ConditionEar, nose & throat
Deviated Septum
A deviated septum is when the thin wall of cartilage and bone dividing the nostrils (the nasal septum) is off-center or crooked, making one nasal passage narrower. Most people have some deviation without symptoms. A significant one can cause a constantly blocked nose, usually worse on one side, noisy breathing, snoring, nosebleeds and recurrent sinus problems. Nasal sprays treat the swelling that adds to the blockage, but only surgery called septoplasty straightens the septum itself.
Also called: Deviated nasal septum, crooked septum, septal deviation, nasal septal deviation
At a glance
- What it is
- A nasal septum that is bent or shifted, narrowing one or both nasal passages.
- How common
- Very common; most adults have some deviation, but only some have symptoms.
- Causes
- Present from birth or development, or caused by a nose injury.
- Symptoms
- One-sided nasal blockage, noisy breathing, snoring, nosebleeds, recurrent sinusitis.
- Treatment
- Steroid sprays, saline and antihistamines for swelling; septoplasty to straighten the septum.
When to get help
Call 911 or go to the ER
- After a nose injury: a soft, painful swelling inside the nose blocking both sides (possible septal hematoma, which needs draining within hours), or clear fluid dripping from the nose
- Heavy nosebleed that will not stop after 20 minutes of firm pressure
See a doctor within a day or two
- A nose that looks newly crooked after an injury, with breathing difficulty (assess within about a week, while setting is still possible)
- Blockage on one side with bloody discharge, facial numbness or a growing lump
Book a routine appointment
- Persistent nasal blockage that limits exercise or sleep despite 4 to 6 weeks of nasal sprays
- Repeated sinus infections or nosebleeds from one side
- Loud snoring or pauses in breathing at night
Usually safe to manage at home
- Mild one-sided stuffiness that comes and goes, especially with colds or allergies
What the nasal septum does
The septum separates the two nostrils and supports the nose. The front part is cartilage, the back is bone. A perfectly straight septum is rare. A deviation becomes important when it narrows a passage enough to obstruct airflow, especially at the nasal valve near the nostril, which is the narrowest part of the airway.
The nose also has turbinates, ridges on the side walls that warm and humidify air. They swell and shrink in a natural cycle, so a deviation can feel worse on one side at certain times. Often the turbinate on the opposite, wider side enlarges to fill the space (turbinate hypertrophy).
Causes
- Congenital or developmental: the septum grows unevenly during childhood. Birth trauma may contribute.
- Injury: a blow to the nose in sports, falls, fights or car crashes. A broken nose often shifts the septum.
- Aging: tissues weaken and the nose can change shape.
Symptoms
- nasal blockage, usually worse on one side, and often constant rather than seasonal
- noisy breathing and mouth breathing, especially at night
- snoring and disrupted sleep
- nosebleeds, because the surface of the deviated septum dries out
- recurrent sinus infections if drainage is blocked
- facial pain or headaches, sometimes
- preferring to sleep on one side to breathe easier
Many people do not realize how blocked they are until they compare sides by closing one nostril at a time.
Deviated septum vs other causes of blockage
| Cause | Pattern |
|---|---|
| Deviated septum | Constant, often one-sided, worse with colds; structural |
| Allergic rhinitis | Both sides, itching, sneezing, seasonal or triggered |
| Turbinate swelling | Alternating sides, often with allergy or irritants |
| Nasal polyps | Gradual blockage, loss of smell, both sides |
| Rebound congestion | After using decongestant sprays for more than 3 days |
| Adenoids (children) | Mouth breathing, snoring |
Allergies and polyps commonly coexist with a deviated septum and make symptoms worse. See allergic rhinitis and nasal polyps.
Diagnosis
A primary care doctor or ENT specialist examines the inside of the nose with a light and speculum, often after a decongestant spray to shrink the lining. Nasal endoscopy, a thin camera, gives a full view of the septum, turbinates and sinus openings. A CT scan is not needed to diagnose a deviated septum but is used if chronic sinusitis is suspected or before surgery.
Treatment
Medical treatment
These do not straighten the septum but reduce swelling of the lining, which often helps enough:
- steroid nasal sprays (fluticasone, mometasone, budesonide) used daily for at least 4 to 6 weeks
- saline sprays or rinses
- antihistamines if allergies contribute
- nasal dilator strips for sleep or exercise
- decongestant sprays only for up to 3 days at a time, to avoid rebound congestion
Septoplasty
Septoplasty straightens the septum by removing or reshaping the bent cartilage and bone through the nostrils, with no external cuts. It is often combined with turbinate reduction. It is usually done under general anesthesia as a day procedure, taking about 30 to 90 minutes.
- Recovery: congestion, mild pain and crusting for 1 to 2 weeks; avoid blowing your nose hard, heavy lifting and strenuous exercise for about 2 weeks.
- Results: most people report significantly better nasal breathing.
- Risks: bleeding, infection, a hole in the septum (perforation), numbness of the upper teeth, change in nose shape (rare) and persistent blockage.
Septorhinoplasty combines septoplasty with reshaping the outside of the nose when the external nose is also crooked.
Complications of untreated deviation
- chronic mouth breathing and dry mouth
- poor sleep and daytime tiredness; it can worsen obstructive sleep apnea though septoplasty alone rarely cures apnea
- recurrent sinusitis
- recurrent nosebleeds
Frequently asked questions
What are the symptoms of a deviated septum?
The main symptoms are nasal blockage, usually worse on one side, noisy breathing, snoring, frequent nosebleeds and repeated sinus infections. Some people have facial pain or headaches. Many people with mild deviation have no symptoms.
Can a deviated septum be fixed without surgery?
The septum itself can only be straightened with surgery. However, steroid sprays, saline rinses, antihistamines and nasal strips reduce swelling and often improve breathing enough that surgery is not needed.
How long does it take to recover from septoplasty?
Most people return to desk work within about a week. Congestion and crusting improve over 1 to 2 weeks, and full healing takes a few months. Avoid strenuous activity and hard nose blowing for about 2 weeks.
Can a deviated septum get worse over time?
Yes. Aging can weaken nasal tissues, and further injuries can increase deviation. Swelling from allergies or infections can also make symptoms feel worse even if the septum itself has not changed.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Otolaryngology-Head and Neck Surgery: Clinical Consensus Statement on Septoplasty with or without Inferior Turbinate Reduction (2015)
- American Academy of Otolaryngology-Head and Neck Surgery: Deviated Septum patient information
- MedlinePlus: Deviated septum
- NHS: Septoplasty
- Mayo Clinic: Deviated septum