Deviated Nasal Septum
A condition where the wall between nasal passages is displaced to one side, affecting breathing
Quick Facts
- Type: Structural Abnormality
- ICD-10: J34.2
- Prevalence: ~80% of people
- Onset: Birth or injury
Overview
A deviated nasal septum occurs when the thin wall (septum) between your nasal passages is displaced to one side. In an ideal nose, the septum separates the left and right sides of the nose into passages of equal size. However, in many people, the septum is off-center or deviated, making one nasal passage smaller than the other.
While most people have some degree of septal deviation, significant deviation can cause breathing difficulties and other uncomfortable symptoms. The condition can be present from birth due to developmental factors, or it can result from injury to the nose. When the deviation is severe enough to block airflow and cause symptoms, it may require medical treatment.
Studies suggest that up to 80% of people have some degree of septal deviation, but only those with severe deviation experience troublesome symptoms. The condition affects men and women equally and can occur at any age, though it's often noticed when nasal congestion becomes persistent or when breathing problems develop during physical activity or sleep.
Symptoms
The symptoms of a deviated nasal septum can vary significantly from person to person. Some individuals may have a severely deviated septum with no symptoms, while others with minor deviation may experience significant discomfort. Symptoms often worsen during upper respiratory infections or allergy seasons.
Primary Respiratory Symptoms
Pain and Discomfort Symptoms
Additional Symptoms
Symptoms by Severity
- Mild Deviation: Occasional congestion, minor breathing difficulties during exercise
- Moderate Deviation: Regular nasal congestion, noticeable breathing differences between nostrils
- Severe Deviation: Persistent breathing problems, sleep disturbances, chronic sinus issues
Sleep-Related Symptoms
- Loud snoring
- Sleep disruption
- Daytime fatigue
- Morning dry mouth
- Restless sleep
- Sleep apnea episodes
Symptoms During Illness
Symptoms often become more pronounced during:
- Upper respiratory infections
- Seasonal allergies
- Exposure to environmental irritants
- Changes in weather or humidity
- Physical exertion
Causes
A deviated nasal septum can result from various factors, occurring either during fetal development or as a result of injury later in life. Understanding the cause can help determine the best treatment approach.
Congenital Causes
Many people are born with a deviated septum due to factors during fetal development:
- Developmental variations: Natural variations in facial growth patterns
- Genetic factors: Family history of facial structural abnormalities
- Birth trauma: Injury during delivery, especially difficult births
- Intrauterine positioning: Pressure on the developing fetus
Traumatic Causes
Injury to the nose is a common cause of septal deviation:
- Sports injuries: Contact sports, falls, or collisions
- Motor vehicle accidents: Impact injuries to the face
- Physical altercations: Fights or assaults
- Childhood accidents: Falls, playground injuries, or rough play
- Occupational injuries: Work-related facial trauma
Age-Related Changes
- Normal aging process affecting nasal structure
- Changes in cartilage and bone over time
- Gradual worsening of existing deviation
- Loss of structural support with aging
Medical Conditions
Certain conditions can contribute to or worsen septal deviation:
- Connective tissue disorders: Conditions affecting cartilage development
- Previous nasal surgery: Complications from rhinoplasty or other procedures
- Chronic inflammation: Long-term sinus infections or allergies
- Tumors or growths: Masses that push against the septum
Environmental Factors
- Chronic exposure to irritants
- Repeated cocaine use (causing septal perforation)
- Long-term use of nasal decongestant sprays
- Exposure to certain chemicals or toxins
Risk Factors
Several factors can increase the likelihood of developing a deviated nasal septum or experiencing symptoms from an existing deviation:
Demographic Risk Factors
- Age: Risk of trauma increases with age; symptoms may worsen over time
- Gender: Males may have higher risk due to increased sports participation
- Family history: Genetic predisposition to facial structural abnormalities
Activity-Related Risk Factors
- Contact sports: Football, hockey, boxing, martial arts
- High-risk activities: Motorcycling, skiing, skateboarding
- Occupational hazards: Construction, law enforcement, military service
- Recreational activities: Rock climbing, cycling without helmets
Medical Risk Factors
- History of nasal or facial injuries
- Previous nasal surgery
- Chronic allergies or sinus infections
- Connective tissue disorders
- Certain genetic syndromes affecting facial development
Environmental Risk Factors
- Living in areas with high pollution
- Exposure to secondhand smoke
- Working with chemical irritants
- Frequent air travel (pressure changes)
Lifestyle Risk Factors
- Substance abuse (particularly cocaine use)
- Excessive use of nasal decongestants
- Not wearing protective equipment during sports
- Aggressive nose blowing or picking
Diagnosis
Diagnosing a deviated nasal septum involves a comprehensive evaluation by a healthcare provider, typically an ENT (ear, nose, and throat) specialist. The diagnosis combines clinical examination with imaging studies when necessary.
Medical History
- Detailed symptom assessment and duration
- History of nasal trauma or injury
- Previous nasal surgeries or treatments
- Family history of nasal or facial abnormalities
- Medication use, including nasal sprays
- Allergy history and triggers
Physical Examination
External Nasal Examination:
- Visual inspection for asymmetry or deformity
- Palpation for structural abnormalities
- Assessment of nasal tip and bridge
Internal Nasal Examination:
- Anterior rhinoscopy: Using a nasal speculum and light
- Nasal endoscopy: Flexible or rigid scope for detailed visualization
- Assessment of: Septal position, turbinate size, nasal passages
- Evaluation of: Mucosal color, swelling, discharge
Diagnostic Tests
Imaging Studies:
- CT scan: Detailed images of nasal and sinus structures
- MRI: For soft tissue evaluation (rarely needed)
- X-rays: Limited use, mainly for trauma assessment
Functional Tests:
- Nasal airflow measurement: Rhinomanometry
- Acoustic rhinometry: Assessment of nasal cavity volume
- Peak nasal inspiratory flow: Breathing capacity testing
Severity Assessment
Healthcare providers classify septal deviation based on:
- Degree of deviation: Mild, moderate, or severe
- Location: Anterior, posterior, or combined
- Functional impact: Effect on breathing and quality of life
- Associated abnormalities: Turbinate hypertrophy, polyps
Differential Diagnosis
Conditions that may cause similar symptoms:
Treatment Options
Treatment for a deviated nasal septum depends on the severity of symptoms and their impact on quality of life. Options range from conservative management to surgical correction.
Conservative Management
Many patients can manage symptoms effectively with non-surgical treatments:
Medications:
- Nasal decongestants: Short-term relief (limit to 3 days)
- Nasal corticosteroid sprays: Reduce inflammation and swelling
- Antihistamines: For allergy-related symptoms
- Saline rinses: Nasal irrigation to clear mucus and irritants
- Nasal strips: External devices to improve airflow
Home Remedies:
- Steam inhalation to reduce congestion
- Humidifiers to maintain optimal moisture
- Sleeping with head elevated
- Regular nasal irrigation
- Avoiding known irritants and allergens
Surgical Treatment
Surgery may be recommended when conservative treatments fail and symptoms significantly impact quality of life:
Septoplasty:
- Procedure: Surgical straightening of the deviated septum
- Approach: Usually performed through the nostrils (closed technique)
- Duration: 30-90 minutes, typically outpatient
- Recovery: 1-2 weeks with gradual improvement over months
- Success rate: 80-90% improvement in breathing
Rhinoplasty:
- Combined functional and cosmetic correction
- Addresses both breathing and appearance
- More extensive surgery with longer recovery
- May be appropriate for trauma-related deviations
Additional Procedures:
- Turbinate reduction: If enlarged turbinates contribute to obstruction
- Sinus surgery: For concurrent chronic sinusitis
- Polyp removal: If nasal polyps are present
Surgical Considerations
- Ideal candidates: Failed conservative treatment, significant symptoms
- Age requirements: Usually after age 16 when nasal growth is complete
- Realistic expectations: Understanding of potential outcomes and limitations
- Overall health: Good surgical candidates without major medical issues
Post-Treatment Care
After Conservative Treatment:
- Regular follow-up appointments
- Monitoring for medication side effects
- Adjustment of treatment plan as needed
After Surgery:
- Nasal packing removal (if used)
- Pain management and wound care
- Activity restrictions for 1-2 weeks
- Regular follow-up visits
- Long-term monitoring for recurrence
Prevention
While congenital septal deviation cannot be prevented, there are measures to reduce the risk of trauma-related deviation and to prevent worsening of existing conditions:
Injury Prevention
- Protective equipment: Wear appropriate helmets and face guards during sports
- Vehicle safety: Always use seatbelts and proper car seats for children
- Home safety: Remove tripping hazards and secure loose rugs
- Sports safety: Learn proper techniques and follow safety rules
- Workplace safety: Use required protective equipment
Nasal Health Maintenance
- Gentle nose care: Avoid aggressive nose blowing or picking
- Proper hygiene: Regular hand washing to prevent infections
- Allergy management: Control allergic reactions that cause inflammation
- Avoid irritants: Stay away from smoke, chemicals, and pollutants
- Humidification: Maintain appropriate humidity levels at home
Lifestyle Modifications
- Avoid substance abuse, particularly cocaine
- Limit use of nasal decongestant sprays
- Stay hydrated to maintain healthy mucous membranes
- Practice stress management to reduce immune system compromise
- Get adequate sleep to support immune function
Early Intervention
- Seek prompt treatment for nasal injuries
- Address chronic allergies and sinus problems
- Regular check-ups if symptoms develop
- Don't ignore persistent breathing problems
Environmental Controls
- Use air purifiers to reduce allergens
- Control dust mites in the bedroom
- Avoid smoking and secondhand smoke
- Keep windows closed during high pollen days
- Regular cleaning to reduce irritants
When to See a Doctor
While mild nasal congestion is common and often resolves on its own, certain symptoms warrant medical evaluation to rule out a deviated septum or other conditions:
Immediate Medical Attention
- Severe nasal trauma or obvious deformity
- Persistent nosebleeds that don't stop with pressure
- Signs of serious infection (fever, severe headache, neck stiffness)
- Complete nasal obstruction preventing breathing
- Severe sleep apnea symptoms
Schedule an Appointment
- Persistent nasal congestion lasting more than 2 weeks
- Difficulty breathing through the nose regularly
- Chronic headaches or facial pain
- Frequent nosebleeds
- Loud snoring affecting sleep quality
- Recurrent sinus infections
Consider ENT Specialist Referral
- Symptoms persist despite treatment
- Multiple failed treatments
- Considering surgical options
- Complex nasal or sinus problems
- Need for specialized testing
Evaluation for Children
- Chronic mouth breathing
- Sleep disturbances or snoring
- Recurrent ear infections
- Speech development issues
- Failure to thrive related to feeding difficulties
Quality of Life Indicators
Seek medical care if nasal symptoms significantly impact:
- Sleep quality and daytime alertness
- Physical activity or exercise tolerance
- Work or school performance
- Social interactions or confidence
- Overall quality of life
Frequently Asked Questions
Yes, a deviated septum can worsen with age due to natural changes in cartilage and bone structure. Additionally, repeated trauma, chronic inflammation, or certain medical conditions can cause further deviation.
Septoplasty is generally considered a safe procedure with low complication rates. However, like any surgery, it carries some risks including bleeding, infection, scarring, and rarely, changes in smell or taste. Most patients experience significant improvement in breathing.
Initial recovery typically takes 1-2 weeks, with most people returning to work within a week. However, full healing and maximum improvement in breathing may take several months as swelling completely resolves.
Septoplasty is generally not recommended for children unless absolutely necessary, as the nose continues to grow until around age 16-18. Surgery before this age could interfere with natural nasal development.
Most insurance plans cover septoplasty when it's medically necessary for functional breathing problems. However, if combined with cosmetic rhinoplasty, the cosmetic portion typically isn't covered.
Yes, a deviated septum can contribute to snoring by obstructing airflow through the nose, forcing mouth breathing during sleep. This can lead to vibration of throat tissues and snoring sounds.
While non-surgical treatments can effectively manage symptoms, they typically don't provide permanent correction of the structural problem. However, many people successfully manage their symptoms long-term with medications and lifestyle modifications.
References
- Rhee JS, Book DT, Burzynski M, Smith TL. Quality of life assessment in nasal obstruction. Laryngoscope. 2003;113(7):1118-1122.
- Mladina R. The role of maxillar morphology in the development of pathological septal deformities. Rhinology. 1987;25(3):199-205.
- Stewart MG, Smith TL, Weaver EM, et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004;130(3):283-290.
- Aziz T, Biron VL, Ansari K, Flores-Mir C. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014;43(1):11.
- American Academy of Otolaryngology-Head and Neck Surgery. Clinical Practice Guideline: Septoplasty. Otolaryngol Head Neck Surg. 2017;156(2_suppl):S1-S28.