the location and severity of nasal septum deviation. Individuals may often be asymptomatic, but the most common signs include epistaxis, increased nasal crusting, altered nasal respiration and the necessity for mouth breathing due to obstruction of the nasal canal, and chronic or recurrent sinusitis, which is frequently encountered among patients in whom deviation causes obstruction of the ostium of the paranasal sinus [2] [3] [4]. Repetitive sneezing, snoring and sleep apnea are also reported, while less common symptoms include facial pain, variable loss of olfaction and headaches [3]. Recent trauma to the nose and face is the key risk factor for deviation, but congenital causes may be responsible as well. Neonates and infants commonly develop deviation of the nasal septum due to trauma during vaginal delivery [2], and in this population, poor feeding and choking due to the presence of food in the respiratory tract are reported in the case of a severe deviation, in addition to nasal obstruction and epistaxis [2]. Various anatomical anomalies, such as increased anterior facial height, mandible with increased overjet and constricted transverse maxillary dimension and a retrognathic maxilla have been documented in patients suffering from nasal septum deviation [4].

Snoring
  • Symptoms of a deviated septum include infections of the sinus and sleep apnea, snoring, repetitive sneezing, facial pain, nosebleeds, difficulty with breathing and mild to severe loss of the ability to smell.The nasal septum is the bone and cartilage[en.wikipedia.org]
  • Some patients had associated pre-operative symptoms of snoring (57.3%), headache (48.0%), rhinorrhoea (38.7%), sneezing (30.7%), hyposmia (30.7%) and epistaxis (21.3%).[ncbi.nlm.nih.gov]
  • Repetitive sneezing, snoring and sleep apnea are also reported, while less common symptoms include facial pain, variable loss of olfaction and headaches.[symptoma.com]
  • A deviated nasal septum can cause sinus infections, sleep apnea, snoring, sneezing attacks, facial pain, nosebleeds, breathing difficulties and a slight to serious loss of sense of smell.[respifacile.com]
  • A severely deviated nasal septum can block one side of your nose and reduce airflow, which can cause difficulty breathing, snoring, recurrent sinus infections, crusting or nosebleeds.[ent-sd.com]
Nasal Septum Abnormality
  • Hello Deviated Nasal Septum - "Abnormal and asymmetrical alignment of the nasal septum that results in acute nasal obstruction and other symptoms of upper respiratory tract." AETIOLOGY - 1.[medicowesome.com]
Pneumonia
  • 1,000,000 Payment: if you become critically ill and live for 10 days after diagnosis Health articles Keep on top of your health and wellbeing with our guides and articles. 6 Jul 2018 Protecting your lungs Ways you can keep your lungs healthy and help avoid pneumonia[aviva.co.uk]
Excessive Sneezing
  • The incidence of excessive sneezing in this study is 15% and these patients were also having allergic rhinitis. The study made by Haytham Kubba, Brian J.G. showed an incidence of 12% sneezing [11]. Thickened septum is seen in 3% of cases. Table 1.[file.scirp.org]
Mitral Valve Prolapse
  • Mitral valve prolapse (MVP) is a characteristic of generalized collagen abnormality. Nasal septum (NS) is constituted by osseous and cartilaginous septums that are highly rich in collagen.[ncbi.nlm.nih.gov]
Mouth Breathing
  • Individuals may often be asymptomatic, but the most common signs include epistaxis, increased nasal crusting, altered nasal respiration and the necessity for mouth breathing due to obstruction of the nasal canal, and chronic or recurrent sinusitis, which[symptoma.com]
  • Other symptoms of a deviated septum include nasal drainage, nosebleeds, mouth breathing, and facial pressure. A crooked or deviated septum is not usually caused by an injury.[nw-ent.com]
  • If the blockage is severe, it may force mouth-breathing at night, which can worsen sleep disorders.[entnet.org]
  • Chronic mouth breathing may worsen snoring or lead to dry mouth and/or sore throat. Usually nasal obstruction is worse on a particular side but may vary from side to side due to other factors, such as colds or allergies.[entallergy1.com]
  • Mouth breathing may result. Sinuses may be narrow and underdeveloped with narrow drainage channels ( 44 ), therefore recurrent sinusitis is a common problem.[doi.org]
Shoulder Pain
  • See treatment details 22 May 2018 Avoiding joint injuries Read our helpful information on how to avoid joint injuries and help ease any knee, hip or shoulder pain.[aviva.co.uk]
Bony Swelling
  • The turbinates are bony swellings on the outer walls of the nasal cavities. Both the nasal septum and turbinates are covered with a delicate mucosal tissue that regularly swells to control airflow in the nose.[nycfacemd.com]
Epistaxis
  • A deviated nasal septum is quite common in the general population and is often asymptomatic, but some individuals can develop chronic nasal obstruction, recurrent epistaxis and are predisposed to chronic sinusitis.[symptoma.com]
  • Some patients had associated pre-operative symptoms of snoring (57.3%), headache (48.0%), rhinorrhoea (38.7%), sneezing (30.7%), hyposmia (30.7%) and epistaxis (21.3%).[ncbi.nlm.nih.gov]
  • This obstruction may predispose the patient to sinusitis, infection and epistaxis (nose bleeds). Treatment Treatment of a deviated septum is based on the patient's symptoms.[healthcentral.com]
  • Spurs : shelf - like projections may lead to headache and epistaxis. ( unilateral obstruction ) 5. Thickening : due to septal hematoma CLINICAL FEATURES of DNS mnemonic TREATMENT - Only required if the symptoms are severe.[medicowesome.com]

Workup

The diagnosis rests on suspecting a deviated nasal septum based on signs and symptoms that are reported by the patient, which is why a detailed patient history can often provide sufficient clues to develop clinical suspicion. Information about recent trauma, chronicity of symptoms, as well as their severity, can be helpful. A thorough physical examination comprised of a full ear, nose, and throat evaluation should follow, and anterior rhinoscopy or nasal endoscopy can confirm the diagnosis, as they provide a direct view into the nasal cavity [2]. Additional procedures have been proposed in the workup, including acoustic rhinometry (evaluation of the nasal cavity by means of acoustic reflection), rhinomanometry (a procedure that measures the resistance of the nasal cavity) and nasal spectral sound analysis, but their specificity and sensitivity remain to be solidified in regular practice [2]. More advanced imaging studies, such as computed tomography (CT), may be useful for preoperative assessment and determination of potential anatomical anomalies, but they are not superior to the standard physical examination when it comes to detecting a deviated nasal septum [5].

Hypocapnia
  • Burnum JF, Hickam JB, McIntosh HD (1995) The effect of hypocapnia on arterial blood pressure. Circulation 9(1):89–95 CrossRef Google Scholar 10.[link.springer.com]
Lymphocytic Infiltrate
  • This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa on concave side when compared with convex side.[ncbi.nlm.nih.gov]

Treatment

  • METHODOLOGY: Eligible for inclusion were randomised controlled trials and non-randomised designs comparing treatment strategies. Risk of bias was assessed using Cochrane's tool.[ncbi.nlm.nih.gov]
  • Once we've approved your claim, you'll get the private treatment you need. 3 And we’ll pay for treatment After you've been treated, send us your invoices.[aviva.co.uk]
  • Treatment Treatment of a deviated septum is based on the patient's symptoms.[healthcentral.com]
  • Medical treatments for nasal obstruction Medical treatments such as nasal steroid sprays or decongestant sprays work to shrink the inferior turbinate which is adjacent to the septum.[houstonadvancedsinus.com]
  • Treatment at The London Clinic For more information about the deviated nasal septum treatment click here If you wish to make an enquiry click here and complete the enquiry form or call 44 (0) 207 616 7693.[thelondonclinic.co.uk]

Prognosis

  • Treatment and prognosis Most common procedure performed is septoplasty. Promoted articles (advertising)[radiopaedia.org]
  • Prognosis Surgical repair is curative and carries little risk. Chronic infection can be painful and lead to complications until it is resolved. If there is continued obstruction, the infection will very likely return.[medical-dictionary.thefreedictionary.com]
  • Prognosis In the most cases, surgery is successful. However, a small percentage of patients choose to have a second surgery for cosmetic reasons or to improve airflow.[drugs.com]

Etiology

  • Pathology Etiology It can be congenital or acquired. The most common acquired cause is trauma from motor vehicle collisions, sports-related injuries, and altercations.[radiopaedia.org]
  • Deviated nasal septum incidence and etiology. Annals Otol Rhinol Laryngol. 1978;87(3):3-20.‏ van der Veken PJ1, Clement PA, Buisseret T, Desprechins B, Kaufman L, et al.[ijorl.com]
  • The most frequent etiology of NSD is nasal trauma, what occurs in men more often. The percentage of volunteers with NSD and nasal obstruction was 60%, for both men and women.[arquivosdeorl.org.br]
  • Our data may support a noncongenital etiology for nasal septal deviation.[shahfacialplastics.com]
  • Incidence and Etiology. Annals of Otology, Rhinology, and Laryngology, 87, 3-20. Neskey, D., Eloy, J.A. and Casiano, R.R. (2009) Nasal, Septal and Turbinate Anatomy and Embryology. Otolaryngologic Clinics of North America, 42, 193-205.[file.scirp.org]

Epidemiology

  • Stamler J, Berkson DM, Dyer A, Lepper MH, Lindberg HA, Paul O et al (1975) Relationship of multiple variables to blood pressure-findings from four Chicago epidemiologic studies.[link.springer.com]
  • Definition of overactive bladder and epidemiology of urinary incontinence. Urology 1997;50:4-14. [ Crossref ] [ PubMed ] Samuelsson EC, Victor FT, Tibblin G, et al.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Due to changes in pathophysiology the patient is more susceptible to chronic rhinitis/rhinosinusitis. KEYWORDS: Chronic inflammation; Microscopy; Nasal mucosa; Nasal septum; Squamous metaplasia[ncbi.nlm.nih.gov]
  • However, the main pathophysiology of these chronic conditions is poorly described and seems to be multifactorial.[cyberleninka.org]

Prevention

  • Medications such as antihistamines, decongestants, and nasal steroid sprays can reduce congestion and inflammation to help prevent a runny nose and postnasal drip.[eoent.com]
  • Packing does not prevent bleeding but will prevent topical decongestants from reaching bleeding sites. Packing also keeps nasal saline from cleaning the inside of the nose.[nycfacemd.com]
  • Though some surgeons still use packing to prevent postoperative bleeding, the National Institute of Health states that, “Nasal packing has several risks for patients and septoplasty can be safely performed without [it].”[rhinoplasty.com]
  • Improving nasal breathing relieves the body of a portion of its respiratory effort and can thus prevent serious accidents. Read more...[respifacile.com]

References

Article

  1. Mohebbi A, Ahmadi A, Etemadi M, Safdarian M, Ghourchian S. An epidemiologic study of factors associated with nasal septum deviation by computed tomography scan: a cross sectional study. BMC Ear, Nose, and Throat Disord. 2012;12:15.
  2. Aziz T, Biron VL, Ansari K, Flores-Mir C. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014;43(1):11.
  3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  4. Aziz T, Biron VL, Ansari K, Flores-Mir C. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014;43(1):11.
  5. Sedaghat AR, Kieff DA, Bergmark RW, Cunnane ME, Busaba NY. Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings. Int Forum Allergy Rhinol. 2015;5(3):258-262.

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Last updated: 2019-07-11 20:58