Deviated Nasal Septum
Treatment for a crooked nasal septum causing persistent nasal blockage or breathing difficulty
What is deviated nasal septum?
The septum is the partition dividing the nose into two passages. It is made of cartilage at the front and bone behind, covered on both sides by the same lining that runs through the rest of the nose. Very few septa are perfectly straight; surveys of ordinary adults find some degree of bend in the large majority, and most of those people never notice it.
A bend becomes a problem when it narrows one passage enough to matter, or when it forms a spur that presses against the side wall. Some are present from birth or from the moulding of delivery, and many follow an injury in childhood that seemed minor at the time and was never treated.
The two sides are linked. When one passage is narrowed, the tissue on the roomier side often enlarges to compensate, so the person ends up with restricted airflow on both. The nose also cycles naturally through the day, congesting one side and then the other, so a fixed bend is often noticed most at night and on one side at a time.
What you might notice
- A blocked nose for weeks
- Loud snoring with pauses in the night
How it is diagnosed
The doctor looks inside both nostrils with a light and a speculum, then usually passes a thin endoscope to see the whole length of the septum back to the throat. The front section is visible from outside; the back is not, and a bend there behaves quite differently.
A decongestant spray is given and the nose examined again. What shrinks with the spray is swelling of the lining, which medication can treat. What does not shrink is structural, and that distinction is the single most useful thing the examination produces.
The outside of the nose is assessed at the same time, since a deviation of the framework changes what surgery can achieve. A CT of the sinuses is added where the drainage pathways may also be involved, and airflow can be measured objectively where the picture and the complaint do not match.
Recovery
Sprays and rinses ask only for consistency. A steroid spray needs six weeks of correct daily use before its effect can be judged, aimed outwards towards the eye on the same side and not straight up the middle, and stopping and restarting it is the usual reason people conclude it did not work.
After surgery, expect the nose to feel blocked and to be bloodstained for about a week, with a dull pressure across the bridge instead of sharp pain. Splints, where they are used, come out in the clinic at around a week. Saline rinses several times a day clear the crusts and are the most useful thing you do in the first month.
Desk work resumes in about a week and exercise at three, with contact sport left for six weeks so the newly straightened cartilage is not knocked. Breathing improves steadily over the first month and settles fully by about three, so it should not be judged in the first fortnight.
If it is left untreated
A bend that does not restrict the airway needs nothing done to it, and most adults have one. Where it is noticed only occasionally, or only during a cold, leaving it alone is entirely reasonable.
A bend that narrows one side permanently has knock-on effects instead of getting worse in itself. The tissue on the roomier side enlarges over years to compensate and eventually stops shrinking back, so the person who waits ends up needing both problems addressed. Restricted airflow also impairs sinus drainage on that side, so sinus trouble becomes more frequent, and habitual mouth breathing dries the throat and disturbs sleep.
A spur pressing hard against the side wall of the nose can cause a persistent one-sided headache, and a septum that has lost its blood supply after injury or repeated cautery can perforate, which is a harder problem to fix than the bend was. Sudden swelling of the septum after a blow to the nose, particularly in a child, needs to be seen the same day.
Questions about deviated nasal septum
Will straightening the septum change how my nose looks?
A septoplasty works entirely inside the nose through the nostril, addressing the partition and not the external framework, so the shape you see should be unchanged. If the outside of the nose is also crooked and you want that corrected, that is a different operation working on the bones and cartilage of the framework, and the two can be combined. Your surgeon will be clear about which one is being discussed, because the aims are different and so are the recovery and the expectations.
Why has my doctor prescribed a spray if the problem is structural?
Because a bent septum and a swollen lining almost always sit together, and only one of them needs surgery. A steroid spray used correctly for six weeks reduces the swelling, and what remains after that is the part attributable to the structure itself. Some people find that is enough. It also gives the surgeon a clearer picture of what an operation would actually achieve, and that is the reason the spray usually comes first even when the bend is obvious on examination.
Will the nose be packed afterwards?
Most surgeons no longer use the tight packing that gave this operation its reputation. Thin silicone splints stitched to the septum are common instead, and they hold it straight while allowing you to breathe through a channel in the middle. They come out at about a week in the clinic, which is uncomfortable for a moment and not painful in the way older packing was. Expect the nose to feel blocked and to be bloodstained for the first week regardless, and expect breathing to improve steadily over the month after that.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about deviated nasal septum
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one