Nasal Septum Deviation | Symptoms, Causes, and Treatment 2024

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PNasal Septum Deviation

The nasal septum is the wall of cartilage and bone that separates the nasal cavities. Ideally, it runs down the center of the nose, dividing it into two equal air passages. However, in some cases, the septum can deviate to one side or the other, obstructing airflow and causing a variety of symptoms. This condition is known as a deviated nasal septum. Let’s take a closer look at the symptoms, causes, diagnosis, and treatment options for a deviated septum in 2024.

What is a Deviated Nasal Septum?

A deviated septum refers to a shift or bend in the nasal septum to one side of the nose’s midline. As a result, one side of the nasal passage becomes smaller, while the other side appears larger. This can cause obstructed airflow, leading to breathing difficulties, congestion, facial pain and pressure, nosebleeds, and other issues. The condition can be present at birth due to abnormal development (congenital) or develop later due to injury (acquired). Septal deviations are quite common, affecting around 80% of people. However, symptoms vary greatly between individuals depending on the severity and location of the deviation.

Symptoms of a Deviated Nasal Septum

The most common symptoms of a deviated septum include:

Difficulty Breathing Through Nose

Since one or both sides of the nasal passages are obstructed or narrowed, airflow through the nose can become challenging. You may notice the need to breathe through your mouth or difficulty getting an adequate breath through your nose. Breathing issues tend to be worse on the side the septum deviates towards. Congestion and stuffiness are also common, especially if the deviation leads to trapped mucus and fluids or swelling of nasal tissues.

Frequent Nosebleeds

As air struggles to flow through the narrowed passages, it often flows more forcefully against nearby tissue surfaces. This constant irritation can result in nosebleeds, particularly on the more obstructed side. Bleeding may be frequent or occur spontaneously without any trauma.

Facial Pain and Headaches

Obstructed airflow and pressure buildup in the sinuses or nasal cavity can lead to facial pain, headaches, and sinus pressure. This typically occurs in the area of the forehead and cheeks but can affect the entire face. The pain may be dull and constant or more intense at specific times.

Sleep Disturbances

Breathing difficulties caused by a deviated septum often disrupt sleep. You may experience loud snoring or obstructive sleep apnea as you struggle to breathe through your nose. As a result, sleep quality suffers and you may feel tired or irritable during the day.

Ear Issues

The nasal passages and ears connect via the Eustachian tubes in the back of the nose and throat. Obstruction in the nose can affect the opening and closing of the Eustachian tubes, leading to fluid buildup and pressure changes in the ears. This can cause earaches, ringing, dulled hearing, and a “plugged” sensation.

Causes and Risk Factors

There are several potential causes of a deviated nasal septum:

Congenital Causes

In some cases, a septal deviation is present from birth due to abnormal growth or fusion of nasal structures during fetal development. Genetic factors likely play a role. While present at birth, symptoms may not arise until later in childhood or adulthood as airflow needs increase.

Traumatic Injury

The nasal septum is vulnerable to injury from impact to the nose. A forceful blow can displace the cartilage and bones of the septum to one side. Common injuries that lead to septal deviations include sports collisions, falls, car accidents, and physical abuse. The resulting crooked septum may slowly worsen over time as it weakens and further shifts away from the midline.

Compression Forces

Prolonged pressure on the nose during development can compress nasal structures to one side. For example, resting an infant on one side during sleep may compress that nostril, gradually deviating from the septum. Mouth breathing may also displace the septum as one side of the nose takes on more airflow.

Other Factors

Less common causes include cysts and tumors which expand and compress the septum. Severe nose-picking may traumatize nasal tissues. In very rare cases, underlying conditions like high blood pressure, connective tissue disorders, or diabetes could contribute to septal changes. Genetics likely play a role as well.

Diagnosing a Deviated Nasal Septum

If you experience ongoing nasal obstruction or related symptoms, see an otolaryngologist (ENT doctor) for an evaluation. They will examine the inside of your nose with special tools to look for any septal deviation, swelling, masses, or blockages.

You may then undergo:

  • Nasal endoscopy – A tiny camera on a thin tube is inserted in the nose to view nasal anatomy. This allows precise identification of the location and severity of any septal deviation.
  • Imaging tests – CT scans or MRI scans provide detailed views of the nasal structures and sinuses. This helps identify any additional issues like sinusitis.
  • Allergy testing – If allergies are contributing to swelling and congestion, allergy testing can identify specific triggers to avoid.
  • Sleep study – If sleep apnea is suspected, you may undergo an overnight sleep study to evaluate breathing disturbances.

Determining the underlying cause and structural changes allows an effective treatment approach to be developed.

Treating a Deviated Nasal Septum

Treatment options for a deviated septum aim to open nasal passages, improve breathing, and prevent complications. The main approaches include:

Septoplasty Surgery

This surgery straightens and repositions the deviated septum to restore normal airflow. It involves making incisions inside the nose to access and restructure the cartilage and bone. Splints or packing may temporarily support the corrected septum as it heals over several weeks. Septoplasty is an outpatient procedure with fast recovery. It is highly effective at improving symptoms when severe deviation is present.

Non-Surgical Options

For mild deviation, nonsurgical approaches may relieve congestion and breathing issues:

  • Saline spray moisturizes dry nasal tissues and removes mucus and irritants
  • Nasal steroid sprays like Flonase reduce inflammation and swelling
  • Antihistamines control congestion and runniness from allergies
  • Pain relievers ease headaches and facial pain
  • Decongestant nasal sprays offer temporary relief, but long-term use is not recommended
  • Nasal strips open the nasal passages from the outside
  • Saltwater nasal irrigation washes away mucus and debris

Additional Procedures

Other procedures may be recommended in conjunction with septoplasty:

  • Turbinate reduction – Enlarged turbinates can further block airflow and are often reduced at the time of septoplasty.
  • Sinus surgery – If sinusitis is contributing to congestion, sinus surgery may be performed simultaneously.
  • Sleep apnea surgery – Those with sleep apnea may undergo additional procedures like adenoidectomy or CPAP.

What to Expect After Septoplasty

Recovery after septoplasty generally takes 1-2 weeks with the following timeline and tips:

  • Early recovery – Expect nasal congestion, pain, and pressure for the first few days. Use prescribed medication to control discomfort. Rest with the head elevated on several pillows.
  • Bleeding – Oozing and spotting of blood are common early on. Call your doctor if you experience excessive bleeding from the nose or down the throat.
  • Activity – Take it easy for the first week to allow healing. Avoid strenuous activity, bending over, heavy lifting, air travel, etc initially.
  • Diet – Stick to soft, cool foods like yogurt, soup, and ice cream early on. Hot spicy foods can irritate healing tissues. Stay hydrated.
  • Packing removal – Any gauze packing is typically removed after a few days. Removing the packing doesn’t hurt but may cause brief bleeding.
  • Medications – Use all prescribed antibiotics, nasal sprays, pain relievers, etc as directed to prevent complications.
  • Follow-up appointment – See your doctor within 2 weeks to ensure proper healing. You may need ongoing steroid spray for several weeks.
  • Avoid nose blowing – Do not blow your nose forcefully for at least 2 weeks until fully healed. Simply dab away drainage as needed.
  • Return to activity – You can generally resume strenuous activity, exercise, and air travel after 2 weeks. Use caution to avoid re-injury to the nasal tissues.

Septoplasty takes time for the final results to appear. It may take several weeks for swelling to fully subside and normal airflow to be restored. Be patient as you recover and avoid reinjuring your nose during those initial weeks.

Results and Success Rate of Septoplasty

When performed correctly for appropriate cases, septoplasty offers excellent outcomes:

  • Improved breathing – Around 80-90% of patients report improved nasal breathing after surgery that is maintained over time. The nose feels wide open and unobstructed.
  • Pain relief – Facial pain and sinus pressure are typically significantly improved or eliminated after surgery. Headaches become less frequent.
  • Quality sleep – With improved breathing, snoring, sleep apnea, and daytime drowsiness are often reduced. Patients report feeling well rested.
  • Prevent bleeding – Spontaneous nosebleeds from irritated nasal tissue usually cease after surgery.
  • Low complication risk – Septoplasty is considered a very safe procedure when performed by an experienced ENT. Serious complications are uncommon when instructions are properly followed.
  • High satisfaction – Overall satisfaction rates with septoplasty are around 85-90%. Patients report greatly improved quality of life and ability to breathe freely.

Be sure to discuss expected outcomes, required follow-up care, and risks with your ENT surgeon prior to septoplasty to make an informed decision. For severe septal deviations causing breathing problems and discomfort, septoplasty can be life-changing.

Risks and Complications of Septoplasty Surgery

While considered very safe and effective when performed correctly, septoplasty does carry some risks and potential complications to consider:

Bleeding

  • Bleeding is common after surgery but excessive loss can be serious. Report heavy bleeding right away as further treatment may be required. Using prescribed medication can help control bleeding.

Infection

  • Bacteria can be introduced during surgery leading to painful infections that may require antibiotics. Proper wound care helps prevent infection.

Nasal Adhesions

  • Scarring during the healing process can lead to abnormal adhesions inside the nasal passage. Further minor surgery may be required to remove adhesions if needed.

Septal Perforation

  • In rare cases, an actual hole may develop in the nasal septum after surgery. Large perforations require surgical repair while small ones often need no treatment.

Loss of Sense of Smell

  • Damage to olfactory nerves can temporarily affect the sense of smell. This side effect is uncommon and typically resolves within a few weeks.

Pain and Swelling

  • Mild to moderate nasal pain, congestion, and pressure are common during the recovery period. Follow instructions to control discomfort.

Unsuccessful Outcome

  • In some cases, septoplasty may not significantly improve airflow if extensive deformity is present. Additional procedures or revision surgery may be necessary.

Carefully following your doctor’s post-op directions can help prevent many septoplasty risks. Be sure to ask your ENT surgeon about potential complications and how they will be managed if they occur.

Frequently Asked Questions About Septoplasty

Here are answers to some common questions about septoplasty surgery:

Is septoplasty painful?

Septoplasty is not generally a very painful procedure, however, you will likely experience mild to moderate nasal pain, congestion, and pressure for the first 1-2 weeks after surgery. Prescription pain medication is used to control discomfort during recovery.

Does septoplasty improve the appearance?

The procedure focuses on straightening the nasal septum to improve breathing, not outward appearance. However, if a deviated septum is causing external nasal deformity, then straightening it can help improve cosmetic appearance as well.

What is the recovery time after septoplasty?

The initial septoplasty recovery period is around 1-2 weeks, avoiding strenuous activity during this time. However, it may take several months for all swelling to resolve and final results to appear. Most people can return to work or school after 1 week.

Can septoplasty fix sleep apnea?

If sleep apnea is caused by nasal obstruction from a deviated septum, then septoplasty may significantly improve it. However, you may need additional treatments for sleep apnea caused by non-nasal factors.

How long does septoplasty last?

When performed properly, the effects of septoplasty are permanent and the straightened septum will not revert back to its original deviated shape. However, a new injury could possibly cause it to bend again.

Can a septoplasty fail?

In some cases, septoplasty may not significantly improve symptoms if the deviation was not the main cause or an unusually severe deformity exists. This may require revision surgery for the best outcome. But in general, septoplasty success rates are very high.

Should I get surgery for a deviated septum?

You should consider septoplasty if a severely deviated septum is causing significant nasal obstruction and discomfort that continues despite nonsurgical treatments. Discuss the pros, cons, and alternative options with your ENT.

Sources

American Academy of Otolaryngology–Head and Neck Surgery. “Deviated Septum.” Accessed November 2022. https://www.enthealth.org/conditions/deviated-septum/

Medline Plus. “Deviated nasal septum – adults.” Accessed November 2022. https://medlineplus.gov/ency/article/001649.htm

Cleveland Clinic. “Septoplasty.” Accessed November 2022.

Bomeli, Steven R., et al. “Efficacy and Safety of Septoplasty.” JAMA Facial Plastic Surgery vol. 17,2 (2015): 133-40. doi:10.1001/jamafacial.2014.1329

Yu, Jae Hoon, et al. “Long-term Patient Satisfaction after Septoplasty Alone Versus Septorhinoplasty.” Journal of Rhinology, vol. 22, no. 2, 2015, p. 119., doi:10.18787/jr.2015.22.2.119.

Wang, De-Yun, et al. “Outcomes from Endoscopic Septoplasty Are Superior to Traditional Septoplasty.” International Forum of Allergy & rhinology vol. 3,12 (2013): 977-82. doi:10.1002/alr.21246

Conclusion

A deviated nasal septum is a common structural cause of nasal congestion that disrupts airflow and breathing. While septal deviation may be present from birth, injury later in life is a frequent cause as well. Symptoms like facial pain, nosebleeds, ear pressure, and sleep disturbances can significantly impact the quality of life when severe. Consulting an ENT specialist is essential, as they can identify the deviation through nasal examination and imaging.

Septoplasty surgery is highly effective in correcting a deviated septum when conservative treatments fail. The procedure straightens and repositions the nasal septum, providing lasting improvement in breathing, sleep quality, pain relief, and more. Recovery takes about 1-2 weeks, during which nasal congestion, discomfort, and bleeding may occur. Risks are low with proper surgical care and follow-up. For most patients with significant nasal obstruction, septoplasty greatly improves comfort and function. Ongoing advances in the technique are helping further optimize outcomes from this beneficial surgery.

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