Diseases & Conditions

Deviated septum

The thin wall inside your nose that separates your right and left nasal cavities is called your nasal septum. Ideally, your septum is situated in the center of your nose, equally separating the two sides of your nose. In about 80 percent of people, however, the nasal septum is displaced to one side, making one nasal passage smaller than the other. When your septum is significantly off-center, you have a deviated septum.

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.

Deviated septum may be present at birth or, more commonly, the result of an injury. Initial treatment of a deviated septum may include medications to manage signs and symptoms. But to correct a deviated septum, surgery is necessary.

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

In some cases, a deviated septum occurs during fetal development and is apparent at birth.

More commonly, a deviated septum is the result of an injury to your nose that causes the nasal septum to be knocked out of position.

In infants, such an injury may occur during the birthing process. In older 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.

See your doctor if you experience recurring sinus infections, frequent nosebleeds or a blocked nostril that doesn't respond to treatment within two to three weeks.

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).

Initial treatment of deviated septum may be directed at managing the signs and 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.
• 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
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.

Because septoplasty is performed through your nostrils, no skin incisions are made and no bruising or noticeable swelling occurs on your face. The surgery, which may take up to one and a half hours, may be done under local or general anesthesia. Following surgery, your nose may be packed with cotton to prevent bleeding.

Depending on how your nose heals and your pain level, you may be able to go home the day of surgery, or you may need to spend the night in the hospital.

What to expect after surgery
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 — cannot be cured with surgery.

Though septoplasty is a generally safe procedure, there are some risks associated with the use of anesthesia. Specific risks depend on the type of anesthesia used and your health. Risks specific to septoplasty may include infection, excessive bleeding, sensitivity loss in your upper teeth or lip, and a change in the shape of your nose. Talk to your doctor about your specific risks before 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.

Neither septoplasty nor rhinoplasty is performed on children, since they are still growing. Both surgeries are generally directed at adults ages 18 and older.