Nasal septal deformities in ear, nose, and throat patients: An international study

doi:10.1016/j.amjoto.2007.02.002

American Journal of Otolaryngology

Volume 29, Issue 2, March–April 2008, Pages 75-82

https://doi.org/10.1016/j.amjoto.2007.02.002 Get rights and content

Abstract

Purpose

The purpose of this study was to investigate the incidence and characteristics of nasal septum deformities in ear, nose, and throat (ENT) patients in various geographic regions in the world.

Materials and methods

Anterior rhinoscopy without nasal decongestion was performed in 17 ENT centers in 14 countries. The septal deformities were classified according to the classification system proposed by Mladina.

Results

A total of 2589 adult ENT patients (1500 males and 1089 females) were examined. Septal deformities were found in 89.2% of subjects. Left-sided deformities were slightly more prevalent than right-sided deformities (51.6% and 48.4%, respectively). The most frequent type of deformity was type 3 (20.4%). Straight septum was found in 15.4% of females and 7.5% of males.

Conclusions

Almost 90% of the subjects showed 1 of the 7 types of septal deformity. There were no statistically significant differences in the incidence of their appearance among particular geographic regions. Type 3 was the most frequent type. Straight septum was twice as frequent in females than in males.

Introduction

There are many articles on nasal septal deformities in the rhinologic literature; however, there lacks a standardized way for describing particular septal deformities. What one can find in most of these articles is just septal deviation or deviated nasal septum, without a precise description of its appearance. Attempts to comprehensively systematize septal deformities started almost 30 years ago at the ear, nose, and throat (ENT) department of the University Hospital Salata in Zagreb, Croatia. They led to a simple classification in 7 types published by Mladina [1] in 1987. This classification was derived from research in Croatia, but what about other populations? Does the classification apply to other geographic regions?

Studies have shown great differences in the morphological and cephalometric values in subjects from various geographic regions. Gurr et al [2] showed that there are considerable differences in the geometry of both external nose and nasal cavities among subjects belonging to various races and ethnic groups. This is in accordance with other studies [3], [4]. Richardson and Marrett [4] found great differences in facial bone shape between British and West African populations, and Marcellino et al [5] found significant differences in the height of the middle facial massif in 6 South American Indian tribes. Japanese authors found remarkable differences in the thickness of the cranial bones of the Neolithic and modern Japanese population [6], and some authors have also found secular changes in the main skull dimensions [7].

It is known that the angulation of the skull base in humans can act like a sort of “cranial pincer” and squeeze the splanchnocranial structures, including the nasal septum, causing the onset of a particular septal deformity. Because the shape of the skull base obviously differs in different populations, the question arises of whether there are also differences in the incidence of septal deformities in subjects from various geographic regions.

The aim of this multi-institutional and multinational study was to investigate the relative frequencies of particular types of septal deformity in ENT patients from various geographic regions and to see whether one and the same classification is applicable to these regions. At the same time, we took the opportunity to investigate the incidence of these septal deformities regarding sex, age, and the side of the deformity.

Section snippets

Methods

The following ENT centers and colleagues were involved in this study: ENT Department, University Hospital Šalata, Zagreb, Croatia (R Mladina); ENT Department, Firat and Ondokuz Mayis University Medical Faculties, Samsun, Turkey (Y Tanyeri); Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M Hasegawa); ENT Department, Tokyo University Branch Hospital, Tokyo, Japan (K Ichimura); ENT Department, University Hospital, Toulouse, France (E Serrano); ENT Department, Al-Azhar Faculty

Results

The study was carried out on a total of 2589 subjects (1500 males and 1089 females).

The general incidence

The general incidence of septal deformity found in the investigation was almost 90%. This is much higher than the incidence (around 70% in adults) reported in the literature over the past decades [8]. Only a recent study by Rao et al [9] in the Hyderabad region in India, based on the same classification as in our study, has shown an incidence higher than 90%. The reason for the high incidence in our study and that of Rao et al could be that they were based on well-defined types of septal

Conclusions

Examination by anterior rhinoscopy showed that almost 90% of the ENT patients in the various geographic regions in the world had 1 of the 7 types of septal deformities.

Type 3 was the most frequently observed type. Its frequency rose with age. It is more frequent in female ENT patients than in male ENT patients.

Type 6, in contrast, was twice as frequent in male ENT patients than in female ENT patients.

Straight septum was twice as frequent in females.

Left-sided septal deformities were slightly

Acknowledgments

The investigation was performed as a part of the scientific project of the Ministry of Health of Republic of Croatia No 3-01.011, led by Prof Dr Ranko Mladina. The authors are very grateful to Prof Dr E Huizing (Utrecht, The Netherlands), Prof Dr Wolfgang Pirsig (Ulm, Germany), Prof Dr Wolf Mann (Mainz, Germany), Prof Dr E Kern (Buffalo, NY), Prof Dr B Wang (Irvine, CA), and Prof Dr R Kamel (Cairo, Egypt) for their precious suggestions.

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Original contributionNasal septal deformities in ear, nose, and throat patients: An international study

Abstract

Purpose

Materials and methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

The general incidence

Conclusions

Acknowledgments

Int J Pediatr Otorhinolaryngol

Int J Pediatr ORL

Int J Pediatr Otorhinolaryngol

The role of maxillar morphology in the development of pathological septal deformities

Rhinology

Acoustic rhinometry of the Indian and Anglo-Saxon nose

Rhinology

Dimensions and resistance of the human nose: racial differences

Laryngoscope

British and West African facial form in ideal occlusion

Ann Hum Biol

Original contribution
Nasal septal deformities in ear, nose, and throat patients: An international study