Deviated Septum

Causes, Symptoms and Treatment of a Deviated Septum

ENT doctor examining teenage girl with nasal speculum

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The septum is the cartilage and bone that divides the nostrils. If the septum is deviated, it means that the wall is not aligned properly and may be dividing the nostrils unevenly. Some sources suggest that up to 80% of the population have a septum that is not centered, but this is only a problem when the septum is deviated far enough to cause bothersome symptoms. Small deviations usually require no treatment, as they do not cause noticeable symptoms.

What Causes a Deviated Septum?

Several things can cause a deviated septum. It can be due to a birth defect such as cleft lip or cleft palate. Other causes include injuries, such as a broken nose (very common), or damage from previous medical treatments.

Symptoms of a Deviated Septum

Symptoms are usually worse on one side than the other (the side that is smaller, since it makes it more difficult for air to pass through this nostril or for mucus and other debris to drain out). A deviated septum can cause problems with the sinuses draining and subsequent infections and sinus problems.

  • difficulty breathing (this is usually the first and most noticeable symptom)
  • congestion
  • frequent nosebleeds
  • sinus infections
  • facial pain
  • headaches
  • post-nasal drip
  • chronic sinusitis
  • blockage of one or both nostrils

Allergies or a common cold can make the symptoms of a deviated septum much worse. A deviated septum may cause or make sleep apnea worse.

Diagnosing a Deviated Septum

A deviated septum is best diagnosed by an otolaryngologist (ear, nose, throat specialist). This can usually be done fairly easily by examining your septum with a bright light and a nasal speculum.

However, because many of the symptoms of deviated septum coincide with other nasal or sinus conditions, these also need to be evaluated. Other conditions that may be present include sinus infection and accompanying swelling, swollen mucous membranes, or other anatomical abnormalities. In rare cases, a deviated septum may be the only cause of your sinus or nasal problems. 

How Is a Deviated Septum Treated?

A deviated septum can be surgically repaired with a procedure called a septoplasty or a submucosal resection (SMR). Both of these procedures are used to repair a deviated septum. An SMR may involve more tissue removal than a septoplasty. The nature of your surgery will depend on the defect and whether or not other surrounding structures are involved. Both procedures are often performed at the same time as nasal-sinus surgery or as part of the procedure to repair a cleft lip or palate. If you are under the age of 18 your doctor may choose to forgo septoplasty until you have finished growing. 

The cleft can commonly be affected as well as the maxillary sinuses. Maxillary fistulas, abnormal passageways between the maxillary sinus and the oral cavity, are not uncommon with a deviated septum and can be repaired simultaneously.

Surgery involves cutting away damaged portions of the septum and removing or realigning them. To avoid the need to make an incision, the procedure is usually done through the nostrils. There is usually no incision or visible bruising or other abnormalities noticeable on the outside of the nose after surgery (unless you also have a rhinoplasty at the same time). The surgeon may use splints or packing to keep the tissue in place while it heals. This also helps to control bleeding. Blood in the nose is also not uncommon after the packing is removed a few days after the surgery.

A septoplasty can be performed in a doctor's office (mild cases), a hospital, or a surgical center, and many people may be able to have same-day procedures. It is performed under both general and local anesthesia. Prior to surgery, your doctor or nurse will give you information about when to stop eating (usually after midnight the day of surgery) and what medications you can or cannot take prior to the surgery. Medications with blood thinning properties, such as aspirin, usually need to be discontinued well in advance of your procedure in order to prevent excessive bleeding during the surgery. Risks of surgery to repair a deviated septum include excessive bleeding, complications from anesthesia and infection. 

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Article Sources

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  1. American Academy of Otolaryngology - Head and Neck Surgery Foundation. Deviated septum. Updated August 2018.

  2. Fried MP. Deviated septum. Merck Manual. Updated March 2019.

  3. University of Michigan Medicine. Repair of a deviated septum (septoplasty). Updated October 21, 2018.