A deviated septum is when the wall of cartilage and bone dividing the two sides of the nose is bent or off-centre. Mild deviation is very common and often causes no symptoms. A more marked deviation can block one or both sides, causing congestion, snoring, mouth breathing or nosebleeds. Treatment starts with medical measures, and surgery, septoplasty or septorhinoplasty, is considered when symptoms persist.
What the septum does
The septum runs down the middle of the nose from the nostrils to the back of the nasal cavity. At the front it is made of flexible cartilage; further back it is bone. As well as dividing the airway into two channels, it supports the bridge and tip. Because it contributes to both breathing and shape, a deviation can affect how the nose works and, in some cases, how it looks, making the tip or lower bridge lean to one side.
Causes
- Development: many people are born with, or develop during growth, a slightly bent septum.
- Injury: a knock to the nose, sometimes in childhood and long forgotten, can buckle or dislocate the septum.
- Sport: contact sports are a common cause of septal injury in adults.
- Previous surgery: earlier nasal operations can occasionally leave a residual or new deviation.
Symptoms
Symptoms depend on where and how severely the septum is bent. Common complaints include a blocked nose, often worse on one side; noisy breathing or snoring; mouth breathing, especially at night; a dry mouth on waking; frequent nosebleeds from the drier side; recurrent sinus problems; and difficulty using nasal sprays. Many people also notice their blockage alternates from side to side over the day, which is the normal nasal cycle made more obvious by the deviation. A deviation near the front of the nose tends to cause more obstruction than one further back.
Diagnosis and when to see a GP
See your GP if nasal blockage is persistent and affecting your sleep, exercise or quality of life. They will ask about allergies and other causes of congestion, look inside the nose and may suggest treatment. If symptoms continue, referral to an ENT specialist allows a closer examination with a small camera. Seek prompt assessment for one-sided blockage with bleeding, crusting or a foul discharge, or for facial numbness or swelling. After a nasal injury, a painful, rapidly worsening blockage needs same-day assessment to rule out a septal haematoma.
Non-surgical treatment
Medical treatment does not straighten the septum, but it can reduce swelling of the nasal lining so there is more room for air. Options include saline rinses, steroid nasal sprays used correctly and consistently, antihistamines where allergy plays a part, and nasal dilators or strips for exercise and sleep. Decongestant sprays should only be used for a few days at a time, because longer use can cause rebound congestion.
Septoplasty and septorhinoplasty
Septoplasty straightens the septum through incisions inside the nose, removing or repositioning bent sections while preserving enough support for the bridge. It is intended to improve breathing without changing the external shape and is usually carried out by ENT surgeons. When the deviation also makes the nose look crooked, or when a patient wants a cosmetic change as well, septorhinoplasty addresses both in one operation. For a detailed comparison, see rhinoplasty vs septoplasty vs septorhinoplasty, and for information about NHS access see rhinoplasty on the NHS.
Recovery, risks and cost
After septal surgery, the nose feels blocked for one to two weeks while the lining heals, and saline rinses help. When combined with rhinoplasty, bruising and external swelling are also expected. Risks include bleeding, infection, a septal perforation, persistent blockage, numbness of the upper front teeth and changes in sense of smell. Mr Nassab offers private rhinoplasty for adults aged 18 and over, and can include septal correction where needed. Rhinoplasty costs from £8,950 and septorhinoplasty is quoted at consultation. The £150 consultation fee is separate.
Frequently Asked Questions
Is a deviated septum normal?
Yes. Most people have some degree of deviation. It only needs treatment if it causes symptoms that affect daily life.
Can a deviated septum be fixed without surgery?
Medical treatments can ease congestion, but only surgery can straighten the septum itself.
Does septoplasty change the look of the nose?
It is not designed to, although straightening the front of the septum can make a slightly crooked tip look more central.
Can a deviated septum cause snoring?
It can contribute to snoring by restricting nasal airflow, although snoring usually has several causes.
Is a deviated septum linked to sinus problems?
A significant deviation can impede drainage and may contribute to recurrent sinus symptoms in some people.
