Septal Deviation (Deviated Septum)
An off-center wall between the nostrils that can block airflow
Quick Facts
- Type: Structural nasal condition
- Cause: Present from birth or from nasal injury
- Main symptom: Blocked nose, often worse on one side
- Treatment: Symptom relief or surgery (septoplasty)
Overview
The nasal septum is the wall of bone and cartilage that divides the inside of the nose into two nostrils. Ideally it sits in the center, giving each side an equal airway. A septal deviation, or deviated septum, means this wall is shifted off-center or crooked, making one nasal passage narrower than the other.
Mild deviation is extremely common and often causes no symptoms at all. When the deviation is more significant, it can block airflow, contribute to congestion, and lead to other nasal problems. Treatment ranges from managing symptoms with medication to surgery that straightens the septum when breathing is significantly affected. Because so many people have at least a slight deviation without any trouble, the key question is not simply whether the septum is crooked, but whether it is actually causing symptoms such as a persistently blocked nose, recurring infections, or disturbed sleep that affect quality of life.
Symptoms
Many people with a deviated septum have no symptoms. When symptoms occur, they may include:
- Blocked or stuffy nose, often worse on one side
- Difficulty breathing through the nose, especially during a cold or with allergies
- Frequent or recurring sinus infections
- Nosebleeds, due to drying of the air over the deviated area
- Noisy breathing during sleep
- A preference for sleeping on a particular side to breathe more easily
- Facial pressure or, sometimes, headaches
Symptoms often become more noticeable when the nasal lining swells, such as during a cold or allergy flare.
Causes
A deviated septum can be present from birth or develop later as a result of injury.
- Present at birth: Some people are born with a deviated septum or develop it during birth.
- Nasal injury: A blow to the nose, such as from sports, a fall, an accident, or a fight, can shift the septum. A broken nose often leaves the septum deviated.
- Normal aging: Changes in the nasal structures over time can increase a deviation or its effects.
Risk Factors
- A previous nasal injury or broken nose
- Contact sports or activities with a risk of facial injury
- Being born with a crooked septum
- Allergies or chronic congestion, which make a deviation more noticeable
Diagnosis
A doctor diagnoses a deviated septum by examining the inside of the nose. Evaluation may include:
- Nasal examination: Using a light and sometimes a small instrument or scope to view the septum and airways.
- A history of symptoms, such as which side feels more blocked and whether you have had a nasal injury.
- Checking for other causes of nasal blockage, such as allergies, polyps, or chronic sinusitis.
- A nasal endoscopy in some cases for a more detailed look.
Treatment
Treatment depends on how much the deviation affects breathing and quality of life. Many people need no treatment at all.
- Managing symptoms: Decongestants, antihistamines, or steroid nasal sprays can reduce swelling and ease blockage, especially when allergies or congestion are also present. These do not straighten the septum but can relieve symptoms.
- Nasal strips or saline rinses: May provide some relief.
- Surgery (septoplasty): A procedure to straighten and reposition the septum, recommended when significant breathing problems persist despite other measures. It is sometimes combined with surgery to reshape the nose or treat the turbinates.
Septoplasty often improves nasal breathing, though some swelling and congestion can have other causes that also need treatment.
Prevention
- Wear protective gear such as a helmet or face mask during contact sports
- Always use a seatbelt to reduce facial injury in collisions
- Take care to avoid falls and blows to the face
- Treat nasal injuries promptly to reduce lasting deviation
When to See a Doctor
See a doctor if you have ongoing nasal blockage that affects your breathing, sleep, or daily comfort, or if you have repeated sinus infections or frequent nosebleeds. Consider an evaluation if you experience:
- Persistent difficulty breathing through one or both sides of the nose
- Recurrent sinus infections
- Nosebleeds that keep returning
- Nasal blockage that does not improve with allergy or congestion treatment
Frequently Asked Questions
Does everyone with a deviated septum need surgery?
No. Mild deviation is very common and often causes no symptoms. Surgery is only considered when a deviated septum significantly affects breathing or causes problems like recurrent infections that do not improve with other treatments such as nasal sprays.
Can a deviated septum be fixed without surgery?
Medications like decongestants, antihistamines, and steroid nasal sprays can relieve symptoms by reducing swelling, but they do not straighten the septum itself. The only way to physically correct a deviated septum is a surgical procedure called septoplasty.
What causes a deviated septum?
Some people are born with one, while others develop it after a nasal injury such as a broken nose from sports, a fall, or an accident. Normal changes with aging can also make a deviation more noticeable over time.
Why does my nose feel more blocked at night?
Lying down increases blood flow to the nasal lining, which swells the tissues and narrows the already smaller side of a deviated septum. This is why many people notice more blockage at night or feel they must sleep on a particular side.
References
- Mayo Clinic. Deviated septum — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Deviated septum.
- American Academy of Otolaryngology-Head and Neck Surgery. Deviated septum.
- National Institutes of Health (NIH). Nasal and sinus health.