What's to know about deviated septum?
An estimated 80 percent of people in the United States (U.S.) do not have a straight nasal septum. Deviated septum, as a medical condition, generally only refers to severely displaced septums. The prevalence of deviated septums in the U.S. is therefore far lower.
When symptoms interfere with breathing, anti-inflammatory medications and corrective surgery may be required.
What is deviated septum?
The septum separates the nasal passages, and displaced or tilted septums are called deviated septums.
The nasal septum is a wall made of cartilage and connective tissue that separates the nasal passages. The nasal passages are lined on either side with mucous membranes.
When the nasal septum is extremely tilted towards one side, it causes one nasal passage to be larger than the other.
Depending on the severity of this difference, nasal blockage, reduced air-flow, and breathing problems can occur. A misaligned septum can also interfere with nasal drainage, leading to an increased rate of infection and postnasal drip.
While some cases of deviated septum are genetic or inherited, the condition can also be caused by an injury.
Deviated septum can develop in utero, or while the fetus is still in the womb, as well as during the birthing process.
A 2012 study in India, found that neonatal deviated septum affected 20 percent of newborns. These cases were related to birthing challenges and occurred more often in larger birth weight babies and those who experienced difficult deliveries.
Deviated septums that are present from birth often have an S or C shape. They are usually smooth and occur more often in the front (anterior) portion of the nose. The extent of the deviation may increase or change naturally as the person ages.
Traumatic or injury-induced deviations later in life tend to have an extreme angle, are irregular in shape, and impact all septal regions equally.
Injury-related deviations may also include dislocated or fractured portions of cartilage.
Symptoms and complications
Symptoms are often mistaken for those of a respiratory infection, common cold, or allergy.
People with mild cases of deviated septum may only notice symptoms during these times.
Other symptoms and signs associated with deviated septum include:
- nasal blockage, often more intense on one side
- nasal congestion
- frequent sinus infections
- sinus infections that are resistant to medication
- frequent nosebleeds
- frequent crusting or dry nose, often in the larger nostril due to increased air flow drying out mucous membranes
- noisy breathing while sleeping
- facial pain
- postnasal drip
- whistling noise while inhaling or exhaling
- a tendency to sleep on one side, often the side opposite the blocked nasal passage
- in severe cases, sleep apnea
Cases that have a significant deformity can be more severe in infants, due to their smaller respiratory passages and reliance on nasal breathing. Complications of severe cases have the potential to be fatal.
People should seek medical attention anytime breathing becomes difficult or laborious, or dizziness or confusion occur.
Many other medical conditions can cause similar symptoms, such as nasal polyps, infections, and allergies, so an ear, nose, and throat (ENT) specialist is typically required for diagnosis.
Once the condition is suspected, a doctor will begin by reviewing medical history for possible causes. These include injuries, previous surgeries, and chronic symptoms.
The doctor will then physically examine the nasal septum using a speculum and bright light.
If the symptoms of deviated septum are not problematic or severe, no particular treatment is needed.
For mild cases, over-the-counter and prescription treatment options exist.
Commonly recommended treatments include:
- steroid sprays to reduce inflammation
- nasal dilators
- saline irrigations
People with bothersome symptoms should also reduce their exposure to irritants, such as allergens, which increase the likelihood of experiencing symptoms and intensify their severity.
For severe cases of deviated septum, a septoplasty may be required.
Image credit: Mike Gerkin, 2011
Septoplasty, a surgical procedure done entirely through the open nostrils, is the recommended treatment for severe cases of deviated septum. The procedure typically takes 1 to 2 hours and uses general or local anesthetic.
Septoplasty does not normally cause external bruising or changes to the appearance of the nose. Once the effects of the anesthetic have worn off, most people are able to return home.
For severe misalignments, the treatment options are often more invasive and nasal surgery may be required in addition to septoplasty.
In this case, the crooked region of septum may be taken out, reshaped, and reinserted.
Most nasal operations are carried out on those over the age of 18 because the cartilage of the septum is continuously growing and changing during childhood and adolescence.
In some cases, and depending on insurance coverage or the ability to cover costs, the decision to seek treatment is a personal rather than medical one.
As with all surgeries, there are risks associated with septoplasty and other nasal surgeries. These include having a reaction to anesthesia, excessive bleeding, and infection.
Depending on certain factors, such as age at surgery and intensity of the misalignment, repeat procedures or surgeries may be necessary.
If a deviated septum was the only cause of breathing problems or sinusitis, symptoms typically reduce or resolve immediately after septoplasty or surgery.