ConditionEar, nose & throat
Septal Deviation (Deviated Septum)
Septal deviation means the nasal septum, the wall of cartilage and bone dividing the nose into left and right sides, is off-center or bent. Most people have some deviation without symptoms. When it is significant, it narrows one or both nasal passages, causing a blocked nose (often worse on one side), noisy breathing, snoring, nosebleeds and sometimes repeated sinus problems. Nasal sprays treat the swelling that often makes it worse. If blockage persists, a septoplasty straightens the septum and usually improves breathing.
Also called: Deviated septum, deviated nasal septum, crooked septum, nasal septal deviation
At a glance
- What it is
- An off-center or bent nasal septum narrowing the nasal airway.
- How common
- Most adults have some deviation. Only some have symptoms.
- Causes
- Present from birth or development, or after a nose injury.
- Symptoms
- Blocked nose (often one side), mouth breathing, snoring, nosebleeds, facial pressure.
- Treatment
- Saline, steroid sprays and antihistamines for swelling. Septoplasty for persistent blockage.
When to get help
Call 911 or go to the ER
- After a nose injury: a soft, painful, purple swelling inside the nose blocking both sides (possible septal hematoma, which needs draining to prevent cartilage damage)
- Clear, watery fluid dripping from the nose after a head or nose injury
- A nosebleed that does not stop after 20 minutes of firm pressure, or with dizziness
See a doctor within a day or two
- A crooked or swollen nose after an injury, to be assessed within about a week while the bones can still be reset
- Fever, facial swelling or severe pain after nasal surgery
Book a routine appointment
- A blocked nose on one or both sides that does not improve with sprays after 1 to 3 months
- Frequent nosebleeds from one side
- Loud snoring, pauses in breathing at night, or daytime sleepiness
- Repeated sinus infections
What the septum does
The septum is made of flexible cartilage at the front and thin bone further back. It supports the nose and divides airflow between the nostrils. A perfectly straight septum is unusual. Deviation becomes a problem when it narrows the airway enough to block airflow, especially at the nasal valve near the front of the nose, the narrowest part of the airway.
Causes
- congenital or developmental: the septum grows unevenly during childhood
- injury: a broken nose (nasal fracture) from sports, falls, fights or accidents, including birth trauma
- aging: cartilage and tissues soften and shift
- previous nasal surgery
Symptoms
- nasal blockage, often worse on one side
- the "nasal cycle," where congestion naturally alternates sides every few hours, becomes more noticeable
- breathing through the mouth, especially at night, causing a dry mouth
- snoring and disturbed sleep, and it can contribute to sleep apnea
- nosebleeds, from dry air flowing over the bent area
- facial pressure or headaches in some people
- repeated sinus infections if drainage is blocked
- reduced exercise tolerance in athletes
Many symptoms are made worse by swelling of the nasal lining from allergies or colds, or by enlarged turbinates (the ridges on the side walls of the nose).
Other causes of a blocked nose
| Cause | Clues |
|---|---|
| Turbinate hypertrophy | Both sides, variable, often with allergies |
| Allergic or non-allergic rhinitis | Sneezing, runny nose, itchy eyes, seasonal pattern |
| Nasal polyps | Both sides, loss of smell, often with asthma |
| Rebound congestion | Overuse of decongestant sprays for more than a few days |
| Enlarged adenoids | Children, mouth breathing, snoring |
| Nasal valve collapse | Sides of the nose suck in when breathing in |
| Tumors | Rare, one-sided blockage with bleeding or discharge |
Diagnosis
A primary care doctor or ENT specialist will:
- look inside the nose with a light and speculum
- use a nasal endoscope, a thin camera, to see the full length of the septum and the turbinates
- sometimes spray a decongestant to see how much the blockage improves, which separates swelling from a fixed deviation
- use the NOSE questionnaire to measure how much the blockage affects daily life
- order a CT scan if chronic sinusitis is suspected
Treatment
Medicines
These do not straighten the septum but reduce swelling around it:
- saline sprays or rinses to moisten and clear the nose
- steroid nasal sprays (fluticasone, mometasone, budesonide), used daily for several weeks
- antihistamines for allergies
- decongestant sprays for no more than 3 days to avoid rebound congestion
- nasal strips at night may help some people
Septoplasty
Septoplasty is surgery to straighten the septum. It is done through the nostrils, usually as a same-day procedure under general anesthesia, and leaves no visible scars.
- the surgeon lifts the lining, removes or reshapes the bent cartilage and bone, and replaces the lining
- it is often combined with turbinate reduction
- splints may be left inside the nose for about a week
- recovery: congestion for 1 to 2 weeks, avoiding nose-blowing and heavy exercise for about 2 weeks
- most people notice better breathing, with full results in a few months
Risks are uncommon and include bleeding, infection, septal perforation (a hole), numbness of the upper teeth, change in nose shape and persistent blockage.
Septorhinoplasty combines septoplasty with reshaping of the outer nose when the external nose is also crooked.
Frequently asked questions
What are the symptoms of a deviated septum?
The main symptom is a blocked nose, often worse on one side. Others include mouth breathing, snoring, nosebleeds, facial pressure, noisy breathing during sleep and repeated sinus infections. Many people with a deviated septum have no symptoms.
Can a deviated septum fix itself?
No. The structure of the septum does not straighten on its own. However, symptoms often improve with treatment of nasal swelling using saline and steroid sprays, which may be all some people need.
Is septoplasty worth it?
For people with significant, persistent blockage from a deviated septum that does not improve with sprays, septoplasty improves breathing and quality of life in most cases. An ENT specialist can tell you whether your symptoms are likely to improve.
Can a deviated septum cause sleep apnea?
A deviated septum can contribute to snoring and make sleep apnea worse by forcing mouth breathing, but it is rarely the only cause. Treating nasal blockage can make CPAP more comfortable. Suspected sleep apnea needs a sleep study.
How long does it take to recover from septoplasty?
Most people return to work or school within about a week. Congestion and mild discomfort last 1 to 2 weeks. Avoid blowing your nose and strenuous exercise for about 2 weeks. Breathing continues to improve over a few months.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Otolaryngology-Head and Neck Surgery: Deviated septum; Clinical consensus statement on septoplasty with or without inferior turbinate reduction
- MedlinePlus (US National Library of Medicine): Deviated septum
- NHS: Septoplasty
- American Rhinologic Society: Nasal obstruction
- Mayo Clinic: Deviated septum