Deviated Nasal Septum

What the septum does

The nasal septum separates the left and right nasal passages and supports the shape of the nose. The front part is flexible cartilage; the back part is thin bone. A perfectly straight septum is unusual. Problems arise when the bend significantly narrows airflow, often at the narrowest point just inside the nostrils (the nasal valve).

Each side of the nose also contains bony shelves covered by soft tissue called turbinates. They swell and shrink in a natural cycle every few hours. A deviated septum often comes with enlarged turbinates on the wider side, see turbinate hypertrophy, which adds to the blockage.

Causes

• Development: the septum grows unevenly during childhood.
• Birth: pressure during delivery.
• Injury: a blow to the nose from sports, falls, fights or car crashes, sometimes with a nasal fracture.
• Aging: nasal tissues weaken and can worsen an existing deviation.

Symptoms

• nasal congestion, usually worse on one side
• alternating blockage as the turbinate cycle shifts
• mouth breathing and a dry mouth, especially at night
• snoring and disturbed sleep
• nosebleeds from drying of the mucosa over the bend
• repeated sinus infections or facial pressure
• preferring to sleep on one side
• reduced sense of smell in some people

Allergies and colds make symptoms worse because they swell the lining in an already narrow passage.

Deviated septum and sleep apnea

A blocked nose can worsen snoring and make CPAP masks harder to tolerate. Septoplasty can improve nasal breathing and CPAP comfort, but it rarely cures obstructive sleep apnea on its own, because most apnea involves the throat. A sleep study is the way to diagnose apnea.

Diagnosis

An ENT (ear, nose and throat) specialist asks about blockage, injuries, allergies, nosebleeds and sleep, and looks inside the nose with a light. They often spray a decongestant first: if blockage improves greatly, swelling is the main problem; if it persists, structure is to blame. A nasal endoscope gives a detailed view further back. A CT scan is used if chronic sinusitis is suspected or before surgery.

Treatment

Medicines for symptoms

These do not straighten the septum but can reduce lining swelling:

• Steroid nasal sprays such as fluticasone or mometasone, used daily, especially if allergies contribute.
• Saline sprays or rinses to clear mucus and moisturize.
• Antihistamines for allergic symptoms.
• Decongestant sprays only for up to 3 days at a time. Longer use causes rebound congestion (rhinitis medicamentosa).
• Nasal strips or dilators that open the nostrils at night.

Septoplasty

Septoplasty straightens the septum through the nostrils, usually without external cuts or changing the outside shape of the nose. It typically takes 30 to 90 minutes under general anesthesia and is done as day surgery. Bent cartilage and bone are trimmed, repositioned or removed. Turbinate reduction is often done at the same time.

Recovery:

• stuffiness and mild pain for 1 to 2 weeks, with mucus and some blood-stained discharge
• splints or packing, if used, removed within about a week
• avoid nose blowing, heavy lifting and strenuous exercise for 1 to 2 weeks
• full healing takes 2 to 3 months

Most people notice clearly better nasal breathing. Risks include bleeding, infection, a hole in the septum (perforation), numbness of the upper teeth, persistent blockage and, rarely, change in nose shape. Over-aggressive turbinate removal can rarely lead to empty nose syndrome, which is one reason modern surgeons preserve turbinate tissue.

Septorhinoplasty combines septoplasty with reshaping the outside of the nose when the nose is visibly crooked.

Frequently asked questions

What are the symptoms of a deviated septum?

Common symptoms are a blocked nose, usually worse on one side, mouth breathing, snoring, nosebleeds, and repeated sinus infections or facial pressure. Many people with a mild deviation have no symptoms at all.

Can a deviated septum fix itself?

No. A deviated septum does not straighten on its own. Medicines can reduce swelling of the nasal lining and improve breathing, but only septoplasty can correct the structure itself.

Does a deviated septum cause sleep apnea?

It can worsen snoring and make sleep apnea harder to treat, especially with CPAP, but it is rarely the main cause. Septoplasty improves nasal breathing and CPAP tolerance, but most people with sleep apnea still need other treatment.

How long does septoplasty recovery take?

Most people return to work or school within a week. Stuffiness eases over 1 to 2 weeks, and strenuous activity can usually resume after about 2 weeks. Full healing inside the nose takes 2 to 3 months.