Tomography Is Not Always Required For The Diagnosis of Nasal Septum Deviation!

Diagnosis of Deviated Nasal Septum

Tomography is Not Always Required for the Diagnosis of Nasal Septum Deviation!

CT scans use X-rays to generate images of computerized two- and three-dimensional bone, cartilage, and other nasal structures. This allows doctors to examine the nose from various angles. Normally, a simple ENT examination and anterior rhinoscopic examination is sufficient for deviation of the nasal septum. In patients with private insurance, if the policy conditions cover the deviation of the septum, it is generally desirable to have a CT scan prior to surgery to document the disease. In chronic sinusitis or endoscopic examination, CT scan is appropriate in patients with treatment-resistant chronic sinusitis in the presence of severe septum deviation, nasal polyps or masses, which prevents complete evaluation of the nasal cavity. Tomography is preferred in patients with facial injuries and traumatic nasal fractures.

It is recommended that patients with complaints of constant nasal congestion (feeling of insufficiency of breathing through the nose, the need to breathe through the mouth) during fast walking or in sporting activities in normal daily life, and patients with complaints of open mouth sleep should be examined by an ENT specialist. Septum deviation may be present at birth, may be curved during growth, or may result from injury to the nose and face.

To examine the interior of the nose, a bright light and sometimes a device designed to open the nostrils (nose speculum) or a long and thin tubular endoscope with a bright light at the end can be used. The diagnosis of nasal septum deviation can be made in this way during a simple nose examination. During the examination, sometimes a decongestant spray can be applied to the nose before and after the examination. Some septum deviations are deep in the nasal cavity and may require more evaluation than endoscopic examination in office conditions. Paranasal sinus computed tomography is generally required as imaging method. Deviation of the nasal septum is usually not necessary for the diagnosis.

What is Acoustic Rhinometry?

Acoustic rhinometry (AR) evaluates the nasal patency based on measuring acoustic reflection of the sound signal in the nasal cavity with structures in the nasal cavity. The AR analyzes the first and reflected sound waves so that the cross-sectional area of ​​the nasal cavity forms an area as a function of the distance from the nasal cavity entry.

Rhinomanometry provides a dynamic physiological assessment of the nose by measuring transnasal pressure and nasal volume airflow to calculate nasal resistance. Nasal sound spectrum analysis (NSSA) provides an indirect method of dynamically evaluating nasal air flow by analyzing the noise caused by the variable nasal air flow in the nasal cavity.

Further diagnostic methods, such as acoustic rhinometry, rhinomanometry, and nasal spectral sound analysis, may be useful in identifying deviation of the nasal septum in the anterior region of the nasal cavity, but use of these tests is limited. Compared with anterior rhinoscopy, nasal endoscopy, and imaging, these advanced diagnostic procedures lack sensitivity and specificity in determining the location and severity of nasal septum deviation.

Nasal Septum Deviation in Children

Diagnosis of Nasal Septum Deviation
The deviation of the nasal septum is a common structural cause of nasal obstruction, and it may be due to intrinsic deformity that affects the bony margins of the quandriangular cartilage or the vometer, the perpendicular plate of the ethmoid, and / or the quadrilateral cartilage itself. In newborns, the prevalence of septal deviation may vary between 1.45% and 6.3%. In a recent scientific study, it analyzed the prevalence of septal deviations in newborns and found that it can be found at a high rate of 22% in vaginally born children, but only 4% of deliveries from cesarean section lead to deviation of the nasal septum. It has been suggested that trauma to the septum since vaginal delivery is a common cause of NSD. On occipitomental radiographs, NSD prevalence was approximately 20% in school-age children aged 6-15 years, with a positive clinical diagnosis in approximately 10% of these children (clinical symptoms were positive). Symptoms of nasal septum deviation in childhood, other nasal congestion causes nasal obstruction such as enlargement of the flesh, allergic rhinitis, upper respiratory tract infections, such as nasal congestion can cause aggravation of the symptoms.

How do you know if your nose has a septum deviation?

Deviation of the nasal septum is in fact more or less severe in many people (found in about 80 of 100 people). Most people with nasal septum deviation do not have much symptoms or complaints. If the amount of deviation of the septum in your nose is excessive, or if it is a curvature close to the narrowest area of ​​the nose, the nasal valve, it may cause the following symptoms:

. nasal congestion
. open mouth sleep and decrease in sleep quality
. headache
. sensation of insufficiency of breathing through the nose during exercise or decreased mobility capacity
. feeling of dryness in the throat
. increased incidence of gum diseases or bad breath
. Increased attacks of chronic pharyngitis
. postnasal drip
. nose bleeding
. need to lie on the side of sleep deviation

In fact, these symptoms may vary depending on the deviation and the amount of curvature. If you have any of these complaints, it is sufficient to consult an ENT specialist.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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