Concha Bullosa and Nasal Septal Deviation

We read with interest Stallman et al’s report on the incidence of concha bullosa and its relationship to nasal septal deviation (1). They mentioned the fact that, to their knowledge, no study had evaluated concha bullosa in relation to nasal septal deviation. It would seem to have been appropriate for these authors to cite a previous report, by Elahi et al, about paraseptal structural changes and chronic sinus disease in relation to the deviated septum (2), because Elahi et al indicate the relationship between nasal septal deviation and concha bullosa. Elahi et al concluded that increasing angles of septal deviation are associated with bilateral sinus disease and contralateral middle turbinate abnormalities (including concha bullosa) and ethmoidal bulla prominence (Table 1). Their study methods differed from Stallman et al’s by grouping the nasal septal deviation according to deviation angles and definition of concha bullosa.

Middle-turbinate abnormalities (percentage) (from Reference 2)

	Group 1 (0–9°)		Group 2 (10–15°)		Group 3 (>15°)
	Ipsilateral	Contralateral	Ipsilateral	Contralateral	Ipsilateral	Contralateral
Hypertrophy	9	22*	9	24*	5	55*
Impaction	15	14	21	18	18	32*
Concha bullosa	18	26	24	38	23	45*
Paradoxic deviation	14	17	9	6	0	5

^*Statistical significance (P < .05).

Although Stallman et al’s literature search missed Elahi et al’s report, we congratulate them on their well-written and nicely illustrated study.