You might have heard the term “deviated septum” and wondered if it could be the cause of your breathing issues. Bottom Line Personal asked rhinologist and surgeon Peter Filip, MD, to explain.
What is a deviated septum?
A deviated septum refers to a displaced nasal septum, the cartilaginous and bony structure covered by mucosa—a soft tissue lining—that divides the left and right nasal cavity.
What does a deviated septum look like?
While most deviations are within the nose and not externally visible, in some cases, especially if you have a nasal fracture from a trauma or a congenital deformity, you might be able to see the deviation on the outside. You might notice nasal asymmetry or an unevenness between the two sides of the nose, possibly on the bridge of the nose or when looking up from the bottom of the nose. Regardless of its outward appearance, a deviated septum’s impact on your ability to breath through your nose is determined by the degree of deviation inside the nose.
What causes a deviated septum?
There are three main causes…
- Trauma: One of the most common causes of a deviated septum is a fracture of the septum that pushes it out of its normal position. This can happen from a trauma to the nose, such as an injury during a contact sport, or an accident. Surprisingly, many trauma-related deviated septums go unrecognized in childhood or the teen years.
- Aging: Some deviations can happen with aging because cartilage “remodels” or changes over time. Combined with changes to the mucosa or other nasal structures, a previously minor deviation can become clinically significant, meaning you start to notice its effects.
- Congenital: Some people are born with a deviated septum, possibly due to developmental anomalies, trauma from going through the birth canal or even the baby’s position in the uterus, but the true incidence of heritable causes is not well known. Some craniofacial syndromes that cause deformities, such as a cleft palate, can cause the septum to be deviated.
What are typical deviated septum symptoms?
The most common symptom is congestion in one or both sides of the nose. In some people, it can be very mild…but in others, it can be so severe that it leads to mouth breathing, snoring and, in some cases, nasal dryness and nosebleeds. With very severe deviations, you may notice that your sense of smell is diminished. Some people develop recurring sinus infections as well if the septum obstructs the sinuses.
How is a deviated septum diagnosed?
An ear, nose and throat specialist (ENT) can make the determination during an office visit by looking at your nose and sinuses from the inside with a camera called an endoscope.
Can a deviated septum be fixed without surgery?
There has been an increased emphasis on conservative management with topicals when symptoms are mild, especially if you’re experiencing other issues such as nasal allergies. In fact, most insurance companies mandate a trial of therapies, often with a nasal steroid, such as fluticasone or mometasone, and an antihistamine spray, such as azelastine, for at least one month before approving surgery. Other insurers even mandate trying both the steroid and an antihistamine spray before proceeding with surgery.
By trying different medications, doctors can delineate two separate problems—an inflamed, swollen nasal cavity…and a deviated septum. These sprays target swelling of the mucosa (the lining of the nose). Some patients breathe much better when using these sprays, which indicates that the septum is not as much the problem as is the swelling (often caused by environmental allergies, pollution, etc.).
Saline irrigations may also help. These nonsurgical treatments aim to reduce inflammation and open nasal passages though they don’t address the deviation directly.
There is also a nonsurgical in-office therapy that may help correct mild cartilage deviations by placing a dissolvable implant in the nose. But this is a new technique, and there is not a lot of supporting literature for it yet.
What does deviated septum surgery involve?
Called septoplasty, this surgery remains the gold standard for correcting a deviation in people with persistent symptoms, such as nasal congestion, that are not relieved by steroids and sprays. It involves making a small incision on the inside of the nose and lifting off the lining of the septum on both sides. Once the deviated portion of the septum (cartilage and bone) is isolated, it can be straightened or, in some cases, removed if not structurally important.
Must a deviated septum be corrected?
Untreated, persistent nasal congestion from a deviated septum can lead to other problems, such as having a hard time exercising, trouble sleeping and snoring. Though a deviated septum won’t affect your overall longevity, it can lead to a decreased quality of life and should be addressed.
