الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The nasal septum is an important physiological and support structure of the nose. It is formed by the quadrangular cartilage anteriorly, the vomer and perpendicular plate of the ethmoid bone posteriorly. Nasal septal deviation is highly accounted condition in the population. It is reported between 18.8-57.6% in the literature.
Nasal septal deviation can occur by pressure and expansion during the downward growth of the septum from the ethmoid ossification centers, upward growth of the maxillary crest, and the development of the premaxilla and vomer. Trauma particularly which occurs by injures in infancy and childhood is a significant factor in the etiology of septal deformity.
Concha bullosa (CB) is defined as aeration located in the middle turbinate. It is the most common anatomic variation of the ostiomeatal complex region.
This study included 40 patients with nasal semptoms due to deviated nasal septum who were admitted for surgical managment in ENT department,Sohag University Hospital in the period from june 2016 to may 2017.
pre operative SINO-NASAL OUTCOME TEST (SNOT-22) including a list of symptoms , social and emotional consequences of nasal disorders was completed by the patients. SNOT-22 includes 22 items grading from 1-5 according to the severity of symptoms.
In this study, the prevalence of CB among patients with nasal septum deviation was 37.5%. A 14%-53.6% prevelence of concha bullosa was reported by various studies
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from the results we claim that when septal deviation is in low level of the nose, there is higher incidence of concha bullosa, this may explain causal relationship between septal deviation and development of concha bullosa. When the airflow is directed upward as a result of low obstruction, the upward turbulence of the air may result in pneumatization of the middle turbinate. further studies may be needed to confirm these suggestion.
Analysing the outcome of surgery was measure 3 monthes after septoplasty, the total SNOT-22 score was reduced, showing a significant improvement of nasal symptoms in SNOT-22 after septoplasty and a significant improvement in facial pain and post nasal discharge after septoplasty.
SNOT-22 Questionnaire was very useful in knowing the severity of patient’s nasal problems and helped us in evaluating and selecting the patients for surgery and in evaluating the outcome and effectiveness of surgery. It also helped us in analysing the severity of symptoms in daily clinical practice.
Conclusion
In conclusion, Concha bullosa is a common anatomical variant detected in the general population. It may occur unilaterally or bilaterally and may or may not be symptomatic. There is a strong association between concha bullosa and deviated nasal septum wherein the deviation was seen away from the concha. However, the increasing incidence of unilateral CB, especially contralateral ones, in septal deviated patients suggested that SD may prevent the development of ipsilateral CB.
There is, however, a strong relationship between the presence of a unilateral or dominant concha and contralateral nasal septal deviation while the air channel between the concha and the nasal septum is preserved. when septal deviation is in low level of the nose, there is higher incidence of concha bullosa, this may explain causal relationship between septal deviation and development of concha bullosa. When the airflow is directed upward as a result of low obstruction, the upward turbulence of the air may result in pneumatization of the middle turbinate
Analysing the outcome of surgery was measure 3 monthes after septoplasty, the total SNOT-22 score was reduced, showing a significant improvement of nasal symptoms in SNOT-22 after septoplasty and a significant improvement in facial pain and post nasal discharge after septoplasty.
SNOT-22 Questionnaire was very useful in knowing the severity of patient’s nasal problems and helped us in evaluating and selecting the patients for surgery and in evaluating the outcome and effectiveness of surgery. It also helped us in analysing the severity of symptoms in daily clinical practice.