© Borgis - New Medicine 2/2005, s. 18-19
Lechosław P. Chmielik, Mieczysław Chmielik
Deviation of the nasal septum versus adenoid hypertrophy
Clinic of Paediatric Otorhinolaryngology of the Medical University of Warsaw
Head: Prof. Mieczysław Chmielik MD, PhD
Summary
Introduction: In world and Polish literature, there are only few and contradictory reports describing the relationship between nasal septum deviations and the function of immune organs of upper respiratory tracts. Therefore we performed an analysis of medical histories of children hospitalized at the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw between 1999 and 2004, for the purpose of surgical treatment nasal septum deviations.
Material: One hundred and four medical histories were submitted to examination. The analysis consisted in establishing the type of septal deviation and its possible convergence with third tonsil hypertrophy. The material was submitted for statistical workout. Based on obtained results, conclusions were drawn and proceeding schemes suggested.
Method: Cottle´s and Mladina´s classifications were adopted to assess the septal deviation. Evaluation of the adenoid hypertrophy was carried out based on radiological photographs or computed tomography images of nasal sinuses. A c2 test was adopted to perform statistical assessments.
Results: Adenoid hypertrophy was detected in 22.12% of cases. Statistical methods gave a test result of c2=2.012. This value is smaller than the critical value for the test. Hence, in the examined material, no interrelation was observed between the nasal septum deviation and adenoid hypertrophy. However, result of the testing method is near – critical.
Conclusions: No statistically significant interrelation between nasal septum deviation and adenoid hypertrophy was ascertained.
INTRODUCTION
Processes in the area of the upper respiratory tract exhibit a substantial differentiation with regard to mechanisms which govern them. The influence of those mechanisms can also be different. Infectious processes in the upper respiratory tract cause an activation of the immune system at its various levels. Impairment of the nasal cavities´ patency is particularly responsible for prolonged infections. Nasal septum deviation is a pathology which undoubtedly contributes to impairment of respiratory tract patency.
One of the classifications which localize lesions is Cottle´s classification of the nasal septum. The classification describes surgical and functional implications of the deviation of the septum where: area I is a column; II is a ventral area located on the nasal septum, co-operating with this fragment of the lateral wall where caudal – ventral endings of the triangular nasal cartilages form a valve; area III is the nasal septum cartilage which supports the bridge of the nose between area I and nasal bones; area IV is made up by the remaining part of the nasal cartilage which is called conchal area; area V consists of bony elements of the nasal septum (vomer and perpendicular lamina of the ethmoid bone).
Mladina´s classification is a different, more modern approach, which includes morphology of lesions.
Type I is described as unilateral ridge which does not disturb the valve function and is situated in the area of valve.
In type II, the valve function is disturbed by unilateral ridge. Positive Cottle´s symptom can be observed after pulling up the nostril, which is a subjective and objective improvement of nose patency.
Type III – one unilateral ridge located at the level of the head of the middle nasal concha.
Type IV – two ridges – one located on the level of the head of the middle nasal concha, the other on the opposite side in the valve area, disturbing the valve functions.
Type V – unilateral spurat the septum base, while on the other side the septum is straight.
Type VI – unilateral groove running through the caudal – ventral part of the septum; spur on the other side and accompanying asymmetry of nasal cavity.
Type VII is a mix of types from I to VI.
In world and Polish literature, reports on interrelations between septal deviations and function of upper respiratory tract immune organs are scarce and far between and often contradictory.
Therefore we performed an analysis of medical histories of children hospitalized at the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw between 1999 and 2004, for the purpose of surgical treatment nasal septum deviations.
MATERIAL
The analysis covered 104 medical histories of children awaiting surgery of nasal septum and encompassed analysis of the type of septal deformity and its possible convergence with adenoid hypertrophy. The material was subject to statistical assessment. Based on obtained results, conclusions were drawn and treatment schemes suggested.
The control group consisted of 80 secondary and primary school pupils randomly chosen from those schools, whose headmasters requested control laryngological examinations to be performed at the Medical University of Warsaw. The analysis of problems within adenoids and nasal septum was performed on those children.
METHOD
Cottle´s and Mladina´s classifications were used to assess septal deviations. Assessment of the adenoid hypertrophy was based on radiological photographs or computed tomography images of nasal sinuses. A c2 test was adopted to perform statistical assessments.
RESULTS
Adenoid hypertrophy was detected in 22.12% of cases. Statistical methods gave a test result of c2=2.012. This value is smaller than the critical value for the test, although results of the testing method are near – critical. Hence in the examined material, no correlation was found between septal deformity and adenoid hypertrophy regardless of the type of deviation or location of the septal deviation.
CONCLUSION
No statistically significant correlation was detected between septal deviation and adenoid hypertrophy.
It is a preliminary report.
Piśmiennictwo
1. Bluestone CD., Stool SE., Arjmand EM.: et al.: Pediatric Otolaryngology Saunders 2003, 918-919. 2.Chmielik M.: Ocena spirograficzna i rynomanometryczna zmodyfikowanej techniki Cottle´a w operacjach przegrody nosa u dzieci. Praca habilitacyjna AM w W-wie 1987. 3.Bluestone CD., Stool SE., Arjmand EM.: et al.: Pediatric Otolaryngology Saunders 2003, 916. 4.Bluestone CD., Stool SE., Arjmand EM.: et al.: Pediatric Otolaryngology Saunders 2003, 22-28. 5.Cole P.: Respiratory rhinometry, a review of recent trends. Rhinology, 1980; 18:3. 6.Nguyen LH., Manoukian J., Yoskovitcg A. et al.: Adenoidectomy: selecton criteria for surgical cases of otitis media. Laryngoscpoe 2004; 114(5): 863-866. 7.Ruben R.J.: Wskazania do adenotomii. Otol. Pol., 1974:27, suppl. 308. 8.Otorynolaryngologia Dziecięca (red.). M. Chmielik 2000, 127-128. 9.Mladina R., Baastaic L.: What do we know about septal deformities? Rhinology 1987; 3:199- 205 (za Olszewska O. i in.: Ocena występowania skrzywień przegrody nosa u dzieci i młodzieży. Otorynolaryngologia 2003; 2, 79-82).
