At what age can a deviated septum be properly assessed in children?

Assessment of Deviated Septum in Children

A deviated septum can be properly assessed in children starting at age 6-7 years, when they can reliably perform the necessary diagnostic tests such as spirometry and provide accurate subjective feedback about their nasal symptoms.

Diagnostic Challenges in Different Age Groups

Young Children (Under 6 years)

• Reliable assessment is difficult due to:
  • Inability to perform standard diagnostic tests like spirometry 1
  • Limited ability to articulate subjective symptoms
  • Ongoing nasal septal growth and development 2
  • Lower incidence of significant septal deviation compared to older children 2

School-Age Children (6-14 years)

• Assessment becomes more feasible:
  • Children can perform spirometry with proper instruction 1
  • Can report subjective symptoms more reliably
  • Should be evaluated using pediatric-specific protocols 1
  • Nasal endoscopy becomes more practical

Adolescents (>14 years)

• Can be assessed similarly to adults
• Important timing consideration: septum continues growing until age 16-17 3
• Higher risk of re-deviation if surgical correction is performed before growth completion 3

Diagnostic Methods by Age

Physical Examination

• Anterior rhinoscopy: Possible at any age but cooperation varies
• Nasal endoscopy: More reliable in children >6 years
• External nasal examination: Can be performed at any age

Objective Testing

• Spirometry: Reliable in children ≥6-7 years 1
• Peak nasal inspiratory flow: Can be performed in cooperative children >6 years
• Imaging (CT/MRI): Can be performed at any age but typically requires sedation in younger children

Clinical Implications

Surgical Considerations

• Surgical intervention (septoplasty) is generally delayed until after age 16-17 when septal growth is complete 3
• Adolescent patients who undergo septoplasty have a significantly higher incidence of re-deviation (21.2%) compared to adults (7.1%) 3
• When septoplasty is deemed necessary in adolescents, patients and parents should be informed about the possibility of re-deviation 3

Non-Surgical Management

• For younger children with nasal obstruction, focus on:
  • Treating allergic rhinitis if present
  • Nasal saline irrigation
  • Short courses of intranasal corticosteroids when appropriate 4
  • Addressing adenoidal hypertrophy which may contribute to obstruction 4

Practical Assessment Algorithm

1. Ages <6 years:

   • Primarily rely on caregiver reports of symptoms
   • Physical examination (anterior rhinoscopy)
   • Consider imaging only if severe symptoms or if surgical intervention is being contemplated

2. Ages 6-14 years:

   • Combine subjective symptom assessment
   • Physical examination including nasal endoscopy when possible
   • Spirometry and peak nasal flow measurements 1
   • Imaging if surgical intervention is being considered

3. Ages >14 years:

   • Complete assessment as in adults
   • Consider growth status before surgical intervention
   • Inform about higher risk of re-deviation if surgery performed before age 17 3

Common Pitfalls to Avoid

• Misinterpreting normal developmental variations as pathological deviation
• Failing to consider adenoid hypertrophy as a cause of nasal obstruction in children
• Performing septoplasty too early, leading to higher rates of re-deviation 3
• Not accounting for the child's ability to cooperate with diagnostic procedures
• Overlooking the contribution of allergic rhinitis to nasal symptoms

Remember that children under age 5 exhibit significantly less septal tortuosity than older children and adults, suggesting that many cases of nasal septal deviation may not be congenital but develop during childhood and adolescence 2.