Do deviated septums increase the risk of sinus infections?

Deviated Nasal Septum and Risk of Sinus Infections

Yes, deviated nasal septums can increase the risk of sinus infections, particularly when the deviation is severe and located in the anterior portion of the nasal cavity or near the ostiomeatal complex. This relationship is supported by evidence showing that anatomical abnormalities can impair normal sinus drainage and ventilation, potentially leading to chronic rhinosinusitis 1.

Mechanism of Increased Risk

A deviated nasal septum can contribute to sinus infections through several mechanisms:

1. Obstruction of Drainage Pathways:

   • Septal deviation can cause stenosis of the drainage-ventilation pathways in the maxillary sinus 1
   • This obstruction can lead to mucus retention and impaired clearance of pathogens

2. Altered Airflow Dynamics:

   • Anterior septal deviations significantly increase nasal resistance more than posterior deviations 2
   • Computational fluid dynamics studies show that deviations in the nasal valve region can more than double nasal resistance 2

3. Impact on Sinus Volumes and Inflammation:

   • Severe septal deviations (>15°) are associated with changes in maxillary sinus volumes 3
   • The chance of finding maxillary sinusitis is significantly increased on the side ipsilateral to severe septal deviation 3

Severity and Location Matters

The relationship between septal deviation and sinusitis depends on:

1. Severity of Deviation:

   • Mild deviations (<9°) typically have minimal impact on sinus health 3
   • Moderate (9°-15°) and severe (>15°) deviations show stronger correlation with sinus disease 3

2. Location of Deviation:

   • Anterior deviations (especially in the nasal valve region) have greater impact on nasal resistance and sinus health 2
   • Posterior nasal cavity can accommodate significant septal deviations without substantial increase in airway resistance 2

Clinical Implications

When evaluating patients with recurrent or chronic sinus infections:

• Radiological Assessment: CT scans can identify septal deviation and evaluate its relationship to the ostiomeatal complex 1
• Surgical Considerations: Septal deviation is listed as a potentially reversible otorhinolaryngology condition that can be addressed surgically when it causes stenosis of drainage pathways 1
• Differential Diagnosis: Consider other causes of nasal obstruction and sinusitis in patients with posterior septal deviations, as these may not significantly affect nasal resistance 2

Important Caveats

• Not all septal deviations lead to sinusitis. The literature shows mixed results regarding the direct causative relationship 4, 5
• Only extremely severe DNS appears to contribute significantly to the etiology of chronic rhinosinusitis 6
• Other factors like allergies, asthma, immunodeficiency, and mucociliary disorders may play more important roles in some patients 6
• CT findings of septal deviation may not necessarily correlate with the severity of symptoms 1

In clinical practice, addressing a significantly deviated septum through septoplasty may be beneficial for patients with recurrent sinus infections, particularly when the deviation is severe and located anteriorly or near the ostiomeatal complex.