How to Approach Nasal Septal Deviations

Gordon H. Sun, MD, MS

December 21, 2015

Making the Diagnosis

The AAO-HNSF clinical consensus statement on septoplasty and inferior turbinate reduction concluded that anterior rhinoscopy, nasal endoscopy, or both are all sufficient for documenting septal deviation prior to septoplasty.[3] Furthermore, the consensus statement indicates that nasal endoscopy is valuable in identifying other possible causes of nasal obstruction, such as sinonasal polyps or tumors, which may not be readily visible on anterior rhinoscopy. However, there was no agreement among the panel members on whether all patients with septal deviation must regularly undergo nasal endoscopy. Most primary care providers do not receive comprehensive training on endoscopic techniques, and so referral to a specialist such as an otolaryngologist is necessary if nasal endoscopy is to be pursued.

The AAO-HNSF septoplasty panel concluded that photodocumentation of the septal deviation is unnecessary prior to performing septoplasty.[3] However, it should be noted that photodocumentation is useful, but not necessarily required, in cases in which an external nasal deformity is contributing to nasal valve collapse, another well-known cause of nasal airway obstruction.[10] In this particular case, the patient had no overt signs of external nasal deformity.

Developed in 1989, acoustic rhinometry is the analysis of sound waves reflected from the nasal passages in order to measure cross-sectional area and nasal volume.[11] The technique is considered rapid, noninvasive, and well tolerated by patients, and it does not require nasal airflow.[12] Developed in the 1960s, rhinomanometry assesses nasal patency by measuring the pressure gradient of airflow through the nasal passages, either through normal patient respiration (active technique) or through air driven into the nostrils from an external course (passive technique).[13,14] The AAO-HNSF septoplasty consensus statement panel could not agree on the value of either acoustic rhinometry or rhinomanometry in the diagnosis of septal deviation.[3] The panel cited systematic reviews demonstrating that acoustic rhinometry or rhinomanometry do not have the sensitivity and specificity of anterior rhinoscopy or nasal endoscopy, and that rhinometry or rhinomanometry test results often do not correlate with patient symptoms.[15,16]

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