Definition

The two nostrils are separated by a structure called the nasal septum. This structure, consisting of bone and cartilage lined by a mucous membrane (mucosa) rich in blood vessels, sits between the nostrils.

A deviated nasal septum occurs when the septum is not positioned exactly in the centre of the nose. This misalignment can result in one nostril being smaller. Severe deviation of the nasal septum can block one nostril, reducing airflow and causing breathing difficulties. The larger nostril, exposed to more air, may become dry, crusty, and prone to nosebleeds due to broken blood vessels.

Symptoms of nasal congestion can arise from a deviated nasal septum due to swelling of the mucous membrane in one or both nostrils. Nasal sprays can alleviate nasal congestion by reducing swelling, while a deviated septum may require surgery to restore its original position.

Causes

Causes of a deviated nasal septum include:

• Congenital abnormalities: In some individuals, a deviated nasal septum is present from birth (congenital), resulting from imperfect fetal development or trauma during delivery.
• Nasal trauma: Following birth, a deviated nasal septum is commonly caused by trauma, such as accidents or sports-related injuries. Nasal trauma frequently occurs during contact sports like martial arts or boxing, while accidents can also contribute to a deviated nasal septum.
• Age: The aging process can induce changes in the nasal structure, potentially exacerbating a pre-existing deviated nasal septum.

Swelling of the nasal lining due to irritation or allergies in the nasal and sinus cavities can worsen blockage, leading to symptoms of nasal congestion on one side.

Read more: Nasal Trauma - Definition, Cause And Risk Factor.

Risk factor

Risk factors for experiencing a deviated nasal septum include:

• Engaging in sports involving physical contact, such as martial arts.
• Not using a seatbelt or helmet when driving.

Symptoms

Most nasal septum deviations do not cause symptoms. Many people are unaware of a deviated nasal septum until a physical examination by a doctor. However, severe deviations can present symptoms such as:

• Blockage of one or both nostrils can interfere with breathing and airflow. This symptom worsens during a cold or allergy, as viral infections or allergies can cause the mucous membrane to swell, blocking the airway.
• Nosebleeds. The mucous membrane in the wider nostril can dry out and bleed easily.
• Snoring. A deviated nasal septum or swelling of the nasal mucous membrane can cause snoring. In severe cases, some people may experience sleep apnea.
• Some people prefer to lie on a particular side to facilitate breathing while sleeping.
• Changes in the shape of the nose. A severely deviated nasal septum can significantly alter the structure of the nose, which is noticeable to others.
• Headache or facial pain.

Diagnosis

Your doctor will begin the examination by asking about your main complaints and symptoms. The doctor will then perform a physical examination of your nose, checking for nasal alignment, tenderness, scars, and the condition of your nasal mucous membrane. If necessary, a specialist may use a flexible camera inserted through the nose to view the nasal condition directly.

Based on this examination, the doctor can diagnose a deviated nasal septum and determine the severity of your condition. If you are seen by a general practitioner or another specialist, they will refer you to an ENT (Ear, Nose, and Throat) specialist.

Management

Initial treatment for a deviated nasal septum aims to manage symptoms. Your doctor may prescribe:

• Decongestants: These medications reduce swelling of the nasal mucous membrane, keeping both nasal passages open. Decongestants are available as nasal sprays and oral medications. Continuous use of decongestants can lead to dependence, and nasal congestion may worsen after stopping the medication. Consult your doctor on how to use decongestants and follow their recommendations.
• Antihistamines: If allergies are suspected, your doctor may prescribe antihistamines to reduce nasal congestion and runny nose symptoms. However, antihistamines can cause drowsiness, affecting daily activities and driving safety.
• Steroid nasal sprays: Steroids can help reduce nasal swelling, typically requiring 1–3 weeks to work effectively. Steroids can have side effects, so use them as your doctor directs.

The above treatments cannot correct the nasal septum's position or change the nose's shape.

If symptoms persist despite medication, your doctor may recommend surgery to correct the nasal septum. This surgery is called septoplasty. The improvement after septoplasty depends on the severity of the deviated nasal septum. Symptoms such as nasal congestion may drastically reduce, but sinus infections or allergies you experience may persist and cannot be treated with surgery.

In some cases, septoplasty is performed along with rhinoplasty, a procedure to change the shape of your nose by modifying the bone and cartilage to alter its form and size.

Complications

A severely deviated nasal septum can cause airway obstruction. If untreated, this can lead to:

• Dry mouth, from frequent mouth breathing
• Chronic nasal discomfort or congestion
• Sleep disturbances due to difficulty breathing normally through the nose at night
• Sinus infections
• Snoring
• Only being able to sleep on one side
• Continuous nosebleeds

Although septoplasty and septorhinoplasty are relatively safe, commonly performed, and rarely cause complications, no surgery is without risks. Possible risks include:

• Infection
• Bleeding
• Loss of smell

Prevention

Since most cases of a deviated nasal septum are caused by trauma, you can take steps to reduce the impact of such trauma:

• Use seat belts and helmets when driving
• Wear face protection when playing sports that could cause facial trauma
• Avoid overly dangerous sports

When to see a doctor?

Consult your doctor if you experience:

• Continuous nasal congestion is unresponsive to medications.
• Nasal congestion makes it difficult to breathe.
• Frequent nosebleeds.
• Sinus infections are indicated by facial pain.

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