Deviated septum
A deviated septum is when the wall of cartilage (the nasal septum) that divides the nose into two separate chambers is shifted away from the midline.
According to the American Academy of Otolaryngology, an estimated 80% of all nasal septums have some degree of deviation. In some instances, this deviation causes no symptoms at all. But in more severe cases, one side of the nose is partially or completely blocked off, which can cause nasal congestion, problems with breathing or nasal discharge.
Causes of a deviated septum
You may be born with a crooked septum, especially if the thin wall that separates your right and left nostrils is displaced to some degree. Or it can result from injury or damage from past treatments.
Other causes of a deviated septum include:
- A connective tissue disease, which may be inherited.
- Aging. In some instances, aging can affect the structures inside the nose and make a deviated septum worse.
- Infections. Sometimes infection can cause swelling and irritation in the nasal passages, which worsen a deviated septum.
- Injury. A deviated septum can also be the result of an injury that causes displacement of the nasal septum. This can happen as an injury during childbirth or later in life. Nasal trauma such as a broken nose from contact sports, falls or car accidents are the most common causes.
In many cases, a deviated septum occurs during fetal development in the womb and is apparent at birth. Why some children are born with a deviated septum and others are not is 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
Your healthcare provider will ask questions about any previous injury and your symptoms. They will then take a health history and do a physical exam.
The physical exam may be done with a handheld tool (nasal speculum) that lets your provider gently open the nostril a little to check for deviation or swelling.
Your provider may use a small lighted scope (otoscope) to look into an ear or a nostril. Your provider may also look at your nasal or sinus passages (nasal endoscopy) using a thin, flexible tube with a bright light and camera in it. They may also examine your nasal cavity before and after applying a decongestant spray for comparison.
If needed, your provider may order a CT scan of your nose.
Based on these examinations, your provider can diagnose a deviated septum and determine the seriousness of your condition, or refer you to an ear, nose and throat (ENT, otolaryngologist) specialist for treatment.
Treating a deviated septum
In some instances, a deviated septum can be relieved without surgery. Depending on the severity of your symptoms, a surgical procedure may be advised. Initial medical treatments will begin with symptom management through 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. Antihistamine medications are used to prevent allergy symptoms such as a runny nose. They can also alleviate nonallergic conditions related to colds or illness. However, antihistamines may cause drowsiness and could impact your ability to perform certain tasks such as driving.
- Corticosteroids. Prescription nasal steroid sprays can help with drainage and reduce swelling in your nasal passage. They typically take 1-3 weeks to reach the maximum effect. Always follow your provider’s instructions before use.
- Decongestants. Decongestants are used to reduce swelling in your nasal tissues to keep both airways open. They can be taken as a pill or a nasal spray. It is recommended to limit use of nasal sprays as they can cause dependency and worsen symptoms after use. Oral decongestants can also create a stimulant effect that may increase blood pressure, heart rate or jitteriness.
Sinus surgery
If you still experience symptoms after using medications, you may consider surgery to correct your deviated septum (septoplasty) or to reshape your nose (rhinoplasty, nose job).
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: Your surgeon will use local anesthesia to numb the area and general anesthesia to put you to sleep during the procedure and make sure you’re comfortable.
- Repair: Your surgeon will separate the membrane that covers the septum. Then the surgeon will remove the deviated cartilage or bone, replace the membranes and suture them back together with stitches.
- Bandaging: Your surgeon may pack your nose with gauze. After surgery, you may have a splint on your nose to help hold its new shape. You may also have nasal packs or soft splints in your nostrils 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 an outpatient.
- A hospital as an inpatient.
Surgery typically takes between 1-3 hours. The surgeon will let you know when you can get back to normal activities.
Many people recover in a few days. They can go back to school or to inactive work in a week or so.
Short-term side effects of surgery may include:
- Achiness in the nose.
- Bruising around the eyes.
- Dull headache.
- Facial puffiness.
- Minimal bleeding in the first few days.
- Ruptured blood vessels appearing as tiny red dots on your skin.
- 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 include:
- Reaction to the anesthesia.
- Nosebleed or blood clot.
- Infection.
- Hole (perforation) 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.
- Dry mouth from chronic mouth breathing.
- Sleep disturbances due to the inability to breathe comfortably through your nose while sleeping.
- Sleep apnea, a serious condition in which a person stops breathing during sleep.
It is important to seek medical care if you experience:
- Frequent nosebleeds.
- Nasal blockages that don’t respond to treatment.
- Recurring or frequent sinus infections 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:
- Playing contact sports such as football, boxing or wrestling.
- Not wearing your seatbelt while riding in a motorized vehicle.
Outlook, key points and next steps
What is the outlook for someone with a deviated septum?
Having a deviated septum is not a life threatening problem, but it can cause an array of frustrating symptoms if it is severe. Living with a deviated septum can be challenging, but medications and surgery, when called for, can provide relief.
A deviated septum can often be prevented, however, by protecting the face and nose by wearing a seatbelt while driving or a helmet while playing contact sports.
Key points about deviated septum
- The septum is cartilage that divides the nose into 2 separate chambers. A deviated septum is when the septum is shifted away from the midline.
- The most common symptom is trouble breathing through the nose.
- You may be born with a deviated septum, or it may be caused by an injury or damage from previous treatments.
- Reconstructive plastic surgery may be done to correct a deviated septum.
- Final results of nasal surgery may not be clear for a year or more.
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.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- 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, and ask about potential side effects.
- Ask if your condition can be treated in other ways.
- 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 you have a follow-up appointment, write down the date, time and purpose for that visit.
- Know how you can contact your provider if you have questions.