An overview of Deviated Septum

A deviated septum is a condition in which the nasal septum (the bone and cartilage that divide the nose in half) is crooked, making one nasal passage smaller. If severe, breathing through the nose can be difficult. Most people naturally have some deviation — only people with severe deviations need treatment.

See your doctor if you experience:

1. A blocked nostril (or nostrils) that doesn't respond to treatment

2. Frequent nosebleeds

3. Recurring sinus infections

A deviated septum occurs when your nasal septum — the thin wall that separates your right and left nasal passages — is displaced to one side.

A deviated septum can be caused by:

1. A condition present at birth. In some cases, a deviated septum occurs when the fetus develops in the womb and is apparent at birth.

2. Injury to the nose. A deviated septum can also be the result of an injury that causes the nasal septum to be moved out of position.

In infants, such an injury may occur during childbirth. In children and adults, a wide array of accidents may lead to a nose injury and deviated septum. Trauma to the nose most commonly occurs during contact sports, rough play such as wrestling or automobile accidents.

The aging process may affect nasal structures, worsening a deviated septum over time.

Swelling and irritation of the nasal cavities or sinus cavities because of an infection can further narrow the nasal passage and result in nasal obstruction.

Most septal displacements result in no symptoms, and you may not even know you have a deviated septum. Some septal deformities, however, may cause the following signs and symptoms:

1. Obstruction of one or both nostrils. This blockage can make it difficult to breathe through the nostril or nostrils. You may notice this more when you have a cold or allergies that can cause your nasal passages to swell and narrow.

2. Nosebleeds. The surface of your nasal septum may become dry, increasing your risk of nosebleeds.

3. Facial pain. There is some debate about the possible nasal causes of facial pain. A possible cause of one-sided facial pain could be a severe deviated septum in which surfaces within the nose touch and cause pressure.

4. Noisy breathing during sleep. A deviated septum or swelling of the tissues in your nose can be one of the many reasons for noisy breathing during sleep.

5. Awareness of the nasal cycle. The nose alternates between being obstructed on one side and then changes to being obstructed on the other. This is called the nasal cycle. Being aware of the nasal cycle isn't typical and can indicate nasal obstruction.

6. Preference for sleeping on a particular side. Some people may prefer to sleep on a particular side to optimize breathing through the nose at night if one nasal passage is narrowed.

You may be able to prevent the injuries to your nose that can cause a deviated septum with these precautions:

1. Wear a helmet or a midface mask when playing contact sports, such as football and volleyball.

2. Wear a seat belt when riding in a motorized vehicle.

During your visit, your doctor will first ask about any symptoms you may have.

To examine the inside of your nose, the doctor will use a bright light and sometimes an instrument designed to spread open your nostrils. Sometimes the doctor will check farther back in your nose with a long tube-shaped scope with a bright light at the tip. The doctor may also look at your nasal tissues before and after applying a decongestant spray.

Based on this exam, he or she can diagnose a deviated septum and determine the seriousness of your condition.

If your doctor is not an ear, nose and throat specialist and you need treatment, he or she may refer you to a specialist for further consultation and treatment.

Managing symptoms

Initial treatment of a deviated septum may be directed at managing your symptoms. Your doctor may prescribe:

Decongestants. Decongestants are medications that reduce nasal tissue swelling, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray. But use nasal sprays with caution. Frequent and continued use can create dependency and cause symptoms to be worse after you stop using them.

Oral decongestants have a stimulant effect and may cause you to be jittery as well as make your blood pressure and heart rate go up.

Antihistamines. Antihistamines are medications that help prevent allergy symptoms, including a stuffy or runny nose. They can also sometimes help nonallergic conditions such as those occurring with a cold. Some antihistamines cause drowsiness and can affect your ability to perform tasks that require physical coordination, such as driving.

Nasal steroid sprays. Prescription nasal corticosteroid sprays can reduce swelling in your nasal passage and help with drainage. It usually takes from 1 to 3 weeks for steroid sprays to reach their maximal effect, so it is important to follow your doctor's directions in using them.

Medications only treat the swollen mucous membranes and won't correct a deviated septum.

Surgical repair

If you still experience symptoms despite medical therapy, you may consider surgery to correct your deviated septum (septoplasty).

During a typical septoplasty, the nasal septum is straightened and repositioned in the center of the nose. This may require the surgeon to cut and remove parts of the septum before reinserting them in the proper position.

The level of improvement you can expect with surgery depends on the severity of your deviation. Symptoms due to the deviated septum — particularly nasal obstruction — could completely go away. However, any other nasal or sinus conditions you have that affect the tissues lining your nose — such as allergies — can't be cured with only surgery.

Reshaping your nose

In some cases, surgery to reshape the nose (rhinoplasty) is performed at the same time as septoplasty. Rhinoplasty involves modifying the bone and cartilage of your nose to change its shape or size or both.

Rhinoplasty results

At left, a woman's nose before rhinoplasty. On the right, the same woman pictured one year after the surgery.

A severely deviated septum causing nasal blockage can lead to:

1. Dry mouth, due to chronic mouth breathing

2. A feeling of pressure or congestion in your nasal passages

3. Disturbed sleep, due to the unpleasantness of not being able to breathe comfortably through your nose at night