The effect of nasal septum deviation on subclinical cardiac autonomic dysfunction


  • Selcan Kesgin Department of Otorhinolaryngology, Abant Izzet Baysal University, Faculty of Medicine, Bolu
  • Murat Sereflican Department of Otorhinolaryngology, Abant Izzet Baysal University, Faculty of Medicine, Bolu
  • Veysel Yurttas Department of Otorhinolaryngology, Abant Izzet Baysal University, Faculty of Medicine, Bolu
  • Fatma Erdem Department of Cardiology, Abant Izzet Baysal University, Faculty of Medicine, Bolu
  • Muharrem Dagli Department of Otorhinolaryngology, Abant Izzet Baysal University, Faculty of Medicine, Bolu



Nasal septum deviation, Atrial fibrillation, Echocardiography, Rhinomanometry


Background: Nasal septum deviation is one of the most frequently encountered nasal pathology in otorhinolaryngology clinics. Disease with a high comorbidity such as obstructive sleep apnea syndrome (OSAS), among whose etiology septum deviation takes place, can cause subclinical pathologies like atrial fibrillation. The main objective of this study was to determine the effect of nasal septum deviation on subclinical cardiac pathologies.

Methods: The study included a total of 80 patients which were a group of 40 patients who admitted to the otorhinolaryngology department with a complaint of nasal obstruction and were diagnosed as having nasal septum deviation and a control group of 40 patients who admitted to the same department with complaints other than nasal obstruction and had no nasal septum deviation for the period of April 2015-August 2015. Initially, all patients were performed rhinomanometric measurement and then the patients were required to grade their symptoms of nasal obstruction using a 10-unit visual analog scale (VAS). Following that, patients were performed to transthoracic echocardiography by cardiology department and all the results were compared between two groups.

Results: In the patient group while the VAS and transnasal pressure were found meaningful higher, the transnasal flow was found meaningful lower than the control group. In the patient group PA septum, PA tricuspide, PA lateral-tricuspide, PA septum-tricuspide values were found meaningful higher than the control group. In the patient group left atrium width (LA), LA volume maximum, LA volume minimum and LA volume p values, which show the size of left atrium, were found meaningful high in comparison to the control group.

Conclusions: As a result of the data obtained from this study, the research demonstrates that nasal septum deviation can cause subclinical cardiac pathologies such as atrial fibrillation and these pathologies can be detected with noninvasive methods such as echocardiography.


Gleeson MJ and Clarke RC. Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7 Ed: 3 volume set, CRC Press; 2008.

Samad I, Stevens H, Maloney A. The efficacy of nasal septal surgery. The Journal of otolaryngology. 1992;21(2):88-91.

Hilberg O. Objective measurement of nasal airway dimensions using acoustic rhinometry: methodological and clinical aspects. Allergy. 2002;57(70):5-39.

Suzina AH, Hamzah M, Samsudin AR. Objective assessment of nasal resistance in patients with nasal disease. J Laryngol Otol. 2003;117:609-13.

Szucs E, Clement PA. Acoustic rhinometry and rhinomanometry in the evaluation of nasal patency of patientswith nasal septal deviation. Am J Rhinol. 1998;12:345-35.

Cook TA, Komorn RM. Statistical analysis of the alterationsof blood gases produced by nasal packing. Laryngoscope. 1973;83:1802-9.

Shim C, Corro P, Park SS, Williams MH Jr. Pulmonary function studies in patients with upper airway obstruction. Am Rev Respir Dis. 1972;106:233-8.

Ciprandi G, Mora F, Cassano M, Gallina AM, Mora R. Visual analog scale (VAS) and nasal obstruction in persistent allergic rhinitis. Otolaryngol Head Neck Surg. 2009;141(4):527-9.

Fan WH, Ko JH, Lee MJ, Xu G, Lee GS. Response of nasal airway and heart rate variability to controlled nasal breathing. Eur Arch Otorhinolaryngol. 2011; 268(4):547-53.

Eccles R. A guide to practical aspects of measurement ofhuman nasal airflow by rhinomanometry. Rhinology. 2011;49:2-10.

Huizing EH, de Groot JAM. Functional Reconstructive Nasal Surgery. George Thieme Verlag, Stuttgart, Germany. 2003:103-104.

Ogura JH, Dammkoehler R, Nelson JR, Kawasaki M, Togawa K. Nasal obstruction and the mechanics of breathing. Physiologic relationships and the effects of nasal surgery. Arch Otolaryngol. 1966;83:135-50.

Williams HL. The clinical physiology and pathology of the nasal airways and of their adjoining air-filled cavities. Ann Otol Rhinol Laryngol. 1970;79:513-8.

Guilleminault C, Korobkin R, Winkle R. A review of 50 children with obstructive sleep apnea syndrome. Lung. 1981;159:275-87.

Quan SF, Gersh BJ. National Center on Sleep Disorders Research; National Heart, Lung, and Blood Institute. Cardiovascular consequences of sleep-disordered breathing: past, present and future: report of a workshop from the National Center on Sleep Disorders Research and the National Heart, Lung, and Blood Institute. Circulation. 2004;109:951-7.

Yurttas V, Ozturk S, Apuhan T, Demirhan A, Tekelioglu UY, Akkaya A, Yazıcı M. Pre-and postoperative evalıation of cardiac autonomic function in patients with nasal septum deviation. Acta Medica Mediterranea. 2014;30:149-53.

Pac A, Karadag A, Kurtaran H, Aktas D. Comparison of cardiac function and valvular damage in children with and without adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2005;69:527-32.

Şereflican M, Kurt ÖK. Otorhinolaryngologic manifestations in obstructive sleep apnea. Acta Med Anatol. 2016;4(1):32-6.

Zwillich CW, Pickett C, Hanson FN, Weil JV. Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis. 198;124(2):158-60.

Olsen KD. The role of nasal surgery in the treatment of obstructive sleep apnea. Otolaryngol Head and Neck Surg. 1991;2:63-8.

Çakır U, Şereflican M, Tuman TC, Yurttaş V, Yıldırım O, Oral M. Sleep and life quality of individuals with septum deviation. Eur J Health Sci. 2015;1(3):101-4.

Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and Cardiovascular disease. J Am Coll Cardiol. 2003;41:1429-37.

Yaung T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165:1217-39.

Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;27:110(4):364-7.

Yagmur J, Yetkin O, Cansel M, Acikgoz N, Ermis N, Karakus Y et al. Assessment of atrial electromechanical delay and influential factors in patients with obstructive sleep apnea. Sleep Breath. 2012;16(1):83-8.

Can I, Aytemir K, Demir AU, Deniz A, Ciftci O, Tokgozoglu L et al. P-wave duration and dispersion in patients with obstructive sleep apnea. Int J Cardiol. 2009;17;133(3):85-9.

Bayir PT, Demirkan B, Bayir O, Duyuler S, Firat H, Güray U et al. Impact of continuous positive airway pressure therapy on atrial electromechanical delay and P-wave dispersion in patients with obstructive sleep apnea. Ann Noninvasive Electrocardiol. 2014;19(3):226-33.

Ozer N, Yavuz B, Can I, Atalar E, Aksöyek S, Ovünç K et al. Doppler tissue evaluation of intra-atrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis. J Am Soc Echocardiogr. 2005;18(9):945-8.

Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol. 2001;6:159-65.




How to Cite

Kesgin, S., Sereflican, M., Yurttas, V., Erdem, F., & Dagli, M. (2016). The effect of nasal septum deviation on subclinical cardiac autonomic dysfunction. International Journal of Research in Medical Sciences, 4(4), 980–986.



Original Research Articles