Septal Deformity Grading Helps Nasal Airway Obstruction Diagnosis

Would a septal deformity grading (SDG) system that accounts for anatomic location and grading of deformity severity help in nasal airway obstruction (NAO) diagnosis?

Bottom line
he reviewed SDG system addresses the challenge of providing objective anatomic information on the severity of nasal septal deformities, and may be valuable when used in conjunction with subjective data gathered from the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire.

Background: NAO is a diagnostic challenge due to discrepancies between subjective symptoms and objective findings. Among NAO causes, nasal septum deformity is very common. There has been an assessment trend toward use of patient-reported outcome measures, specifically the NOSE scale. A standardized system would help address anatomic localization and inconsistent grading.

Study design: Retrospective cohort study of 120 patients with nasal obstruction.

Setting: University of California, Irvine Medical Center.

Synopsis: Preoperative NOSE scores ranged from 0 to 100; postoperative NOSE scores ranged from 0 to 90. NOSE and SDG scores were recoded into high or low septal score groups using the 75th and 25th percentiles, respectively. There was a statistically significant difference comparing high and low SDG score groups with revision operations, between nasal trauma history and previous nasal/septal surgery. The odds of having a revision operation were 2.3 times higher for high SDG scores than low SDG scores. The odds of having a nasal trauma history were 1.33 times higher for high versus low SDG scores, and the odds of having a nasal/septal surgery history were 2.9 times higher for low versus high SDG scores. In the multivariate logistic model, the odds of having nasal trauma history were 1.2 times higher for high versus low SDG. There were statistically significant differences in mean composite SDG scores between primary and revision operations, for history and no history of nasal trauma, and for history and no history of nasal/septal surgery. For mean preoperative NOSE scores, there were statistically significant differences between primary and revision operations, and between history and no history of chronic sinusitis. Limitations included broad differential diagnosis and a patient population that may be biased toward having major surgery.

Citation: Gu JT, Kaplan S, Greenfield S, Calloway H, Wong BJF. Validation of a septoplasty deformity grading system for the evaluation of nasal obstruction. Laryngoscope. 2019;129:586–593.