Deviated nasal septum

What is a deviated nasal septum?

The nasal septum is the central partition in the nose made of bone and a rubbery substance (called cartilage) which separates the two nostrils. It is rarely situated absolutely in the middle but in most people it is straight and fairly centrally placed. However, in some people the septum is either bent or deviated in some way. This can be very mild or, in some cases, so bad that one nostril is completely blocked.

Generally speaking there are two main types of deviation. The first occurs because the lower end of the septum becomes dislocated i. e. pulled from its attachment at the bottom of the nose. It becomes pushed to one side therefore narrowing one of the nostrils. The other type of deviation happens because the septum becomes deformed either in a bow shape or an 'S' shape. This can cause partial or complete blockage of both nostrils.

Why does it occur?

Most cases of deviated nasal septum result from some kind of trauma, either in the recent past or long forgotten such as in childbirth. Sometimes it can occur for no obvious reason.

What are the symptoms?

As mentioned above a deviated nasal septum can cause blockage of one or both nostrils which is not fully relieved by decongestants. Because a deviated septum can interfere with the drainage of catarrh from the sinuses, it can be a cause of recurrent sinus infections. As catarrh builds up in the sinuses then infection can occur. For the same reason, a deviated septum can be a cause of repeated ear infections or 'glue ear' because the drainage of mucus from the middle ear can be interrupted. People who scuba dive may find it difficult to equalise the pressure in their ears as they dive if they have a deviated septum because of a resulting blockage to the channels between the ears and the nasal passages.

How is it diagnosed?

Diagnosis can usually be made by the physician or specialist simply examining the nasal passages and finding an inequality in the size of the nostrils and a deformity of the septum. It is usually fairly obvious and is sometimes associated with a deviation of the nose.

What is the treatment?

Mild forms of deviation of the nasal septum do not require treatment other than treating the occasional symptoms such as sinusitis or nasal congestion with antibiotics and decongestants. However it is advisable not to use decongestants for a long period of time without a physicians advice, as misuse causes rebound action, where the symptoms may reoccur and may be worse than before. Where the deviation is more severe and is causing significant problems, the treatment is a surgical correction of the deformity. This can be done in one of two ways:

Submucous resection (SMR): This operation is usually done under general anaesthetic and involves peeling back the lining of the nose from the septum and removing the cartilage and bone from the deviated area. The lining is then replaced. The nose is gently packed for about 24 hours to maintain the correct position and usually the patient is allowed home after a day or two.

Septoplasty: A septoplasty involves removing less of the septum and trying to re-position it in the middle after straightening it. Sometimes the septum is held in place after the operation with splints which are placed inside the nostrils. Patients are sometimes instructed not to blow their nose for a week or two to allow the septum to heal up in the correct position.

Medications

• For minor discomfort, you may use non-prescription drugs, such as decongestants, to decrease nasal secretions.
• Antibiotics to fight infection, if necessary.
• Caution: Avoid over-the-counter nasal sprays.

Last updated 4 April 2018