Deviated septum
A deviated septum occurs when the cartilage wall inside your nose, called the nasal septum, is pushed off-center instead of being in the middle where it should be.
According to the American Academy of Otolaryngology, approximately 80% of nasal septums are deviated to some extent. While some deviations may not cause any symptoms, more severe cases can lead to partial or complete blockage of one side of the nose, resulting in nasal congestion, breathing difficulties, or nasal discharge.
What causes a deviated septum?
You may be born with a crooked septum, often when the thin wall dividing your right and left nostrils is displaced. Alternatively, it can develop due to injury or damage from previous treatments.
Other causes of a deviated septum include:
Connective tissue disorders, which may be inherited
Aging which can sometimes affect nasal structures and exacerbate a deviated septum
Infections which can lead to swelling and irritation in the nasal passages, worsening the condition
Injury such as during childbirth or later in life from incidents like sports-related accidents, falls, or car crashes, which can cause nasal trauma like a broken nose
In many cases, a deviated septum develops during fetal development in the womb and becomes noticeable at birth. The exact factors contributing to why some children are born with a deviated septum while others are not are not fully known.
Symptoms of a deviated septum
Other people normally can’t tell if you have a deviated septum, and in some instances you may not be able to tell either, especially if you are not experiencing symptoms.
The most common symptoms of septal deformities may include:
Trouble breathing through the nose, or one side of the nose, is the most common symptom. This is often more noticeable if you have a cold or allergies, as your nasal passages swell or narrow.
Facial pain on one side, caused by the surfaces in the nose touching and causing pressure due to a severe deviated septum.
Loud breathing and snoring during sleep due to swollen nasal tissues.
Preference for sleeping on a particular side to optimize breathing through the unobstructed nasal passage.
Nosebleeds, which occur if the surface of your septum is too dry.
Postnasal drip.
Stuffiness, congestion, or a feeling of fullness or inflammation in the sinuses (sinusitis).
Diagnosing a deviated septum
To diagnose a deviated septum, your healthcare provider will inquire about any prior injuries and symptoms, followed by a thorough health history review and physical examination.
During the physical exam, a handheld tool called a nasal speculum may be used to gently widen the nostril for inspection of deviation or swelling. Additionally, your provider might utilize a small, illuminated scope known as an otoscope to examine the nasal passages or ears. Nasal endoscopy, which involves a flexible tube with a camera and light, may also be employed to visualize the nasal cavity before and after applying a decongestant spray for comparison.
If necessary, your provider may recommend a CT scan of your nose for further evaluation. Based on these assessments, your provider can diagnose the deviated septum and assess its severity. They may also refer you to an ear, nose, and throat (ENT) specialist for specialized treatment.
Treating a deviated septum
In certain cases, non-surgical methods may alleviate a deviated septum. The decision for surgery depends on the severity of symptoms. Initially, medical treatments focus on symptom relief using medications.
Medications
Medications may be prescribed as a relief effort to ease your symptoms. However, medications will only treat the swollen mucous membranes and won’t correct a deviated septum since it is a structural problem. Your provider may recommend you the following:
Antihistamines: These medications prevent allergy symptoms like a runny nose and can also help with nonallergic conditions such as colds. However, they may cause drowsiness, affecting activities like driving.
Corticosteroids: Prescription nasal sprays reduce swelling and aid drainage in the nasal passage. They may take 1-3 weeks to reach full effectiveness.
Decongestants: These medications reduce nasal tissue swelling, keeping airways open. They are available as pills or nasal sprays, but nasal spray use should be limited to avoid dependency and worsening symptoms. Oral decongestants may have stimulant effects, impacting blood pressure and heart rate.
Sinus surgery
If symptoms persist despite medication, surgical options such as septoplasty or rhinoplasty may be considered.
Septoplasty is a reconstructive surgery done to correct a deviated nasal septum. The procedure is done through the nostrils. During the procedure, parts of the septum may be removed, or readjusted and reinserted into the nose. There are three main steps to a septoplasty:
Anesthesia: Local anesthesia numbs the area, while general anesthesia ensures comfort and unconsciousness during the procedure.
Repair: The surgeon separates the membrane covering the septum, removes or adjusts the deviated cartilage or bone, and then sutures the membranes back together.
Bandaging: Gauze may be used to pack the nose, and a splint may be applied to maintain the nose's new shape post-surgery. Additionally, nasal packs or soft splints in the nostrils may be utilized to stabilize the septum.
In some cases, rhinoplasty (surgery to reshape the nose) may be performed at the same time as septoplasty. Rhinoplasty involves modifying the bone and cartilage of your nose to change its shape or size or both.
Nasal surgery may be done with traditional open surgery from inside the nose. When open surgery is done, small scars appear at the base of the nose but are often not noticeable. Scarring is not visible when internal surgery is done. Depending on the severity of the deviation, septoplasty may be done in:
A surgeon’s office.
An outpatient surgery center.
A hospital as either an outpatient or an inpatient.
The duration of surgery typically ranges from 1 to 3 hours. Your surgeon will provide guidance on when you can resume normal activities.
Following surgery, many individuals recover within a few days and can return to school or sedentary work within approximately a week.
Short-term side effects of surgery may include:
Nasal discomfort or achiness
Bruising near the eyes
Mild headaches
Facial swelling
Minor bleeding during the initial days
Appearance of small red dots due to ruptured blood vessels
Swelling around the eyes
Healing can be slow. You may have some swelling for months, especially in the tip of the nose. The “final results” of a nasal surgery may not be apparent for a year or more.
As with any surgery, there can be complications. People vary greatly in their anatomy and the ability to heal. The outcome is never fully predictable.
The level of improvement you can expect with septoplasty depends on the severity of your deviation. Symptoms such as nasal obstruction can go away completely. Other conditions such as allergies, however, cannot be cured with surgery.
Surgical complications may involve:
Adverse reaction to anesthesia
Nosebleeds or blood clots
Infection
Septal perforation (hole in the septum)
Problems and complications caused by a deviated septum
In some more severe cases of a deviated septum, normal sinus drainage is affected which can result in repeated (recurrent) sinus infections. Other complications can include:
Constant congestion or pressure in your nasal passages
Chronic dryness in the mouth due to habitual mouth breathing
Disrupted sleep patterns caused by difficulty breathing through the nose during sleep
Risk of developing sleep apnea, a serious sleep disorder characterized by breathing interruptions during sleep
It is important to seek medical care if you experience:
Frequent nosebleeds
Nasal obstructions unresponsive to treatment.
Recurring sinus infections stemming from nasal blockage.
Risks of having a deviated septum
A deviated septum can affect anyone, especially if you have been injured. In some instances, however, a deviated septum cannot be prevented. You are at greatest risk of developing a deviated septum from an injury. Risk factors include:
Participation in contact sports like football, boxing, or wrestling
Failure to wear a seatbelt while traveling in a motor vehicle
Outlook, key points and next steps
What is the outlook for someone with a deviated septum?
While a deviated septum is typically not life-threatening, it can lead to various frustrating symptoms, especially if it is severe. Managing life with a deviated septum can present challenges, but relief is often attainable through appropriate medications or surgical interventions.
Moreover, taking preventive measures, such as wearing a seatbelt while driving or using a helmet during contact sports, can help reduce the likelihood of developing a deviated septum.
Key points about deviated septum
The septum, which separates the nose into two chambers, can become deviated, causing breathing difficulties
Common symptoms include nasal congestion and difficulty breathing
Deviated septums may result from birth defects, injury, or previous medical treatments
Reconstructive surgery is an option to correct severe cases of a deviated septum
It may take up to a year or more to fully see the results of nasal surgery
Next steps
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen
Prior to your appointment, jot down any questions or concerns you wish to address
Consider bringing along a companion who can assist you in asking questions and recalling important information
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are
Inquire about alternative treatment options, if available
Know why a test or procedure is recommended and what the results could mean
Know what to expect if you do not take the medicine or have the test or procedure
If a follow-up appointment is scheduled, ensure to record the date, time, and purpose of the visit
Familiarize yourself with the means of contacting your provider for any subsequent inquiries or concerns
