Is Computed Tomography Imaging of Deviated Nasal Septum Justified for Obstruction Confirmation?

Abstract

Third-party payers request objective confirmation of the nasal septum deviation (NSD) severity by computed tomography (CT) before authorizing financial support for septoplasty. Previous studies have provided contradictory results related to the link between obstruction severity and CT-measured angle of the NSD. The aim of this study was to investigate whether the diverse CT morphology of NSDs (including previously neglected types and shapes) could predict obstruction severity. The study included 225 patients with NSD. The CT morphology of the septum was analyzed using 5 different classifications of NSD that are commonly used in the clinical practice and research. The angle of NSD was also measured. Nasal obstruction was assessed by the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. A relationship between CT morphology and the angle of the NSD and NOSE scores was analyzed using appropriate regression models. Patients with NSDs located in the anterior part of the septum always have some degree of nasal obstruction, while those with posterior NSDs did not necessarily report obstruction symptoms no matter how complicated NSD they have. Regression analysis did not reveal any causal relationship between NOSE scores and CT morphology and the angle of NSD. The presence of spurs and whether they divide nasal passages have no statistically significant predictive effect on the obstruction severity. The CT morphology and the angle of the NSD could not predict severity of the nasal obstruction. Requesting CT examination just to objectively confirm nasal obstruction is not justified.

Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery

“…Therefore, when it comes to the complain of chronic nasal obstruction in patients, all nasal structures that may contribute to the symptom must be assessed separately and carefully to establish an appropriate treatment plan [2,12]. There are many evaluation strategies for NSD and chronic nasal obstruction [28,29]. However, each method is difficult to comprehensively assess the structural factors of chronic nasal obstruction alone, due to large variations in the nasal structure [29].…”

“…There are many evaluation strategies for NSD and chronic nasal obstruction [28,29]. However, each method is difficult to comprehensively assess the structural factors of chronic nasal obstruction alone, due to large variations in the nasal structure [29]. At present, except for anterior rhinoscopy and nasal endoscopy, CT is the most widely used method [28][29][30], because it can provide important information on the sinonasal structure in patients with chronic nasal obstruction.…”

“…However, each method is difficult to comprehensively assess the structural factors of chronic nasal obstruction alone, due to large variations in the nasal structure [29]. At present, except for anterior rhinoscopy and nasal endoscopy, CT is the most widely used method [28][29][30], because it can provide important information on the sinonasal structure in patients with chronic nasal obstruction. Moreover, surgeons also prefer CT to determine what they believe to be abnormal structures and what they plan to correct during nasal ventilation surgery [28].…”

“…NSD can be classified into various types according to the morphology of NSD, the maxima angle of NSD, the location of NSD, etc. [29]. Unfortunately, there are no existent, internationally accepted classifications of septal deviation [31].…”

Septoplasty alone is not suitable for most structural nasal obstructions

“…For patients with structural nasal obstruction, the objective evaluation of NSD is still difficult, 13 especially because it is difficult to accurately determine the importance of NSD in the aetiology of the structural nasal obstruction. Anterior rhinoscopy and nasal endoscopy are considered the gold standards for the evaluation of NSD; however, these methods depend on the clinician's experience 14 . In addition, the examiner's judgement of the precise location, deviation angle, and clinical impact on the patient of NSD can also be variable.…”