A deviated septum occurs when the thin wall (nasal septum) between your nostrils 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. However, in many people, 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, causing difficulty breathing, nosebleeds and other symptoms.
Treatment of nasal obstruction may include medications or adhesive strips to manage symptoms. But to correct a deviated septum, surgery is necessary.
A deviated septum occurs when the thin wall (nasal septum) between your nostrils is displaced to one side. In many people, the nasal septum is displaced — or deviated — making one nasal passage smaller.
When a deviated septum is severe, it can block one side of your nose and reduce airflow, causing difficulty breathing. The additional exposure of a deviated septum to the drying effect of airflow through the nose may sometimes contribute to crusting or bleeding in certain individuals.
Nasal obstruction can occur from a deviated nasal septum, from swelling of the tissues lining the nose, or from both. Treatment of nasal obstruction may include medications to reduce the swelling or adhesive strips that may help open the nasal passages. To correct a deviated septum, surgery is necessary.
Most septal deformities result in no symptoms, and you may not even know you have a deviated septum. Some septal deformities, however, 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 can cause your nasal passages to swell and narrow.
- Nosebleeds. The surface of your nasal septum may become dry, increasing your risk of nosebleeds.
- Facial pain. Though there is some debate about the possible nasal causes of facial pain, a severe deviated septum that impacts the inside nasal wall, when on the same side as one-sided facial pain, is sometimes considered a possible cause.
- Noisy breathing during sleep. This can occur in infants and young children with a deviated septum or with swelling of the intranasal tissues.
- Awareness of the nasal cycle. It is normal for the nose to alternate being obstructed on one side, then changing to being obstructed on the other. This is called the nasal cycle. The nasal cycle is a normal phenomenon, but being aware of the nasal cycle is unusual and can be an indication that there is an abnormal amount of nasal obstruction.
- Preference for sleeping on a particular side. Some people may prefer to sleep on a particular side in order to optimize breathing through the nose at night. This can be due to a deviated septum that narrows one nasal passage.
When to see a doctor
See your doctor if you experience:
- A blocked nostril (or nostrils) that doesn't respond to treatment
- Frequent nosebleeds
- Recurring sinus infections
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. A deviated septum can also be the result of an injury that causes the nasal septum to be moved out of position. In infants, such an injury may occur during childbirth. 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.
The normal aging process may affect nasal structures, worsening a deviated septum over time. Also, changes in the amount of swelling of nasal tissues, because of developing rhinitis or rhinosinusitis, can accentuate the narrowing of a nasal passage from a deviated septum, resulting in nasal obstruction.
For some people, a deviated septum is present at birth — occurring during fetal development or due to injury during childbirth. After birth, a deviated septum is most commonly caused by an injury that moves 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 causing nasal obstruction, it can lead to:
- Dry mouth, due to chronic mouth breathing
- A feeling of pressure or congestion in your nasal passages
- Disturbed sleep, due to the unpleasantness of not being able to breathe comfortably through the nose at night
Nasal septum deviation or deviated nasal septum (DNS) is a common physical disorder of the nose, involving a displacement of the nasal 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 breathing difficult. Most people have some sort of imbalance in the size of their breathing passages. In fact, estimates indicate that 80% of people, most unknowingly, have some sort of misalignment to 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 develop a deviated septum after 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 difficulty breathing. Recurrent or repeated sinus infections can also be a sign of a deviated septum. Other symptoms include frequent:
- Facial pain
- Postnasal drip
A deviated septum may also cause sleep apnea, a serious condition in which a person stops breathing during sleep.
Deviated Septum Treatments
Sometimes symptoms of a deviated septum can be relieved with medications. If medicine alone doesn't offer adequate relief, a surgical procedure called septoplasty may be needed to repair a crooked septum and improve breathing.
Deviated Septum Surgery
During septoplasty, a surgeon, working through the inside of the nose, makes a small incision in the septum and then removes the excess bone or cartilage required to even out the breathing space of the nostrils.
Sometimes, a rhinoplasty, or "nose job," is combined with septoplasty to improve the appearance of the nose. This procedure is called septorhinoplasty. Septoplasty may also be combined with sinus surgery.
Surgery to repair a deviated septum is usually performed in an outpatient setting under local or general anesthesia and takes about one to one and a half hours, depending on the amount of work being done. You should be able to go home three to four hours after surgery.
Internal splints or soft packing material may be put in the nose to stabilize the septum as it heals. If a septoplasty is the only procedure performed, there should be little to no swelling or bruising after surgery. However, if a septorhinoplasty is performed, a week or two of swelling and bruising is normal following the procedure.
If possible, it is best to wait until after the nose has stopped growing, around age 15, to have surgery.
Newer procedures are becoming available that use balloon septoplasty techniques that avoid actual surgery and are done in the office setting. These are being done for milder cases.
Deviated Septum Surgery Risks
No surgery is completely risk-free, and the benefits of undergoing 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) of the septum
- Loss of the ability to 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, or ENT. There are a number of reasons why you may be experiencing these symptoms, including chronic sinusitis or nasal allergies. Make sure you get the right diagnosis so that you can get the treatment you need.
The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.
Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A "deviated septum" occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.
Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma.
A deviated septum may cause one or more of the following:
- Blockage of one or both nostrils
- Nasal congestion, sometimes one-sided
- Frequent nosebleeds
- Frequent sinus infections
- At times, facial pain, headaches, postnasal drip
- Noisy breathing during sleep (in infants and young children)
In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a "cold" (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the "cold" resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too.
Diagnosis Of A Deviated Septum:
Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.