© Borgis - New Medicine 2/2005, s. 26-27
Lechosław P. Chmielik
Nasal septum deviation and chronic sinusitis in children
Clinic of Paediatric ENT, Medical University of Warsaw, Poland
Head: Prof. Mieczysław Chmielik MD, PhD
Deviations of the nasal septum disrupt the airflow through the nose. This is what has given rise to the idea that over a certain period of time, this would cause problems in the paranasal sinuses.
Most ENT handbooks state that one of the main causes of chronic rhinosinusitis may be nasal septum deviations. There are only a few publications concerning this condition, and the conclusions are often in disagreement with each other.
The subject of the present study is the analysis of the problem, based on 162 patients with nasal septum deviations, and a control group consisting of 80 pupils of secondary school age. In the present analysis, a direct dependence between deviation of the nasal septum and chronic sinusitis was not established.
Respiration is a basic function of every living organism. The human respiratory system is extremely complex and allows accurate coverage of the oxygen requirement in almost all climatic conditions. The complicated functions of this system have been intensively investigated, yet the system has not been fully explored. Various parts of the respiratory system cooperate, which, in normal health conditions, ensures efficient ventilation of the alveoli. A healthy upper respiratory system is a functional entity. Certain abnormalities of its various parts may have a negative impact on neighbouring and distant organs. A deviation of the nasal septum, which changes the airflow in this part of the respiratory tract, can affect the state of the paranasal sinuses as well as the functions of the auditory tube (1.3). One of those deviation-locating classifications is Cottle´s division of the nasal septum. Mladina´s classification is another, more modern approach, which includes the morphology of lesions
In the last decades, a dynamic development of developmental age nose surgery may be noticed. While in the first half of the 20th century most ENT manuals, describing Killian´s method, stated that surgery should be postponed until the age of 16 or 18, after introducing Cottle´s method of septum surgery, nose surgeries were carried out regardless of age, in any situation that caused the deformation to make breathing difficult. A deviated septum in a child impairs patency of the upper airways, thus causing recurrent infections of this area. An evaluation of influence of septum deviation on adenoiditis or prolonged inflammatory sinus disease has been mentioned many times in numerous scientific publications, while there are very few and poorly documented reports describing how the septum deviation affects the auditory tube, hence the state of hearing.
AIM OF THE STUDY
The objective of the paper is to analyse the lesion incidence in paranasal sinuses when nose septum deviated, considering their location, deviation shape and all concurrent diseases.
MATERIAL AND METHOD
We have analysed medical histories of 162 patients with treated and operated nasal septum at the Clinic of Paediatric Otorhinolaryngology of the Medical University of Warsaw, in the years 1999-2004 and a control group consisting of 80 pupils of secondary school age.
The analysis concerned:
– Morphology of nasal septum deviation (classification according to Mladina and Cottle)
– Analysis of concurrent symptoms
The control group consisted of 80 secondary and primary school pupils randomly chosen from schools, whose headmasters contacted the Medical University in Warsaw concerning control laryngological examinations. Those children allowed an analysis of the problems in the nose and paranasal sinuses. This diagnosis was based on medical and subject examination as well as on additional examinations (lateral radiogram of nasopharynx, or computed tomography of paranasal sinuses and nasopharynx). Radiological examinations were performed in both the study and control groups for those children whose clinical examination suggested impairment of sinus patency. The examinations were carried out at the Department of Children´s Radiology of the Medical University in Warsaw. Nasal sinusitis was diagnosed on the basis of observed clinical and radiological lesions fulfilling the definition criteria for this disease.
RESULTS AND DISCUSSION
The final analysis concerned on those children from the study and control groups, for whom full documentation (described above) was collected. There were one hundred-and-four patients in the study group and forty-one in the control group. Both groups were statistically comparable x2=2.387.
In the study group, sinusitis complicated nasal septum deviation in 22.12% of cases.
In the control group, sinusitis was observed in 11.9%. Nevertheless, statistical analysis did not reveal any essential differences between both groups. This result is however close to substantial results, different than the percentage obtained for patients in the control group (x2=2.012).
When analysing existing literature reports, these are not unequivocal, but drawing further conclusions based on our material would involve the enlargement of the study group counts for studies of impact of various types of septum deformations on coexisting sinusitis. The issue analysis was presented here in Tables I and II.
Table 1. Analysis of the location of nasal septum deviation (n = 104).
|Section of the septum (Cottle)||Number of cases||% of study group|
Table 2. Analysis of the nature of nasal septum deviations (n=104).
|Type of deformation (Mladina)||Number of cases||% of study group|
The study group consisting of patients with individual types of deviation location or deformations is not large enough to ensure proper statistic results. This topic requires further investigation.
Analysis did not show evident relationship between chronic sinusitis and nasal septum deviation. However, further investigation of the issue seems to be required.
1. Betlejewski A., Zaorski P.: Skrzywienie przegrody nosa oraz stan zatok przynosowych, wzajemne zależności. Otolaryngologia Polska 1997; supl 21; 22-26. 2.Chmielik M.: Ocena spirograficzna i rynomanometryczna zmodyfikowanej techniki Cottle´ a w operacjach przegrody nosa u dzieci. Praca habilitacyjna AM w W-wie1987. 3.Collet S., Bertrand B., Cornu S. et al.: Is septal deviation a risk factor for chronic sinusitis? Reviev of literature. Acta ORL Belgica 2001; 55;299-304. 4.Subaric M., Mladina R.: Nasal septum deformities in children and adolescents: a cross sectional study of children from Zagreb,Croatia, Int. J. of Ped. ORL 2002; 63:41-48.