© 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.
In the examined group as well as in the control group coexistence of associated diseases which could influence the pathology of the auditory tube and tympanic cavity was assessed. The medical histories of one hundred and four patients were submitted for analysis with respect to laryngological examination (descriptions of nasal septum deviation and otoscopic ear description, in particular), results of audiometry (tone audiogram and tympanogram), results of rhinomanometric and radiological examination of the nasopharynx and paranasal sinuses or CT of paranasal sinuses.
Authors who claim that nasal septum deviation can cause hypoacusia maintain that the complication is caused by dysfunction of the auditory tube. This complication can follow the appearance of the hypoacusis itself. That is why, when evaluating the audiological consequences of nasal septum deviation, adenoids and chronic inflammatory sinusitis, mainly tympanometric curves were taken into consideration. It is noteworthy that all children with hearing loss in the examined group could be classified in the section which the audiometrists described as „hypoacusia”. The only exception was a patient with conductive deafness after oncological chemotherapy, who was therefore not connected with nasal septum deformation. In order to analyse the audiological results of nasal septum deformation, adenoiditis, chronic inflammatory sinusitis and allergy of the upper air passages, tympanometric curve was mainly adopted for the above-mentioned reasons.
Statistical analysis was done by the chi-squared test.
RESULTS AND discussion
The ultimate analysis included only those children from both groups for whom we had full documentation (described above). There were one hundred and four patients from the examined group and forty-one from the control group. The groups were statistically comparable, c2=2.587.
In the examined group 57.00% of patients with a deviated nasal septum had no additional complications as checked in the examination. All the children had satisfactory hearing. In the tympanometry type A and good hearing in the examined group were (68.00%) children.
In the control group there were 71.43% of children who did not have complications. No case of hypoacusia was found in this group. In the examined group there were 15.38% of children with hypoacusia. In the control group this number was 12%. Statistical analysis showed that there were no statistically significant differences between the two groups (c2=0.200).
In the examined group there were 22.12% of patients in whom the DSN was adenoidal complications. Among them, hypoacusia was detected in 12.5% of the examined group while in the control group hypertrophy of the adenoids was found in 11.9% of cases of whom 9.52% of the whole control group had hypoacusia. Analysis of the relationship between adenoidal hypertrophy and hypoacusia found that it is crucial, c2=32.389.
In the examined group sinusitis complicated the nasal septum deviation in 22.12% of cases. Among these, hypoacusia was detected in 8.65% of the examined group, while in the control group sinusitis was found in 11.9% of cases, being present in 2.38% of the control group. Statistical analysis revealed an important relationship between the existence of sinusitis and hypoacusia, c2=10.591.
Analysis of the configuration of septum deformations according to Mladina´s scheme revealed that there were no special predispositions of particular forms of deviation to create hypoacusis. A full statistical analysis was carried out for type V, c2=0.009, and type VII, c2=1.010. It must be noted that deviations of types I, IV and VI are rare forms, and in the given data there are too few cases to draw statistical conclusions. In the researched material, the percentage of patients with adenoids was not substantially greater than in the control group, c2 =2.017. However, this is not the main subject of this study and to prove this thesis would require wider clinical data.
The percentage of children with sinusitis and a deviated nasal septum was not statistically different from the percentage of patients with both diseases in the control group, X2=2.017.
All existing literature reports are not unequivocal, but drawing further conclusions from the above material would involve enlarging the number of cases of this type.
Table 1. Number´s case in Mladina´s classification.
| Type of DSN | Numbers | % |
| 1 | 0 | 0.00 |
| 2 | 6 | 12.00 |
| 3 | 4 | 8.00 |
| 4 | 2 | 4.00 |
| 5 | 17 | 34.00 |
| 6 | 1 | 2.00 |
| 7 | 20 | 40.00 |
CONCLUSIONS
1. The configuration of nasal septum deviation has no influence on development of auditory tube dysfunction.
2. Nasal septum deviation does not immediately cause disturbance of auditory tube function, and hence it does not cause hypoacusia in children.
Fig. 2. Type´s tympanometry.
Piśmiennictwo
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