Association between septal deviation and sinonasal papilloma.
OBJECTIVES/HYPOTHESIS Rhinosinusitis might have many etiologies that lead to a common presentation of inflammation and impaired mucociliary clearance. Anatomic factors were once thought to play a large role in the pathogenesis of rhinosinusitis, and septal deviation was examined in multiple studies with conflicting results. With the more recent appreciation that the development of rhinosinusitis is likely multifactorial, it is appropriate to re-examine possible anatomic etiologies. A systematic analysis of septal deviation and rhinosinusitis was therefore performed to better define this association and describe possible etiologic mechanisms. Examination of a large sample, accomplished through systematically identifying and combining previous studies, may compensate for the several shortcomings of these separate analyses. A systematic analysis was therefore performed to answer the question, is septal deviation associated with rhinosinusitis? STUDY DESIGN Systematic analysis of previously published studies. METHODS Following a structured literature search, articles examining the association of septal deviation and rhinosinusitis were analyzed quantitatively and qualitatively. Based on the quantitative results, a septal deviation angle (SDA) cutoff of 10 degrees was chosen for distinguishing positive from negative for septal deviation in the qualitative analysis. RESULTS Of over 300 references initially identified, 13 articles comprised the basis of this review. Increasing angles of septal deviation were associated with increasing prevalence of rhinosinusitis in multiple studies. Combining the results of five previous studies on this subject demonstrated significant association of septal deviation and rhinosinusitis (P = .0004, chi(2) analysis). The clinical effect was found, however, to be modest with an odds ratio of 1.47. Interestingly, in all studies that examined the laterality of rhinosinusitis associated with septal deviation, inflammation was found bilaterally. Based on the data from this analysis, it appears that many of the previous analyses were insufficiently powered to detect an association between rhinosinusitis and septal deviation. Others failed to find an association by examining subjects with small SDAs. CONCLUSIONS Septal deviation is associated with an increased prevalence of rhinosinusitis, although the impact of this anatomic anomaly is limited. It appears to be one of many possible factors that might lead to the development of rhinosinusitis.