Deviated Septum
An off-center wall between the nostrils
Quick Facts
- Type: Structural nasal condition
- Main effect: Blocked or uneven nasal breathing
- Common causes: Present at birth or from injury
- Treatment: Symptom relief or surgery (septoplasty)
Overview
The nasal septum is the wall of bone and cartilage that separates the inside of the nose into a left and a right passage. Ideally it sits in the center, so both sides are about equal in size. A deviated septum is when this wall is shifted to one side, making one nasal passage narrower than the other.
Many people have at least a slight deviation and never notice it. When the deviation is more significant, it can block airflow on one or both sides, cause congestion, and contribute to other nose and sinus problems. A deviated septum is common and, when it causes symptoms, can usually be managed and, if needed, corrected with surgery.
Symptoms
Many deviated septums cause no problems. When symptoms occur, they often relate to airflow and drainage.
- Nasal obstruction or congestion, often worse on one side
- Difficulty breathing through the nose, especially during a cold or with allergies
- Frequent or recurrent sinus infections
- Nosebleeds, from drier airflow over the deviated area
- Noisy breathing during sleep, snoring, or disturbed sleep
- A tendency to favor sleeping on one side to breathe better
Symptoms can be more noticeable when the lining of the nose is already swollen from a cold or allergies.
Causes
A deviated septum can be present from birth or develop later from an injury to the nose.
- Present at birth: The septum may form off-center during development, or shift during birth.
- Injury: A blow to the nose from sports, falls, accidents, or contact during play can move the septum out of position.
- Aging: The shape of the nose and septum can change over time, sometimes worsening an existing deviation.
Allergies and congestion do not cause a deviated septum, but they can make the symptoms of one more noticeable by swelling the already-narrowed passage.
Risk Factors
- A nasal injury, especially during contact sports or accidents
- Being born with an off-center septum
- Not wearing protective gear during activities with a risk of facial injury
- Allergies or chronic congestion, which can make symptoms more bothersome
Diagnosis
A deviated septum is usually diagnosed during an examination of the nose:
- Physical exam: A clinician looks inside the nose with a light and a small instrument (a nasal speculum) to see the position of the septum.
- Nasal endoscopy: A thin, lighted scope provides a closer view of the inside of the nose and sinuses.
- Imaging: A CT scan may be used to evaluate the nose and sinuses in detail when surgery or other problems are being considered.
The exam also checks for other causes of blockage, such as swollen tissues (turbinates), polyps, or allergies.
Treatment
Treatment depends on how much the deviation affects breathing and quality of life. Many people start with measures to reduce congestion before considering surgery.
- Managing congestion: Saline rinses, nasal steroid sprays, and treating allergies can ease symptoms by reducing swelling.
- Decongestants and antihistamines: Provide temporary relief; decongestant sprays should be used only short-term.
- Septoplasty: A surgical procedure that straightens and repositions the septum to open the nasal passages, recommended when symptoms are significant and do not improve with other measures.
- Combined surgery: Septoplasty may be done along with reducing swollen turbinates or correcting other nasal problems.
Medications relieve symptoms but do not straighten the septum; only surgery corrects the deviation itself.
Prevention
- Wear a helmet or face protection during contact sports and risky activities
- Use a seatbelt to reduce facial injury in vehicle crashes
- Treat allergies and congestion to keep nasal symptoms manageable
- Seek care after a significant nose injury to address damage early
When to See a Doctor
See a doctor if you have ongoing nasal blockage that affects sleep or daily life, repeated sinus infections, or frequent nosebleeds. Seek prompt care after a nose injury if there is severe bleeding that will not stop, a noticeably crooked or swollen nose, or trouble breathing, as the septum or surrounding bones may be damaged and benefit from early treatment.
Frequently Asked Questions
Does everyone with a deviated septum need surgery?
No. Many people have a mild deviation that causes no problems or only minor symptoms, which can be managed with saline rinses, nasal steroid sprays, and allergy treatment. Surgery is considered when blockage significantly affects breathing or sleep and does not respond to these measures.
Can a deviated septum cause sinus infections?
It can contribute to them. A narrowed passage can interfere with drainage and airflow, making recurrent sinus infections more likely. Treating congestion and, in some cases, correcting the septum can reduce how often infections occur.
Will nasal sprays fix a deviated septum?
No. Sprays and other medications relieve symptoms by reducing swelling, but they cannot straighten the wall between the nostrils. Only a surgical procedure called septoplasty corrects the deviation itself.
What is septoplasty?
Septoplasty is surgery to straighten and reposition the nasal septum, opening up the nasal passages. It is usually done through the inside of the nose and is recommended when a deviated septum causes significant breathing problems that other treatments have not helped.
References
- Mayo Clinic. Deviated septum.
- MedlinePlus, U.S. National Library of Medicine. Deviated septum.
- American Academy of Otolaryngology-Head and Neck Surgery. Deviated Septum.
- Cleveland Clinic. Deviated Septum.