The Relationship Between Nasal Septal Deviation and Rhinosinusitis: A Systematic Review

ImportanceNasal septal deviation (NSD) and rhinosinusitis (RS) are common conditions with overlapping symptoms, yet they require distinct treatment approaches. Clarifying their relationship is essential to guide preventative management strategies.ObjectiveTo examine the association between NSD and RS.DesignSystematic review following the PRISMA guidelines. Embase, MEDLINE, and Web of Science were searched from inception to January 2025.ParticipantsStudies were included if participants were adults (≥18 years); studies conducted exclusively in pediatric populations were excluded.Main Outcome MeasuresAssociation between NSD and RS based on prevalence, NSD severity, and mean nasal septal angle (NSA), as well as overall study quality and risk of bias.ResultsA total of 34 studies were included, of which 26 reported NSD and 8 reported RS as their primary outcome. Among the studies reporting on NSD, 17 assessed prevalence, of which 7 (41.2%) demonstrated an association with RS; 5 assessed severity, of which 2 (40.0%) demonstrated an association between moderate/severe NSD and RS; and 10 assessed mean NSA, of which 3 (30.0%) demonstrated an association with RS. All studies reporting on RS assessed prevalence, of which 4 (50.0%) demonstrated an association with NSD. Overall, 16/40 (40.0%) individual outcome measures indicated an association between NSD and RS. A risk of bias analysis identified 12/34 (35.3%) studies as low risk. Of these, 5/17 (29.4%) individual outcomes measures demonstrated an association between NSD and RS.ConclusionThe current body of evidence reveals an inconclusive relationship between NSD and RS. Variability in definitions, diagnostic criteria, and outcome measures, combined with insufficient control for bias, limit the ability to draw definitive conclusions.Relevance:We propose standardized reporting guidelines to ensure consistency across studies and enable more meaningful comparisons. Implementing this framework may ultimately support the development of preventative strategies to optimize patient outcomes.PROSPERO registration numberCRD42024514049.