European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 3, pp 671–677 | Cite as

Relationship between nasal septal deformity, symptoms and disease severity in chronic rhinosinusitis

  • Tomislav GregurićEmail author
  • Tomislav Baudoin
  • Dejan Tomljenović
  • Marko Grgić
  • Mario Štefanović
  • Livije Kalogjera


The objective of this study was to evaluate the interaction of nasal septal deformity (NSD), including the contribution of septal spurs, with the severity of subjective symptoms, impairment of health-related quality of life (HRQoL) and sinus mucosal hyperplasia in patients with chronic rhinosinusitis (CRS). One hundred seventeen patients with CRS were assigned to three groups with mild, moderate or severe NSD, according to the measured nasal septal angle, including the presence of contact septal spurs. All CRS patients completed the visual analog scale (VAS) symptom severity score and the Sino-Nasal Outcome Test (SNOT-22) questionnaire. Symptoms scores, SNOT-22 and Lund–Mackay (LM) scores among the three NSD groups were compared. Related anatomy from the study group was compared with 100 control patients. VAS score for postnasal discharge in CRS patients was significantly higher in patients with mild NSD. There was a significantly higher LM score in CRS patients with severe NSD, compared to those with mild (P = 0.001) or moderate NSD (P = 0.005). CRS patients with a contact spur demonstrated a significantly higher LM score (P = 0.006) compared to those without a contact spur, and no differences in VAS symptom scores or HRQoL scores. There was a similar prevalence of septal deformities in CRS patients and in the non-ENT population. Our results support the conclusion that in patients with CRS, associated NSD or contact septal spur do not contribute significantly to CRS symptom severity or HRQoL impairment, but may have an impact on sinus mucosal hyperplasia.


Chronic rhinosinusitis Nasal septal deformity Septal spur Septal deviation Sino-Nasal Outcome Test 22 Visual analog scale 



This research was approved by the Ethics Committee of University hospital Centre “Sestre milosrdnice”, Zagreb School of Medicine. The research related to this paper is a part of the scientific project supported by a grant of Croatian Ministry of Science (grant No 065-06 50235-0145—“Research on interaction of infection and allergy in rhinosinusitis and nasal polyposis” Principal investigator, L. Kalogiera).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Benninger MS, Ferguson BJ, Hadley JA et al (2003) Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 129S:S1–S32CrossRefGoogle Scholar
  2. 2.
    Stammberger H, Posawetz W (1990) Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 247:63–76PubMedGoogle Scholar
  3. 3.
    Elahi MM, Frenkiel S (2000) Septal deviation and chronic sinus disease. Am J Rhinol 14:175–179CrossRefPubMedGoogle Scholar
  4. 4.
    Yousem DM, Kennedy DW, Rosenberg S (1991) Ostiomeatal complex risk factors for sinusitis: CT evaluation. J Otolaryngol 20:419–424PubMedGoogle Scholar
  5. 5.
    Stallman JS, Lobo JN, Som PM (2004) The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease. AJNR Am J Neuroradiol 25:1613–1618PubMedGoogle Scholar
  6. 6.
    Harar RP, Chadha NK, Rogers G (2004) The role of septal deviation in adult chronic rhinosinusitis: a study of 500 patients. Rhinology 42:126–130PubMedGoogle Scholar
  7. 7.
    Parsons DS, Batra PS (1998) Functional endoscopic sinus surgical outcomes for contact point headaches. Laryngoscope 108:696–702CrossRefPubMedGoogle Scholar
  8. 8.
    Ramadan HH (1999) Nonsurgical versus endoscopic sinonasal surgery for rhinogenic headache. Am J Rhinol 13:455–457CrossRefPubMedGoogle Scholar
  9. 9.
    Welge-Luessen A, Hauser R, Schmid N et al (2003) Endonasal surgery for contact point headaches: a 10-year longitudinal study. Laryngoscope 113:2151–2156CrossRefPubMedGoogle Scholar
  10. 10.
    Bhattacharyya N, Fried MP (2003) The accuracy of computed tomography in the diagnosis of chronic rhinosinusitis. Laryngoscope 113:125–129CrossRefPubMedGoogle Scholar
  11. 11.
    Bhattacharyya N (2006) Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis. Laryngoscope 116:1–22CrossRefPubMedGoogle Scholar
  12. 12.
    Fokkens WJ, Lund VJ, Mullol J et al (2012) EPOS 2012: european position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 50:1–12PubMedGoogle Scholar
  13. 13.
    Morley AD, Sharp HR (2006) A review of sinonasal outcome scoring systems—which is best? Clin Otolaryngol 31:103–109CrossRefPubMedGoogle Scholar
  14. 14.
    Hopkins C, Gillett S, Slack R et al (2009) Psychometric validity of the 22-item sinonasal outcome test. Clin Otolaryngol 34:447–454CrossRefPubMedGoogle Scholar
  15. 15.
    Lund VJ, Kennedy DW (1997) Staging for rhinosinusitis. Otolaryngol Head Neck Surg 117:S35–S40CrossRefPubMedGoogle Scholar
  16. 16.
    Mladina R, Cujić E, Subarić M et al (2008) Nasal septal deformities in ear, nose, and throat patients: an international study. Am J Otolaryngol 29:75–82CrossRefPubMedGoogle Scholar
  17. 17.
    Earwaker J (1993) Anatomic variants in sinonasal CT. Radiographics 13:381–415CrossRefPubMedGoogle Scholar
  18. 18.
    Messerklinger W (1967) On the drainage of the normal frontal sinus of man. Acta Otolaryngol 673:176–181CrossRefGoogle Scholar
  19. 19.
    Jones N, Strobl A, Holland I (1997) A study of the CT findings in 100 patients with rhinosinusitis and 100 controls. Clin Otolaryngol Allied Sci 22:47–51CrossRefPubMedGoogle Scholar
  20. 20.
    Yasan H, Doğru H, Baykal B et al (2005) What is the relationship between chronic sinus disease and isolated nasal septal deviation? Otolaryngol Head Neck Surg 133:190–193CrossRefPubMedGoogle Scholar
  21. 21.
    Collet S, Bertrand B, Cornu S et al (2001) Is septal deviation a risk factor for chronic sinusitis? Review of literature. Acta Otorhinolaryngol Belg 55:299–304PubMedGoogle Scholar
  22. 22.
    Orlandi RR (2010) A systematic analysis of septal deviation associated with rhinosinusitis. Laryngoscope 120:1687–1695CrossRefPubMedGoogle Scholar
  23. 23.
    Polat C, Dostbil Z (2010) Evaluation of the nasal mucociliary transport rate by rhinoscintigraphy before and after surgery in patients with deviated nasal septum. Eur Arch Otorhinolaryngol 267:529–535PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Bhattacharyya N (2005) Symptom and disease severity differences between nasal septal deviation and chronic rhinosinusitis. Otolaryngol Head Neck Surg 133:173–177CrossRefPubMedGoogle Scholar
  25. 25.
    Poirrier AL, Ahluwalia S, Goodson A et al (2013) Is the Sino-Nasal Outcome Test-22 a suitable evaluation for septorhinoplasty? Laryngoscope 123:76–81CrossRefPubMedGoogle Scholar
  26. 26.
    Rudmik L, Mace J, Ferguson BJ et al (2011) Concurrent septoplasty during endoscopic sinus surgery for chronic rhinosinusitis: does it confound outcomes assessment? Laryngoscope 121:2679–2683PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Stammberger H, Wolf G (1988) Headaches and sinus disease: the endoscopic approach. Ann Otol Rhinol Laryngol Suppl 134:3–23PubMedGoogle Scholar
  28. 28.
    Abu-Samra M, Gawad OA, Agha M (2011) The outcomes for nasal contact point surgeries in patients with unsatisfactory response to chronic daily headache medications. Eur Arch Otorhinolaryngol 268:1299–1304CrossRefPubMedGoogle Scholar
  29. 29.
    Abu-Bakra M, Jones NS (2001) Prevalence of nasal mucosal contact points in patients with facial pain compared with patients without facial pain. J Laryngol Otol 115:629–632CrossRefPubMedGoogle Scholar
  30. 30.
    Harrison L, Jones NS (2013) Intranasal contact points as a cause of facial pain or headache: a systematic review. Clin Otolaryngol 38:8–22CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Tomislav Gregurić
    • 1
    Email author
  • Tomislav Baudoin
    • 2
  • Dejan Tomljenović
    • 2
  • Marko Grgić
    • 2
  • Mario Štefanović
    • 3
  • Livije Kalogjera
    • 2
  1. 1.Department of RadiologyUniversity Hospital Centre “Sestre Milosrdnice”ZagrebCroatia
  2. 2.Department of ORL, Head and Neck SurgeryUniversity Hospital Centre “Sestre Milosrdnice”ZagrebCroatia
  3. 3.Clinical Institute of ChemistryUniversity Hospital Centre “Sestre Milosrdnice”ZagrebCroatia

Personalised recommendations