What Is a Deviated Septum?
A deviated septum is a condition in which the nasal septum – the bone and cartilage that divide the nasal cavity of the nose in half – is significantly off center, or crooked, making it hard to breathe. Most people have some sort of imbalance in the size of their breathing passages. In fact, it's estimated that 80% of people, most unknowingly, have some sort of misalignment of their nasal septum. Only the more severe imbalances cause significant breathing problems and require treatment.
Deviated Septum Causes
Some people are born with a deviated septum. Other people have a deviated septum after an injury or trauma to the nose.
Deviated Septum Symptoms
The most common symptom of a deviated septum is nasal congestion, with one side of the nose being more congested than the other, along with a hard time breathing. Repeated sinus infections can also be a sign of a deviated septum. Other symptoms include frequent:
- Facial pain
- Postnasal drip
- Loud breathing and snoring during sleep
- Obstruction of one or both nostrils
- Noisy breathing during sleep
- Awareness of the nasal cycle
- Preference for sleeping on a particular side
Many sleep apnea patients have a deviated nasal septum.
Deviated Septum Diagnosis
Your doctor, or an ear, nose, and throat (ENT) specialist, will ask you a series of questions and examine inside your nostrils to diagnose a deviated septum. Some questions to expect may include:
- Do you have trouble breathing?
- Do you have trouble sleeping or snore often?
- How often do you have sinus infections?
- How long have you had these symptoms?
- How severe are your symptoms?
- Have you had any injuries or trauma to the nose?
- Do you have a history of nosebleeds?
- Have you or do you take any medications currently for these symptoms?
- Do you have a decreased sense of smell?
- Does taking a decongestant help with your symptoms?
The physical exam may involve a few pieces of equipment to see the inside of your nostrils. Your doctor may use a light to see the inside of your nose and possibly a lit tube-shaped scope to see farther back inside your nostrils. A nasal speculum will carefully open the nostril pathways, allowing your doctor a better look. They may see how your septum looks before and after applying a decongestant spray.
After your exam, your doctor or ENT will be able to diagnose if you have a deviated septum and what your next steps should be.
Deviated septum self-test
A medical diagnosis is the only sure way of knowing if you have a deviated septum. But doing the following self-exam may help you decide to seek medical attention.
If your nostrils are uneven, you might have a deviated septum. Try tilting your head back to see inside your nostrils while looking in the mirror. Or take a picture of the inside of your nose. If your nostrils are uneven, you might have a deviated septum.
Here is another way to self-test for a deviated septum:
- Hold one nostril closed with your finger.
- Breathe in through the open nostril. Notice how easy or difficult it is.
- Switch sides and repeat.
If you have a hard time breathing easily through one or both nostrils, you may have a deviated septum.
Deviated Septum Treatments
A deviated septum can sometimes be relieved with medications. If medicine doesn't offer relief, surgery may be needed to repair a crooked septum and improve breathing.
Medication for a deviated septum
Your doctor may prescribe medication to ease the symptoms of a deviated septum. While these medications may help with your symptoms, they will not permanently correct a deviated septum.
Medications for symptoms of a deviated septum may include:
Decongestants can be taken either orally or as a spray. They help reduce swelling of the nasal cavity to increase airflow. But both may have side effects. Oral decongestants can rev up some people. Spray decongestants often have a rebound effect, working well for a few days only to boomerang and make symptoms worse afterward. Neither is intended for long-term use.
Nasal steroid sprays
Nasal steroid sprays increase drainage by reducing swelling. A prescription corticosteroid may take 1-3 weeks to reach full effect. Be sure to follow your doctor's instructions when using it.
Antihistamines can help reduce symptoms like a runny or stuffy nose. They often cause drowsiness and should be used with caution before driving or when you're taking other medications.
As an additional treatment option, nasal strips are non-medicated and are easily found over the counter. They attach to the outside of your nose and gently open your nostrils to increase airflow.
Deviated Septum Surgery
If you are considering surgery for a deviated septum, there are different procedures your doctor may recommend. Deviated septum repair is usually done under local or general anesthesia. If possible, it is best to wait until after the nose has stopped growing, around age 15, to have surgery.
Before a septoplasty, your doctor will review your medical history, give you a physical exam, and take pictures of your nose from various angles.
During septoplasty, a surgeon, working through the inside of the nose, makes a small cut in the septum and removes the excess bone or cartilage required to even out the breathing space of the nostrils. Internal splints or soft packing material may be put in the nose to stabilize the septum as it heals.
A septoplasty typically takes an hour to an hour and a half, depending on the work being done. You should be able to go home 3 to 4 hours after surgery. Occasionally, patients stay overnight in the hospital. If the septoplasty is the only procedure done, there should be little to no swelling or bruising after surgery.
Septorhinoplasty combines a septoplasty with a rhinoplasty, or "nose job.” This improves both the function and appearance of the nose.
Before a septorhinoplasty, a plastic surgeon will evaluate you and review your medical history. They may take photographs and 3D images, as well as jaw and chin measurements. This will help your surgeon create the shape of your nose that best suits your facial features.
A week or two of swelling and bruising is normal after this procedure.
A submucosal resection is similar to a septoplasty. They both straighten the septum by removing cartilage from the septum to open the nasal cavity. A submucosal resection may require more cartilage removal. Today, septoplasty is more common.
Nasal turbinates are long, thin bones covered in a layer of tissue inside the walls of the nose. When they swell or become blocked, airflow decreases. A turbinate outfracture is a procedure done to move the nasal turbinates to open the airways. During this procedure, small amounts of tissue may be gently shaved off to open the nasal cavity.
Before a turbinate outfracture, your doctor will review your medical history. Be sure to share with them if you are taking any medications, as they may ask you to stop before and during the procedure. You’ll need to avoid eating or drinking anything after midnight the night before your procedure.
Nasal turbinate is an outpatient procedure – you can expect to go home the same day. Swelling and pain may persist for 2-3 days. Full recovery takes about 2 months. But most patients have a long-term positive outcome with improved breathing 2 to 3 years after surgery.
Deviated Septum Surgery Risks
No surgery is completely risk-free, and the benefits of surgery – in this case, being able to breathe better – must outweigh the risks. Septoplasty and septorhinoplasty are common and safe procedures; side effects are rare. Still, talk with your doctor about the possible risks of surgery before you make a treatment decision.
Although rare, risks of septoplasty and/or rhinoplasty may include:
- Hole (perforation) in the septum
- Loss of your sense of smell
If you are having nasal symptoms and think you may have a deviated septum, make an appointment to see an ear, nose, and throat doctor. There are a number of reasons you can have these symptoms, including chronic sinusitis or nasal allergies. Make sure you get the right diagnosis so that you can get the treatment you need.
Can a Deviated Septum Cause Sleep Apnea?
A deviated septum causes restricted nasal airflow. This can lead to mouth-breathing and snoring, which is linked to sleep apnea. And having a deviated septum increases your chance of sinus infections that can disrupt sleep quality.
One 9-year study of sleep apnea in those with a deviated septum found that sleep apnea occurred nearly 4.5 times more in those with a deviated septum.
A deviated septum happens when the bone and cartilage of the nose are off-center. Symptoms include restricted breathing, headaches, sleep apnea, and nosebleeds. Your doctor or an ear, nose, and throat specialist can diagnose you if you think you have a deviated septum. With your doctor, you can decide which treatment is best: over-the-counter medication, prescribed medication, or surgery.
Deviated Septum FAQs
Is it worth fixing a deviated septum?
Whether or not you fix your deviated septum will depend on how severe your symptoms are and the effect your symptoms have on your quality of life. After discussing your individual situation with your doctor, you’ll be able to determine if surgery is right for you.
What happens when someone has a deviated septum?
Living with a deviated septum can restrict the airflow through the nostrils, making it hard to breathe. It can also cause headaches, sleep apnea, sinus infections, nosebleeds, and a reduced sense of smell.
What is the main cause of a deviated septum?
A deviated septum happens when the bone and cartilage that separate the two sides of your nose are crooked, rather than straight. You can be born with a deviated septum, or it can happen after an injury or trauma to the nose.