Limits...
Measurement tools for the diagnosis of nasal septal deviation: a systematic review.

Aziz T, Biron VL, Ansari K, Flores-Mir C - J Otolaryngol Head Neck Surg (2014)

Bottom Line: Online searches resulted in 23 abstracts after removal of duplicates that resulted from overlap of studies between the electronic databases.An additional 15 abstracts were excluded due to lack of relevance.Compared to anterior rhinoscopy, nasal endoscopy, and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence, location, and severity of NSD.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Edmonton, Alberta, Canada. carlosflores@ualberta.ca.

ABSTRACT

Objective: To perform a systematic review of measurement tools utilized for the diagnosis of nasal septal deviation (NSD).

Methods: Electronic database searches were performed using MEDLINE (from 1966 to second week of August 2013), EMBASE (from 1966 to second week of August 2013), Web of Science (from 1945 to second week of August 2013) and all Evidence Based Medicine Reviews Files (EBMR); Cochrane Database of Systematic Review (CDSR), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Database of Abstracts of Reviews of Effects (DARE), American College of Physicians Journal Club (ACP Journal Club), Health Technology Assessments (HTA), NHS Economic Evaluation Database (NHSEED) till the second quarter of 2013. The search terms used in database searches were 'nasal septum', 'deviation', 'diagnosis', 'nose deformities' and 'nose malformation'. The studies were reviewed using the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results: Online searches resulted in 23 abstracts after removal of duplicates that resulted from overlap of studies between the electronic databases. An additional 15 abstracts were excluded due to lack of relevance. A total of 8 studies were systematically reviewed.

Conclusions: Diagnostic modalities such as acoustic rhinometry, rhinomanometry and nasal spectral sound analysis may be useful in identifying NSD in anterior region of the nasal cavity, but these tests in isolation are of limited utility. Compared to anterior rhinoscopy, nasal endoscopy, and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence, location, and severity of NSD.

Show MeSH

Related in: MedlinePlus

Areas of the nasal cavity according to Cottle. Area 1: nostril. Area 2:nasal valve. Area 3: area underneath the bony and cartilaginous vault, also called the attic. Area 4: anterior aspect of the nasal cavity including the heads of the turbinates and the infundibulum. Area 5: the posterior aspect of the nasal cavity, including the tails of the turbinates. (Adapted from Egbert H et al. Incorrect terminology in nasal anatomy and surgery, suggestions for improvement. Rhinology, 2003; 41:129-133).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4042609&req=5

Figure 2: Areas of the nasal cavity according to Cottle. Area 1: nostril. Area 2:nasal valve. Area 3: area underneath the bony and cartilaginous vault, also called the attic. Area 4: anterior aspect of the nasal cavity including the heads of the turbinates and the infundibulum. Area 5: the posterior aspect of the nasal cavity, including the tails of the turbinates. (Adapted from Egbert H et al. Incorrect terminology in nasal anatomy and surgery, suggestions for improvement. Rhinology, 2003; 41:129-133).

Mentions: The flow chart of the electronic database search and final selection of studies to be included in the systematic review is outlined (Figure 1). Online searches resulted in 23 abstracts [13-36] after removal of duplicates that resulted from overlap of studies between the electronic databases. Fifteen studies were excluded [16-30] after full review of the articles and reasons for their exclusion are listed in Table 1. This resulted in a total of 8 studies [13,14,31-36] to be included in this systematic review. Key details of the included studies are listed in Table 2. Three studies [14,32,33] discussed the analysis of nasal sound intensity on expiration [32], inspiration [14] and both inspiration/expiration [33] in 2000-4000 Hz frequency interval as diagnostic modality for nasal septal deviation. It was suggested in two of these studies that there was a positive correlation between severity of NSD and in intensity of nasal sounds [14,32]. Three other articles [13,31,35] concluded that acoustic rhinometry (AR) was a reliable tool in diagnosing anterio-caudal NSDs (Figure 2) [13,35]. One study [31] concluded that the sensitivity of AR in detecting anterio-caudal septal deviations is 57% and specificity is 70% when assessing even minor septal deviations that are visible on CT scans, but might not be clinically relevant. Another study [35] concluded that acoustic rhinometry could detect NSD due to statistically significant differences in the cross sectional areas and nasal cavity volumes between obstructed and unobstructed sides of the nose. One article on rhinomanometry concluded that it has limited diagnostic value in the clinical setting due to its ability to only diagnose major septal deviations in the anterior region and these were found only in a minority of the sample patients [34]. Finally, one study [36] concluded that physical examination from nasal endoscopy/anterior rhinoscopy is an accurate method of diagnosing septal deviation patients requiring septal surgery.


Measurement tools for the diagnosis of nasal septal deviation: a systematic review.

Aziz T, Biron VL, Ansari K, Flores-Mir C - J Otolaryngol Head Neck Surg (2014)

Areas of the nasal cavity according to Cottle. Area 1: nostril. Area 2:nasal valve. Area 3: area underneath the bony and cartilaginous vault, also called the attic. Area 4: anterior aspect of the nasal cavity including the heads of the turbinates and the infundibulum. Area 5: the posterior aspect of the nasal cavity, including the tails of the turbinates. (Adapted from Egbert H et al. Incorrect terminology in nasal anatomy and surgery, suggestions for improvement. Rhinology, 2003; 41:129-133).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4042609&req=5

Figure 2: Areas of the nasal cavity according to Cottle. Area 1: nostril. Area 2:nasal valve. Area 3: area underneath the bony and cartilaginous vault, also called the attic. Area 4: anterior aspect of the nasal cavity including the heads of the turbinates and the infundibulum. Area 5: the posterior aspect of the nasal cavity, including the tails of the turbinates. (Adapted from Egbert H et al. Incorrect terminology in nasal anatomy and surgery, suggestions for improvement. Rhinology, 2003; 41:129-133).
Mentions: The flow chart of the electronic database search and final selection of studies to be included in the systematic review is outlined (Figure 1). Online searches resulted in 23 abstracts [13-36] after removal of duplicates that resulted from overlap of studies between the electronic databases. Fifteen studies were excluded [16-30] after full review of the articles and reasons for their exclusion are listed in Table 1. This resulted in a total of 8 studies [13,14,31-36] to be included in this systematic review. Key details of the included studies are listed in Table 2. Three studies [14,32,33] discussed the analysis of nasal sound intensity on expiration [32], inspiration [14] and both inspiration/expiration [33] in 2000-4000 Hz frequency interval as diagnostic modality for nasal septal deviation. It was suggested in two of these studies that there was a positive correlation between severity of NSD and in intensity of nasal sounds [14,32]. Three other articles [13,31,35] concluded that acoustic rhinometry (AR) was a reliable tool in diagnosing anterio-caudal NSDs (Figure 2) [13,35]. One study [31] concluded that the sensitivity of AR in detecting anterio-caudal septal deviations is 57% and specificity is 70% when assessing even minor septal deviations that are visible on CT scans, but might not be clinically relevant. Another study [35] concluded that acoustic rhinometry could detect NSD due to statistically significant differences in the cross sectional areas and nasal cavity volumes between obstructed and unobstructed sides of the nose. One article on rhinomanometry concluded that it has limited diagnostic value in the clinical setting due to its ability to only diagnose major septal deviations in the anterior region and these were found only in a minority of the sample patients [34]. Finally, one study [36] concluded that physical examination from nasal endoscopy/anterior rhinoscopy is an accurate method of diagnosing septal deviation patients requiring septal surgery.

Bottom Line: Online searches resulted in 23 abstracts after removal of duplicates that resulted from overlap of studies between the electronic databases.An additional 15 abstracts were excluded due to lack of relevance.Compared to anterior rhinoscopy, nasal endoscopy, and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence, location, and severity of NSD.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Alberta, Faculty of Medicine and Dentistry, School of Dentistry, Edmonton, Alberta, Canada. carlosflores@ualberta.ca.

ABSTRACT

Objective: To perform a systematic review of measurement tools utilized for the diagnosis of nasal septal deviation (NSD).

Methods: Electronic database searches were performed using MEDLINE (from 1966 to second week of August 2013), EMBASE (from 1966 to second week of August 2013), Web of Science (from 1945 to second week of August 2013) and all Evidence Based Medicine Reviews Files (EBMR); Cochrane Database of Systematic Review (CDSR), Cochrane Central Register of Controlled Trials (CCTR), Cochrane Methodology Register (CMR), Database of Abstracts of Reviews of Effects (DARE), American College of Physicians Journal Club (ACP Journal Club), Health Technology Assessments (HTA), NHS Economic Evaluation Database (NHSEED) till the second quarter of 2013. The search terms used in database searches were 'nasal septum', 'deviation', 'diagnosis', 'nose deformities' and 'nose malformation'. The studies were reviewed using the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results: Online searches resulted in 23 abstracts after removal of duplicates that resulted from overlap of studies between the electronic databases. An additional 15 abstracts were excluded due to lack of relevance. A total of 8 studies were systematically reviewed.

Conclusions: Diagnostic modalities such as acoustic rhinometry, rhinomanometry and nasal spectral sound analysis may be useful in identifying NSD in anterior region of the nasal cavity, but these tests in isolation are of limited utility. Compared to anterior rhinoscopy, nasal endoscopy, and imaging the above mentioned index tests lack sensitivity and specificity in identifying the presence, location, and severity of NSD.

Show MeSH
Related in: MedlinePlus