Multiparametric ultrasound study of the nasal septum: prospective study

INTRODUCTION: The nasal cavity is a complex anatomical structure. The nasal septum (NS), consisting of cartilage, bone elements and mucous membrane, divides the cavity into two symmetrical parts, its average thickness is about 2 mm. From 75 to 80% of the world’s population suffer from various forms of deformity of the NS. Surgical interventions on this anatomical structure are one of the most frequently performed otorhinolaryngological operations, while undesirable surgical outcomes vary from 10 to 27%. The most common complications are septal perforation, septal flotation, secondary anterior deformity, and external nasal deformity. 

OBJECTIVE: Improving the diagnosis of pathological conditions of the nasal septum.

MATERIALS AND METHODS: A total of 128 patients (72 women and 56 men aged 18 to 69 years) were subjected to ultrasound of the NS. The control group included 30 subjects without NS pathology. The first group included 52 patients with NS perforation. The second group consisted of 46 patients with NS curvatures. The studies were carried out on expert-level ultrasound devices (i-800, Canon; Resona 7, Mindray) linear sensors with a frequency range of 3 to 20 MHz. Multicomponent (multiparameter) ultrasound included: B-mode, color duplex scanning mode (CDS), ultrasonic shear wave elastography (SWE). In the gray-scale B-mode, the structure, contours, and echogenicity of the NS were studied. The arterial vessels of the NS were studied using the CDS mode, the parameters of blood flow were determined: the maximum linear velocity of blood flow in cm/sec — V_max, the minimum linear velocity of blood flow in cm/sec — V_min, the index of vascular resistance — Ri in units. Dominant arteries (DA) in the vascular plexus of the NS on both sides were determined, the parameters of blood flow in which were maximum in comparison with the rest of the arteries. To determine the elasticity of the NS (in kPa), the SWE mode was used. 

Statistics: analysis was carried out in the SPSS software package version 21.0. The normality of the sample distribution was assessed using the Kolmogorov-Smirnov criterion.

RESULTS: The cartilaginous part of the NS is normally visualized as a homogeneous isoechogenic structure, with clear contours. Perforated openings of the NS, different in size, are visualized as anechoic areas with clear contours. The mean V_max values in DA were 26,000 (14,000–38,000) cm/sec; (p<0.001 on both sides). The median Ri in DA was 0.5650 (0.3500–0.6900) units; (p<0.001 on both sides of the NS). The results of the hemodynamic parameters of the DA of the first group (NS perforation) showed that the blood flow in 4 subjects differed significantly from the parameters of the control group. The parameters of blood flow in the DA of the second group (NS curvature) did not differ from the parameters of the control group. The study of the elasticity of the cartilaginous part of the NS reliably shows an increase in its stiffness with age. The stiffness values increase with perforation of the NS (43.05±3.44 kPa; p<0.001), which is explained by impaired vascularization of the NS in this pathology. 

DISCUSSION: In the grayscale B-mode, it is possible to clearly visualize the cartilaginous part of the NS and determine those ultrasound criteria that are characteristic of the norm and for pathological conditions. Ultrasound allows you to clearly determine the size, contours and localization of the perforated opening. For normal survival rate of the relocated endonasal flap during plastic surgery on NS, the parametrs of the vessels that nourish this flap is important. Parameters of DA allow to predict the survival rate of the relocated endonasal flaps. The study of the elasticity of the cartilaginous part of the NS reliably shows an increase in its stiffness with age. The stiffness values increase with NS perforation (43.05±3.44 kPa; p<0.001), which is explained by impaired vascularization of the NS in this pathology.

CONCLUSION: Multicomponent ultrasound of the NS allows you to reliably obtain results about the state of its cartilaginous region, to identify deformities and defects of the septum, to study the parameters of the vessels involved in the blood supply of the NS, the elasticity of the NS in normal and pathological conditions.

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