Abstract
ObjectiveTo perform a systematic review of measurement tools utilized for the diagnosis of nasal septal deviation (NSD).MethodsElectronic 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 s 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.ResultsOnline 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.ConclusionsDiagnostic 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.
Highlights
Nasal septal deviation (NSD) is a common diagnosis made by otolaryngologists but is one that is not usually based on objective measurements
Online searches resulted in 23 abstracts [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36] after removal of duplicates that resulted from overlap of studies between the electronic databases
Anterior rhinoscopy and nasal endoscopy performed in the decongested state can diagnose the location and severity of nasal septal deviations, but it is an uncomfortable test that is subject to significant inter-rater variability [1,31]
Summary
Nasal septal deviation (NSD) is a common diagnosis made by otolaryngologists but is one that is not usually based on objective measurements. There can be a significant inter-observer variability in terms of diagnosing the condition, verifying its precise location, quantifying the degree of deviation, and assessing its clinical impact on patients. This subjectivity can lead to unnecessary surgical treatments, patient complications and low patient satisfaction rates. In the current era of evidence-based medicine, society demands that surgical interventions demonstrate clinically significant improvements. Since there is no consensus agreement about diagnosing NSD objectively, interventions treating NSD lack a strong evidence base.
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