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Deviated septum

A deviated septum occurs when the thin wall (nasal septum) inside your nose is displaced to one side. Your septum separates your right and left nasal cavities and ideally is situated in the center of your nose, equally separating the two sides. In about 80 percent of people, however, the nasal septum is displaced, making one nasal passage smaller.

When a deviated septum is severe, it can block one side of your nose and reduce airflow. Resulting signs and symptoms can include difficulty breathing, nasal congestion, nosebleeds and frequent sinus infections.

A deviated septum may be present at birth or, more commonly, the result of an injury. Treatment of nasal obstruction may include medications to manage symptoms. But to correct a deviated septum, surgery is necessary.

If a deviation in your nasal septum is minor, you may have no symptoms and you may not even know you have a deviated septum. If the deviation is severe, however, it may cause the following signs and symptoms:

• Obstruction of one or both nostrils. This obstruction can make it difficult to breathe through the nostril or nostrils. This may be more noticeable when you have a cold (upper respiratory tract infection) or allergies that cause your nasal passages to swell and narrow.
• Nasal congestion. As a result of nasal congestion, postnasal drip also is common. Postnasal drip occurs when mucus is blocked from flowing out of your nose, causing it to drip into and linger in the back of your throat.
• Nosebleeds. The surface of your nasal septum may become dry, increasing your risk of nosebleeds.
• Frequent or recurring sinus infections. Sinus infections can result from blocked mucus and are often marked by facial pain and headaches.
• Noisy breathing during sleep. This is more common in infants and young children with deviated septums.

When to see a doctor
See your doctor if you experience:

• Recurring sinus infections
• Frequent nosebleeds
• A blocked nostril that doesn't respond to treatment within two to three weeks

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Deviated septum

A deviated septum occurs when your nasal septum — the thin wall that separates your right and left nasal passages — is displaced to one side.

A deviated septum can be caused by:

• A condition present at birth. In some cases, a deviated septum occurs during fetal development and is apparent at birth.
• Injury to the nose. More commonly, a deviated septum is the result of an injury that causes the nasal septum to be knocked out of position. In infants, such an injury may occur during the birthing process. In children and adults, a wide array of accidents may lead to a nose injury and deviated septum — from tripping on a step to colliding with another person on the sidewalk. Trauma to the nose most commonly occurs during contact sports, active play or roughhousing, or automobile accidents.

For some people, a deviated septum is present at birth — occurring during fetal development or due to injury during the birthing process. After birth, a deviated septum is most commonly caused by an injury that knocks your nasal septum out of place. Risk factors include:

• Playing contact sports
• Not wearing your seat belt while riding in a motorized vehicle

If you have a severely deviated septum it may cause:

• Chronic sinus infections
• Postnasal drip or nasal congestion
• Nosebleeds
• Facial pain and headaches

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred directly to a specialist (otolaryngologist)

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For a deviated septum and its complications, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

During a physical exam, your doctor will ask about your symptoms — such as nosebleeds or nasal congestion — and ask whether you've had any trauma to your nose.

Using a bright light and an instrument (nasal speculum) designed to spread open your nostrils, your doctor will examine the inside of your nose. Based on this exam, he or she should be able to diagnose deviated septum and determine the seriousness of your condition.

If treatment is necessary, your doctor may refer you to an ear, nose and throat specialist (otolaryngologist).

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Results of rhinoplasty

Managing symptoms
Initial treatment of deviated septum may be directed at managing the symptoms of the condition, such as nasal congestion and postnasal drip. Your doctor may prescribe:

• Decongestants. Decongestants are medications that reduce nasal congestion, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray. Use nasal sprays with caution, however. Frequent use can create dependency and cause symptoms to be worse (rebound) after you stop using them.
• Antihistamines. Antihistamines are medications that help prevent many cold and allergy symptoms, including runny nose. Avoiding a runny nose is important when you have a deviated septum because the mucus can become blocked in your narrow nasal passage, causing discomfort, postnasal drip or, ultimately, a sinus infection.
• Nasal cortisone sprays. Prescription nasal cortisone sprays can reduce inflammation in your nasal passage and help prevent runny nose — thus reducing your risk of nasal blockage and sinus infection.

Medications are only a temporary fix, however, and won't correct a deviated septum.

Surgical repair (septoplasty)
If you experience especially bothersome symptoms — such as significant airway obstruction, chronic sinusitis or frequent nosebleeds — you may consider surgery to correct a deviated septum (septoplasty).

Septoplasty is the only way to repair a deviated septum. During septoplasty, your nasal septum is repositioned in the center of your nose. This may require your surgeon to cut and remove parts of your septum before reinserting it in the proper position.

The level of improvement you can expect with surgery depends on the severity of your deviation. Symptoms due to the deviated septum — such as nosebleeds and nasal obstruction — often completely resolve. However, any accompanying nasal or sinus conditions — such as allergies — can't be cured with surgery.

Reshaping your nose
In some cases, surgery to reshape the nose (rhinoplasty) is performed at the same time as septoplasty. Rhinoplasty involves readjusting the bone and cartilage of your nose to change its shape or size or both.

You may be able to prevent the injuries to your nose that can cause deviated septum with these precautions:

• Wear a helmet when playing contact sports, such as football and hockey.
• Wear a seat belt when riding in a motorized vehicle.