Back to basics: nasendoscopy beats CT, again!
Reviewed by Christos Georgalas

There are few otolaryngologists (or patients) who have not been confronted with a computed tomography scan referring to a deviated septum. In a very similar way to the accidental findings of sinus mucosal thickening, the clinician is left in a difficult position, trying to explain to the patient (and to the referring physician or neurologist) that the diagnosis of sinusitis is clinical and not radiological. This paper resolves, in a rather elegant way, the issue: septal deviation associated with significant nasal obstruction is a clinical diagnosis, based on thorough examination including endoscopy and clinical history. Blinded assessment of septal deviation on CT does not correlate with clinically important septal deviation, except in the area of bony septum (and then again, only poorly).

Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings.
Sedaghat AR, Kieff DA, Bergmark RW, et al.
INTERNATIONAL FORUM OF ALLERGY AND RHINOLOGY
2015;5(3):258-62.