title: Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings.
abstract: BACKGROUND
  Performance of septoplasty is dependent on objective evidence of nasal septal deviation. Although physical examination including anterior rhinoscopy and endoscopic examination is the gold standard for evaluation of septal deviation, third-party payors' reviews of septoplasty claims are often made on computed tomography (CT) findings. However, the correlation between radiographic evaluation of septal deviation with physical examination findings is unknown.
  
  
  METHODS
  Retrospective, blinded, independent evaluation of septal deviation in 39 consecutive patients from physical examination, including anterior rhinoscopy and endoscopic examination, by an otolaryngologist and radiographic evaluation of sinus CT scan by a neuroradiologist. Four distinct septal locations (nasal valve, cartilaginous, inferior/maxillary crest and osseous septum) were evaluated on a 4-point scale representing (1) 0% to 25%, (2) >25% to 50%, (3) >50% to 75%, and (4) >75% obstruction. Correlation between physical examination and radiographic evaluations was made by Pearson's correlation and quantitative agreement assessed by Krippendorf's alpha.
  
  
  RESULTS
  Statistically significant correlation was detected between physical examination including nasal endoscopy and radiographic assessment of septal deviation only at the osseous septum (p = 0.007, r = 0.425) with low quantitative agreement (α = 0.290). No significant correlation was detected at the cartilaginous septum (p = 0.286, r = 0.175), inferior septum (p = 0.117, r = 0.255), or nasal valve (p = 0.174, r = 0.222). Quantitative agreement at the nasal valve suggested a bias in CT to underestimate physical exam findings (α = -0.490).
  
  
  CONCLUSIONS
  CT is a poor substitute for physical examination, the gold standard, in assessment of septal deviation. Clinical decisions about pursuit of septoplasty or third-party payors' decisions to approve septoplasty should not be made on radiographic evidence.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
authors.forename: David A
authors.initials: DA
authors.lastname: Kieff
authors.forename: Regan W
authors.initials: RW
authors.lastname: Bergmark
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cunnane
authors.forename: Nicolas Y
authors.initials: NY
authors.lastname: Busaba
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery; D009300:Nasal Septum / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D010808:Physical Examination / Q000592:standards*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: computed tomography; delivery of healthcare; deviated nasal septum; health policy; insurance, health; nasal surgical procedures; practice guidelines; septoplasty