What is a deviated septum and how common is it?
The septum is the midline wall that divides the nasal cavity into right and left passages; its front part is made of cartilage and its back part of bone. Ideally it is expected to sit straight in the midline; when it is bent in one or more directions, the condition is called a deviated septum. Studies show that a significant proportion of the population has some degree of septal deviation; most of these deviations are mild and never cause symptoms. A deviation only becomes a clinical problem, and treatment only comes into consideration, when it restricts airflow to a meaningful degree.
A septal deviation may be present from birth, or it may develop after trauma to the nose (sports injuries, falls, blows). Even small, unnoticed injuries in childhood can turn into a marked deviation over time. During growth and development, the cartilage and bone structures growing at different rates is also a factor that contributes to deviation in some cases.
What are the symptoms?
The most prominent and most common sign of a deviated septum is nasal obstruction, which is usually more dominant on one side. The obstruction is usually felt more on the side towards which the septum is bent; however, over time obstruction on both sides can also develop as the turbinate on the opposite side enlarges to compensate. Other complaints that may accompany it include mouth breathing, snoring, poorer sleep quality, recurrent sinusitis attacks, post-nasal drip, nasal dryness and shortness of breath during exercise.
People who have had one-sided obstruction since birth or for a very long time may get used to it over time and may not notice it as a problem affecting their daily life. For this reason, patients often clearly notice their complaints only when additional obstruction develops on the other side (for example during a seasonal allergy or a cold). In some cases, more frequent nosebleeds, headache and a feeling of pressure in the face may also accompany it.
In some patients with a marked septal deviation, nasal dryness, crusting and a feeling of irritation may also develop because the airflow inside the nose is unevenly distributed. In children and teenagers, a mouth-breathing habit caused by nasal obstruction can affect jaw and dental development in the long term, so early assessment is particularly important in this age group.
Causes and other sources of nasal obstruction
A deviated septum is not the only cause of nasal obstruction; in many patients more than one factor contributes to the blockage. Turbinate hypertrophy (enlargement of the turbinates), allergic rhinitis, nasal polyps and chronic sinusitis are other conditions that frequently accompany a deviation or make the obstruction worse. Particularly against a background of allergic rhinitis, the turbinates are chronically swollen and can make the effect of the septal deviation even more pronounced.
For this reason, the assessment examines not only the state of the septum but all the structures inside the nose as a whole. Correctly identifying the real source of the obstruction is very important for the success of the treatment plan; correcting only the septum while ignoring accompanying turbinate enlargement or an allergic background can mean that the expected relief after surgery is not achieved.
In some patients, nasal obstruction can result simply from temporary swelling of the nasal lining — without any structural abnormality — due to hormonal changes, long-term use of certain medicines or exposure to environmental irritants. Distinguishing these functional causes from structural deviation is important in order to avoid unnecessary surgery, and this distinction is made largely through a detailed history and examination.
How does the diagnostic process work?
Diagnosis begins with a detailed patient history and an examination of the inside of the nose. With anterior rhinoscopy the gross deviation of the septum can usually be seen easily; however, when the deviation is in the further back and deeper parts of the nose, a more detailed examination with nasal endoscopy is needed. During endoscopic examination, accompanying turbinate enlargement, the presence of polyps or signs of sinusitis can also be assessed in the same session.
In cases where it is considered necessary — particularly if accompanying chronic sinusitis is suspected or surgery is being planned — a computed tomography (CT) scan of the paranasal sinuses may be requested. This imaging shows both the anatomy of the septum and the condition of the sinuses in detail and contributes to surgical planning. In patients with a suspected allergic background, allergy tests may be added to the diagnostic process.
During the examination, the extent to which nasal obstruction affects the patient’s daily life, sleep and overall quality of life is also asked about. In order to assess the severity of the complaints objectively, some clinics may use standard patient questionnaires; such scales help both to document the situation before treatment and to compare the improvement after treatment.
Treatment options
Conservative approaches
In mild deviations and when the symptoms do not greatly affect daily life, conservative methods are usually the first choice. Intranasal corticosteroid sprays, saline irrigation and treatment of accompanying allergic rhinitis can ease the feeling of obstruction by reducing swelling of the nasal lining. These approaches do not correct the structural deviation of the septum, but they can provide symptomatic relief by keeping the accompanying mucosal swelling under control. If complaints continue despite these treatments, the surgical option is considered.
Septoplasty surgery
Septoplasty is a surgical procedure that aims to open the air passage by straightening the bent pieces of cartilage and bone. The operation is performed entirely through the inside of the nose; it leaves no external incision or scar and does not change the outer appearance of the nose. If turbinate enlargement is present, a reduction procedure can be performed in the same session; in this way all sources of the obstruction are addressed in a single session.
If the patient also wishes to have an aesthetic change to the nasal dorsum or tip, the procedure can be planned as a septorhinoplasty, in which septoplasty and rhinoplasty are performed together. In this case both functional and aesthetic goals are addressed in the same operation.
Recovery and follow-up
In the first days after septoplasty, mild nasal congestion, discharge and swelling are expected findings; this is a natural consequence of the operation and settles on its own over time. Most patients can return to their daily activities within a few days; however, it is recommended to avoid heavy physical exertion, sports where the nose may be hit and staying in hot environments for long periods during the first weeks. A clear improvement in breathing usually appears within a few weeks, in parallel with the swelling going down, and full recovery can take a few months.
After surgery, cleaning of the inside of the nose and examinations carried out under the doctor’s supervision are important for healing to proceed well. During these check-ups, crusts inside the nose are cleaned, additional saline irrigation is recommended if necessary, and whether healing is progressing as expected is assessed. Keeping accompanying conditions such as allergic rhinitis under control after surgery as well is recommended for the relief to last in the long term.
Rare findings after surgery include a temporary change in the sense of smell, mild tenderness over the nasal dorsum and small residual deviations where the septum could not be fully centred; most of these settle on their own over time without needing any further procedure. In the small number of cases where a significant problem occurs, further assessment and, if necessary, planning of a revision can be carried out.
It is important for patients to keep their expectations realistic after surgery; the improvement in breathing usually progresses gradually and it may take a few months for the swelling to go down completely. In the long term, with regular follow-up and continuation of preventive treatment when necessary, the great majority of patients report lasting and marked relief.
Frequently asked questions
Does a deviated septum correct itself? No, the structural deviation of the septum does not correct itself; however, accompanying mucosal swelling can be reduced with medical treatment.
Can the obstruction be relieved without surgery? In mild cases intranasal sprays and allergy treatment can ease the symptoms, but for marked structural deviations a permanent solution is provided by septoplasty.
Does the shape of the nose change after septoplasty? No, standard septoplasty does not affect the outer appearance of the nose; if an aesthetic change is wanted, this is addressed with a separately planned septorhinoplasty.
When can I return to work or school after surgery? Most patients can return to their daily activities and working life within a few days; for heavy physical activity, the time recommended by the doctor should be waited.
Can the deviation come back? After septoplasty performed with the correct technique, significant recurrence is not expected, but a new injury to the nose can cause a deviation again.
For the summary:
Back to the short articleThis article is for general information purposes only; please consult your physician for diagnosis and treatment.