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© Borgis - New Medicine 3/2006, s. 79-81
Lechosław P. Chmielik
Types of nasal septum deviation and hearing loss in children
Department of Paediatric Otorhinolaryngology, Medical University, Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Summary
Summary
Aim: Respiration is a basic function of every living organism. The human respiratory system is extremely complicated. The complicated functioning of this system has been extensively investigated, yet the system has not been fully recognized. 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. It can also cause adenoids. In the available literature on skeletal deviations of the nasal septum and their influence on the state of hearing and, particularly, on the state of the auditory tube and middle ear, there are no uniform views. The aim of this work is to analyse the frequency of changes in tympanometry in children with a deviated nasal septum with regard to their location, shape and associated diseases.
Material and method: We analysed the medical history of 50 nasal septum patients who were treated or operated on at the Clinic of Paediatric ENT, Medical University of Warsaw, in the years 2005-2006. The analysis concerned morphology of nasal septum deviation (division according to Mladina), establishment of frequency of occurrence of conductional hypoacusia on the basis of parents´ information and audiometry examination and tympanometry performed on all children and analysis of accompanying symptoms which can cause hypoacusia in children with a deviated nasal septum.
Conclusions: Type of nasal septum deviation does not immediately cause disturbance of auditory tube function, and hence it does not cause hypocausia in children.
INTRODUCTION
The human respiratory system is extremely complicated, and enables precise control of oxygen requirements in almost all climatic conditions. Particular parts of the respiratory system cooperate with one another, which, in normal health conditions, ensures efficient ventilation of the alveoli. The complicated functioning of this system has been extensively investigated, yet the system has not been fully recognized. A healthy upper respiratory system is a functional entity. Certain abnormalities of specific parts can have a negative influence on both neighbouring and distant organs. 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. It can also cause adenoids. One should take into account that the type of deviation of the nasal septum, and the location of the deviations, can have a larger or smaller influence on the organs mentioned above.
The literature defines several divisions of types of nasal septum deviation, with respect to their location.
Mladina´s (Fig. 1) classification is another, more modern, approach which includes the morphology of changes.
Fig. 1. Mladina´s classification. 1– nasal septum. 2– turbinate.
Type I is described as a unilateral crest which does not disturb the function of the nasal valve. It is situated in the area of the valve.
In type II, disturbance of the valve function is caused by the unilateral crest. Positive Cottle´s symptom can be observed after raise of the nostril, which gives a subjective and objective improvement in the nose patency.
Type III – one unilateral crest at the level of the head of the middle nasal concha.
Type IV defines two crests – one at the level of the head of the middle nasal concha, and the other on the opposite side in the valve area, disturbing the valve functions.
Type V is a unilateral ridge on the base of the septum, while on the other side the septum is straight.
Type VI shows a unilateral sulcus running through the caudal-ventral part of the septum, while on the other side there is a ridge and accompanying asymmetry of the nasal cavity.
Type VII is a mix of types from I to VI.
Evaluation of the influence of septum deviation on adenoid hypertrophy or prolonged inflammatory sinus disease has been mentioned many times in numerous scientific publications. However, reports describing how septum deviation affects the auditory tube, and hence the state of hearing, are very few and poorly-documented.
In the available literature on skeletal deviations of the nasal septum and their influence on the state of hearing and, particularly, on the state of the auditory tube and middle ear, there are no uniform views. In some current manuals, septum deviations are said to be responsible for causing conductional hypoacusia. However, the manuals do not link the commonly occurring middle ear diseases with these deviations
Contemporary diagnostic possibilities provide a way to assess precisely the size and location of the septum deviations. On the other hand, there are methods which allow evaluation of the state of the auditory tube as well as the state of hearing via audiometry and tympanometry. Hearing loss diseases are divided with regard to quantity: socially efficient hearing (to 30dB), hearing loss (from 30dB to 80dB), and deafness (above 80dB).
AIM
The aim of this work is to analyse the frequency of changes in tympanometry in children with a deviated nasal septum with regard to their location.
MATERIAL AND METHOD
We analysed the medical history of 50 nasal septum patients who were treated or operated on at the Clinic of Paediatric ENT of Medical University of Warsaw.
The analysis concerned morphology of nasal septum deviation (division according to Mladina)
– establishment of frequency of occurrence of conductional hypoacusia on the basis of parents´ information and audiometry examination and tympanometry performed on all children and analysis of accompanying symptoms which can cause hypoacusia in children with a deviated nasal septum.
The control group consisted of 50 secondary and primary school pupils chosen at random from schools whose headteachers approached the Medical University of Warsaw to carry out control laryngological examinations. Laryngological and audiometry and tympanometry examination was carried out on those children.

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Piśmiennictwo
1. Becker W., et al.: Ear, Nose and Throat Diseasses. G. Thieme Verlag Stattgart 1994; 95. 2.Chazan R.: Zakażenia układu oddechowego - Alfa-medica press 1998, 79. 3.Chiappe de Miscione M.: II Manual of Ped. ORL. Red. T. Sih wyd. Roland Eavey Harward Med. Sc. 20011, 230. 4.Chmielik M.: Ocena spirograficzna i rynomanometryczna zmodyfikowanej techniki Cottle´a w operacjach przegrody nosa u dzieci. Praca habilitacyjna AM w W-wie 1987. 5. Darrow D.H., et al.: Zapalenie ucha środkowego. Current Opinion in Otolar. Head and Neck Surgery 2004; 1, 2, 15-22. 6.Gray L.: The deviated nasal septum aetiology. J. Laryng. Otol., 1965; 7: 567-575. 7.Kawalski H., Śpiewak P.: How septum deformations in newborns occur. Int. J. Pediatr. Otorhinolaryngol., 1998; 1: 23-30. 8.Kenna M.A.: in: Practical Pediatric Otolaryngology red. Cotton R.T. print. Lippincott-Raven Philadelphia - New York 1999; 229. 9.Krzeski A., Janczewski G.: (red.) Choroby nosa i zatok przynosowych, Wydawnictwo Medyczne SANMEDIA Sp.z o.o. Wydanie II. 1998; 275-276. 10.Lund V.J., et al.: Quantification for staging sinusitis. Ann. Otol. Rhinol. Laryngol., 1995; 104, 10, cz. 2, suppl. 167: 17-21. 11.Majer W., Krebs A.: Is surgery of the inner nose indicated before tympanoplasty. Effects of nasal obstruction and reconstruction on the Eustachian tube. Laryngorhinootologie. 1998; 77(12) 682-688. 12.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. 13.Szymański J.: Podręcznik Oto-Ryno-Laryngologii PZWL, Warszawa 1971; 334.
Adres do korespondencji:
Lechosław P. Chmielik
Department of Paediatric Otorhinolaryngology, Medical University in Warsaw
00-576 Warszawa, ul. Marszałkowska 24
tel./fax +48 22 628-05-84
e-mail: laryngologia@litewska.edu.pl

New Medicine 3/2006
Strona internetowa czasopisma New Medicine