Significance of relationship between anatomical variants of middle turbinate and nasal septum in recurrent acute rhinosinusitis patients

Satya Sundar G. Mohapatra, Niranjan Sahu, Siba N. Rath, Mahesh C. Sahu, Rabindra N. Padhy


Background: Aim of the study was to evaluate the significance of relationship between anatomical variants of middle turbinate and nasal septum, and role for the causation of recurrent acute rhinosinusitis (RARS) in a tertiary care teaching hospital.

Methods: Retrospective analysis of sinonasal computerized tomography (CT) images of 160 patients with history of RARS during August 2015 to December 2016 was done for evaluation of concha bullosa (CB) and paradoxical middle turbinate (PMT) associated with deviated nasal septum (DNS). Measurements of CB, PMT and septal deviation angles were recorded. Patients with acute and expansile paranasal sinus diseases were excluded.

Results: Of the total 160 RARS cases with DNS, 120 cases had unilateral (contralateral and ipsilateral) and bilateral (dominant and similar sized) CB, and were distributed into group I (contralateral and dominant) and group II (ipsilateral and similar sized bilateral) basing on the direction of septal convexity. Maximum transverse diameter of CB (MTDCB) and septal deviation angle values were highly significant (p =0.0001) in group I CB cases. Direction of septal convexity had no significance (58 to right and 62 to left) in relation to CB pneumatization. Septal deviation severity in group I CB cases was highly significant (p =0.0001). The fraction of 40 unilateral and bilateral PMT cases revealed no significance (p =0.45) with severity of DNS.

Conclusions: Anatomical variants of middle turbinate associated with DNS caused increased prevalence of OMC pattern RARS. Contralateral and dominant CBs had shown relationship in direct proportion to the severity of septal deviation contributing to recurrent rhinosinusitis.


Concha bullosa, Deviated nasal septum, Paradoxical middle turbinate, Deviation angle, Recurrent acute rhinosinusitis

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