Clin Exp Otorhinolaryngol.  2016 Mar;9(1):39-43. 10.21053/ceo.2016.9.1.39.

Clinical Implications of Septal Deviation in Lateralized Olfaction

• Choi YS
• Ryu YJ
• Rhee J
• Seok J
• Han S
• Jin HR
• Kim DW

• KMID: 2166284
• DOI: http://doi.org/10.21053/ceo.2016.9.1.39

Abstract

OBJECTIVES
Results of butanol threshold tests (BTTs) have shown that birhinal olfaction tends to converge toward monorhinal olfaction of the dominant nostril. However, birhinal olfaction may also be worse than dominant-side monorhinal olfaction. The goal of our study was to investigate the effect of deviated nasal septum on birhinal olfaction in patients with lateralized olfaction and to examine the effect of septoplasty in these patients.
METHODS
A retrospective study with planned data collection was conducted in 518 patients who underwent BTTs. Lateralized olfaction was defined as monorhinal BTT scores that differed by >2 between sides. Underestimated birhinal olfaction was defined as a birhinal BTT score >2 lower than the dominant nostril monorhinal BTT score. Patients with lateralized olfaction were divided into 2 groups: group 1, underestimated birhinal olfaction; and group 2, without underestimated birhinal olfaction.
RESULTS
Among 518 patients, 112 with lateralized olfaction were enrolled in this study. Group 1 included 23 patients (20.5%) and group 2 included 89 patients (79.5%). The severity of septal deviation (ratio of the distance of narrower side to wider side) did not differ between the 2 groups. Septal deviation to the dominant nostril was more common in group 1 than group 2 (73.9% vs. 37.6%; P=0.002). Five patients with septal deviation to the dominant nostril with underestimated birhinal olfaction underwent septoplasty. Improved lateralized olfaction occurred in all 5 patients postoperatively (P=0.041).
CONCLUSION
Septal deviation of the dominant nostril in patients with lateralized olfaction is associated with underestimated birhinal olfaction. Septoplasty may improve olfaction by increasing airflow in the dominant olfactory side.

Keyword

Smell; Nasal Septum; Nasal Cavity; Septoplasty

MeSH Terms

Data Collection
Humans
Nasal Cavity
Nasal Septum
Retrospective Studies
Smell*

Figure

• 

  Fig. 1. Overall flow sheet of olfactory function tests. BTT, butanol threshold test; Group 1, underestimated birhinal olfaction; Group 2, without underestimated birhinal olfaction. *Difference of >2 BTT scores between the two nostrils. †Birhinal olfaction BTT lower than dominant monorhinal olfaction by >2 BTT scores.

• 

  Fig. 2. Septal deviation in groups 1 and 2. Group 1 exhibited a significantly higher percentage of patients with septal deviation of the dominant olfaction side than group 2. Group 1, underestimated birhinal olfaction; Group 2, without underestimated birhinal olfaction.

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  Fig. 3. BTT scores before and after septoplasty. The difference in BTT scores between birhinal and dominant side monorhinal olfaction was significantly decreased after surgery. BTT, butanol threshold test; Preop, preoperative; postop, postoperative.

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  Fig. 4. Effect of septal deviation on BTT score. (A) For individuals with septal deviation of the nondominant olfaction side, the dominant olfaction side BTT score did not differ from the birhinal BTT score. (B) For those with deviation of the dominant olfaction side, birhinal BTT was lower than the dominant side monorhinal BTT in some cases. BTT, butanol threshold test. *Dominant olfaction side.

Reference

1. Good KP, Martzke JS, Daoud MA, Kopala LC. Unirhinal norms for the University of Pennsylvania Smell Identification Test. Clin Neuropsychol. 2003; May. 17(2):226–34.

2. Mohr C, Rohrenbach CM, Laska M, Brugger P. Unilateral olfactory perception and magical ideation. Schizophr Res. 2001; Mar. 47(2-3):255–64.

3. Zucco G, Zeni MT, Perrone A, Piccolo I. Olfactory sensitivity in early-stage Parkinson patients affected by more marked unilateral disorder. Percept Mot Skills. 2001; Jun. 92(3 Pt 1):894–8.

4. Brand G, Millot JL, Biju C. Comparison between monorhinal and birhinal olfactory stimulations in bilateral electrodermal recordings. C R Acad Sci III. 2000; Nov. 323(11):959–65.

5. Gudziol V, Hummel C, Negoias S, Ishimaru T, Hummel T. Lateralized differences in olfactory function. Laryngoscope. 2007; May. 117(5):808–11.

6. Klimek L, Hummel T, Moll B, Kobal G, Mann WJ. Lateralized and bilateral olfactory function in patients with chronic sinusitis compared with healthy control subjects. Laryngoscope. 1998; Jan. 108(1 Pt 1):111–4.

7. Frasnelli J, Livermore A, Soiffer A, Hummel T. Comparison of lateralized and binasal olfactory thresholds. Rhinology. 2002; Sep. 40(3):129–34.

8. Gordon AS, McCaffrey TV, Kern EB, Pallanch JF. Rhinomanometry for preoperative and postoperative assessment of nasal obstruction. Otolaryngol Head Neck Surg. 1989; Jul. 101(1):20–6.

9. Mlynski G. Surgery of the nasal septum. Facial Plast Surg. 2006; Nov. 22(4):223–9.

10. Kamani T, Yilmaz T, Surucu S, Turan E, Brent KA. Scanning electron microscopy of ciliae and saccharine test for ciliary function in septal deviations. Laryngoscope. 2006; Apr. 116(4):586–90.

11. Altundag A, Salihoglu M, Tekeli H, Saglam M, Cayonu M, Hummel T. Lateralized differences in olfactory function and olfactory bulb volume relate to nasal septum deviation. J Craniofac Surg. 2014; Mar. 25(2):359–62.

12. Damm M, Vent J, Schmidt M, Theissen P, Eckel HE, Lötsch J, et al. Intranasal volume and olfactory function. Chem Senses. 2002; Nov. 27(9):831–9.

13. Kimmelman CP. The risk to olfaction from nasal surgery. Laryngoscope. 1994; Aug. 104(8 Pt 1):981–8.

14. Pfaar O, Huttenbrink KB, Hummel T. Assessment of olfactory function after septoplasty: a longitudinal study. Rhinology. 2004; Dec. 42(4):195–9.

15. Leopold DA, Hummel T, Schwob JE, Hong SC, Knecht M, Kobal G. Anterior distribution of human olfactory epithelium. Laryngoscope. 2000; Mar. 110(3 Pt 1):417–21.

16. Zhao K, Scherer PW, Hajiloo SA, Dalton P. Effect of anatomy on human nasal air flow and odorant transport patterns: implications for olfaction. Chem Senses. 2004; Jun. 29(5):365–79.

17. Jun BC, Song SW, Kim BG, Kim BY, Seo JH, Kang JM, et al. A comparative analysis of intranasal volume and olfactory function using a three-dimensional reconstruction of paranasal sinus computed tomography, with a focus on the airway around the turbinates. Eur Arch Otorhinolaryngol. 2010; Sep. 267(9):1389–95.

18. Hytönen ML, Lilja M, Makitie AA, Sintonen H, Roine RP. Does septoplasty enhance the quality of life in patients? Eur Arch Otorhinolaryngol. 2012; Dec. 269(12):2497–503.

19. Perry BF, Kountakis SE. Subjective improvement of olfactory function after endoscopic sinus surgery for chronic rhinosinusitis. Am J Otolaryngol. 2003; Nov-Dec. 24(6):366–9.

20. Gudziol V, Lotsch J, Hahner A, Zahnert T, Hummel T. Clinical significance of results from olfactory testing. Laryngoscope. 2006; Oct. 116(10):1858–63.

21. Doty RL. Office procedures for quantitative assessment of olfactory function. Am J Rhinol. 2007; Jul-Aug. 21(4):460–73.