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

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.

Figure 1

Summary of systematic review process.

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).