Curvature of the nasal septum: symptoms and diagnosis
Last reviewed: 23.04.2024
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Symptoms of curvature of the septum of the nose
The main symptom of the curvature of the septum of the nose is the difficulty of nasal breathing, which can be one-sided or two-sided. If there is a pronounced displacement of the septum to the right or to the left (especially in the anterior regions), the patient complains of difficulty or lack of breathing through the corresponding half of the nose, but this is absolutely not necessary. Often the subjective feeling of insufficiency of breathing through this or that half of the nasal cavity does not correspond to the shape of the septum of the nose. More often the difficulty of nasal breathing is either constant, equally pronounced on both sides, or alternating due to the nasal cycle. Other symptoms characteristic of diseases of the nasal cavity are less frequent in the curvature of the nasal septum, however, with prolonged deformation due to the phenomena of developing secondary vasomotor rhinitis, patients can complain of nasal discharge, sneezing attacks. Disturbance of smell is not typical for this disease: patients, as a rule, are able to normally smell. Other symptoms of the disease are usually associated with concomitant diseases (sinusitis, otitis, etc.).
Diagnosis of curvature of the septum of the nose
Correct collection of anamnesis allows you to adequately build a plan for the subsequent examination. The main focus of the history is on the presence of trauma. Fractures of the nose, which confirms the traumatic origin of the disease. It is necessary to more carefully identify the anamnestic signs of diseases, somehow related to the curvature of the septum of the nose, since the symptoms, for example, of chronic sinusitis, can be veiled by the existing deformity and the resulting difficulty of nasal breathing. /
Physical examination.
Since the curvature of the septum of the nose (especially post-traumatic) is often combined with various deformities of the external nose, examination of the patient begins with a careful study of the shape of the nose pyramid, paying attention to the structure of its bone and cartilage part. Typical changes in the shape of the nose, combined with the curvature of the septum of the nose, are scoliotic and saddle-shaped deformities, as well as deformation of the columella (subluxation of the caudal margin of the cartilage of the septum of the nose). Scoliotic deformity more often captures a more fragile and traumatized cartilage department, retraction of columella develops as a result of previous abscesses, chondroperichondritis or unsuccessful operations on the septum of the nose. In those cases when it is planned to perform septo- or rhinoseptoplasty, it is necessary to carry out photodocumentation of the findings. Preoperative photos should be taken in portrait mode in at least three projections - straight (full face), lateral (profile) and basal, showing the shape of the nostrils.
When palpation of the external nose, it is also possible to identify the character of deformation of bone and cartilaginous structures,
Instrumental research
The main and in most cases an adequate method of diagnosing the curvature of the septum of the nose is anterior rhinoscopy. Inspection of the nasal cavity begins without a nasal mirror, simply lifting the tip of the nose with your thumb and lighting the vestibule of the nasal cavity with a frontal reflector. In some cases, to facilitate the examination, it is required to shear the hairs on the threshold of the nose. This examination, in contrast to anterior rhinoscopy with a nasal mirror, allows one to evaluate the shape of the caudal nasal septum cartilage and its relation to the lateral cartilage of the nose and large cartilages of the wings, and also the angle of the nasal valve and the transverse size of the nasal vestibule (nasal valve area). In the stern, the angle of the nose valve should be at least 15 degrees.
After examination of the vestibule of the nose with anterior rhinoscopy, the deeper sections of the septum of the nose are examined. For their detailed examination, it is better to pre-animate the mucous membrane with a 0.1% solution of epinephrine or xylometazoline. In the diagnosis of deformities of the posterior part of the septum of the nose, endoscopic examination helps, which is also carried out after anesthesia and anemia of the mucous membrane with an endurous or flexible endoscope
A definite role in the diagnosis of deformities of the septum of the nose is played by CT. This study is especially important for the identification of thorns and ridges located in the posterior sections that are not visible with anterior rhinoscopy due to hypertrophy of nasal conchae or obturating polyps in the nasal cavity.
Differential diagnosis of curvature of the septum of the nose
The cause of difficulty in nasal breathing in the curvature of the septum can also be vasomotor and allergic rhinitis, chronic sinusitis, adenoids.
Indications for consultation of other specialists
In the presence of clinical signs of allergic rhinitis, consultation of an allergist (setting of skin tests with allergens) is shown.
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