The role of septal deviation in adult chronic rhinosinusitis: a study
of 500 patients.Harar RP, Chadha NK, Rogers G.
The Royal National Throat, Nose and Ear Hospital, Kings Cross, London
WC1X 8DA, United Kingdom. harar@freenetname.co.uk

Septal deviation is a common finding and its role in the pathogenesis
of chronic rhinosinusitis remains uncertain. The aim of this study was
to assess the impact of septal deviation in the region of the
ostiomeatal complex with regards to sinus disease, as staged by the
Lund-Mackay scoring system in a group of adult patients with symptoms
of chronic rhinosinusitis. Five hundred consecutive patients who had
undergone CT scanning of the paranasal sinuses for possible chronic
sinus disease between Sept. 2002 and Dec. 2003 were recruited. Septal
deviation at the ostiomeatal complex on coronal CT scan was evaluated
using Radworks diagnostic 5.1 software (Applicare Medical Imaging BU).
There were 219 patients with CT positive sinus disease. 281 of the
patients had normal sinus CT scans (control group) and were therefore
patients with rhinitis rather than rhinosinusitis. Our study showed no
significant difference between the chronic rhinosinusitis group and
the control group with regards to septal deviation. Nor were we able
to demonstrate any correlation between the severity of septal
deformity at the ostiomeatal complex region and the severity of sinus
disease or OMC disease.

The role of septal deviation in adult chronic rhinosinusitis: a study
of 500 patients.Harar RP, Chadha NK, Rogers G.
The Royal National Throat, Nose and Ear Hospital, Kings Cross, London
WC1X 8DA, United Kingdom. harar@freenetname.co.uk

Septal deviation is a common finding and its role in the pathogenesis
of chronic rhinosinusitis remains uncertain. The aim of this study was
to assess the impact of septal deviation in the region of the
ostiomeatal complex with regards to sinus disease, as staged by the
Lund-Mackay scoring system in a group of adult patients with symptoms
of chronic rhinosinusitis. Five hundred consecutive patients who had
undergone CT scanning of the paranasal sinuses for possible chronic
sinus disease between Sept. 2002 and Dec. 2003 were recruited. Septal
deviation at the ostiomeatal complex on coronal CT scan was evaluated
using Radworks diagnostic 5.1 software (Applicare Medical Imaging BU).
There were 219 patients with CT positive sinus disease. 281 of the
patients had normal sinus CT scans (control group) and were therefore
patients with rhinitis rather than rhinosinusitis. Our study showed no
significant difference between the chronic rhinosinusitis group and
the control group with regards to septal deviation. Nor were we able
to demonstrate any correlation between the severity of septal
deformity at the ostiomeatal complex region and the severity of sinus
disease or OMC disease.

Is septal deviation a risk factor for chronic sinusitis? Review of
literature.Collet S, Bertrand B, Cornu S, Eloy P, Rombaux P.
Catholic University of Louvain, ENT and HNS Department, Cliniques
Universitaires UCL de Mont-Godinne, Yvoir, Belgium.
stephanie.collet@orlo.ucl.ac.be

INTRODUCTION: The purpose of this work is to examine the role of
septal deviation in adults in the pathogenesis of chronic sinusitis.
This evaluation would allow a better understanding of the contributing
factors to this pathology and would improve results in their
management. MATERIAL AND METHODS: This review was based on a Medline
research over English and French literature published between 1980 and
May 2001. Twenty-five papers were scrutinized.

RESULTS: Few investigators examined the role of the deviated septum on
sinus disease. Methodologies and results are often contradictory.
Furthermore, these studies are mainly based on radiological imaging.
In most studies, prevalence of septal deviation looks the same
compared among patients with radiological rhinosinusitis and among
general population.

An increased incidence and severity of sinus disease correlated to an
increasing angle of septal deviation in the ostiomeatal complex area
is reported by Calhoun (7), Youssem (4), Matschke (18) et Elahi (20).
One study (1) demonstrates a significant association between the shape
of the nasal septum and the location of the sinus disease: septal
crest is associated with homolateral sinusitis, "watch-glass shaped
diformity" with controlateral sinusitis. Stammberger (21, 25) suggests
a pathophysiological role of the septum through a mechanical
obstruction on the ostiomeatal complex; Danese (1) and Blaugrund (19)
by an alteration of the ciliary activity secondary to a modified air
flow. Bachert (24) demonstrates a connection between septal deviation
and antral ventilation. CONCLUSION: This literature review cannot
establish a definite role to the nasal septum neither as the
pathogenesis of chronic sinusitis nor as a contributing factor. No
relationship between septal surgery combined with sinus surgery, and
the postoperative prognosis nor on the subjective comfort of patients
can be demonstrated. Subsequently, it appears that performing
septoplasty only aims at relieving nasal obstruction complaint or at
improving surgical access to the ethmoid sinus.