Deviated septum
Deviated septum is a condition of the nose when the cartilage separating two nasal passages is deformed (not straight in shape). This happens frequently in people, and is usually found by the ENT doctor or an Allergy doctor who does a nose exam. You might notice a pale pink bulge in the middle of the nose while looking through the mirror inside your nostril. This may be a nasal septum deviating to one side.
In this article:
- What Is deviated septum?
- Symptoms
- When to see a doctor
- Causes
- Risk Factors
- Complications
- Prevention
- Diagnosis
- References
What Is deviated septum?
Deviated septum is a condition of the nose when the cartilage separating two nasal passages is deformed (not straight in shape). This happens frequently in people, and is usually found by the ENT doctor or an Allergy doctor who does a nose exam. You might notice a pale pink bulge in the middle of the nose while looking through the mirror inside your nostril. This may be a nasal septum deviating to one side.
What is a nasal septum? This is an anatomical structure of the nose that is made of cartilage as a base plate, and covered with the same mucus membrane as the whole inner cavity of the nose.
Why is it important to have nasal septum straight? The nose has a humidifier/filter function for the breathing – the air that you inhale through the nose will be moisturized, cleaned and disinfected inside the nasal cavity. So, the separation of the two nasal passages together with nasal other structure (nasal turbinates, cavities and sinuses) creates a perfect flow that ensures all air motion in a certain pattern. If the nasal septum changes shape, it may impact normal air movement and cause problems.
Does deviated septum changes the shape of the nose? No, not really. In fact, the opposite may happen. A trauma to the nose that affects bony structure where nasal septum attaches may affect how the nasal septum is positioned and cause deviation (if not healed correctly).
Why did my septum get deviated? There are few different reasons why it happens. But basically, anything that causes inflammation or trauma to the nasal septum may cause deviation (a change in shape). The nasal septum has two points of attachment – the bony edge in the middle of the face between the eyes on the upper side, and the tip of the nose on the lower side. As you can imagine, if the septum swells up it cannot keep pushing the tip of the nose to grow (like Pinocchio). So, instead the cartilage plate ether flips to the side or takes an S form.
Symptoms
Deviated septum happen overnight, unless it is caused by the injury. It takes months and years for nasal cartilage to change the shape. In many cases, it does not produce much symptoms at all. It comes as a surprise when a doctor exclaims: “You got a deviated septum!” But sometimes, it is really the nasal problems that lead to the discovery of the abnormal septum shape. Here are some symptoms of the deviated septum:
- Nasal congestion. It is more common on one side.
- Whistling noises in the nose during the breathing cycle, or snoring
- Headaches. People call them “sinus headaches”
- Runny nose (rhinorrhea)
- Sinus infections
- Postnasal drip (mucus running on the back of the throat).
A significantly deviated septum frequently uncovers life-long environmental allergy. Many ENT specialists will refer you to an allergist before considering a septum surgery. Treating allergy is important, as congestion and other symptoms may persist even if surgery is done correctly.
When to see a doctor
As we discussed, most people do not even know their septum is deviated. Here are couple of reasons to request an ENT consultation:
- Chronic congestion on one side of the nose
- Sleep apnea or significant snoring
Causes
Nasal septum deviation can be caused by:
- Long-standing allergic inflammation of the nose (allergic rhinitis)
- Trauma of the nose
- Congenital face defects
Allergy is one of the main reasons for the nasal septum to change shape. There are many allergic bioactive factors that are being released by the cells during local inflammatory response. These factors cause cartilage to swell and enlarge. This change can take months to years, but eventually the cartilage changes shape and develop bulge or a spur on one side of the nasal cavity. Sometimes the septum twists in an S shape, so the bulge is seen on both sides.
During the trauma of the nose a bone that holds the cartilage of the nasal septum is broken. In other cases, the cartilage itself cracks. If the fracture is not big and not displaced, it can heal on its own. But if the displacement of the parts is significant enough, the nasal septum may form abnormal shape and develop spurs.
In some genetic diseases or inborn face malformations the nasal septum might not form right, or does not attach properly. In such situation a Pediatric ENT surgeon will consult a family on the right procedure and timing to correct a deformity.
Risk Factors
There are certain risk factors that may lead to nasal deviation:
- Contact sports and sports that involve fast speed ball (golf, hockey, baseball, socker, etc.)
- Sports that involve fighting (martial arts, box, kickboxing, football, etc.)
- Long-standing untreated nasal allergy
- Family history of face malformation syndrome, infections during pregnancy causing birth defects
- Plastic surgery of the nose
Complications
The main problem of the deviated septum is abnormal nasal flow. If the blockage is significant, the sinus infections may develop. There is also a considerable social aspect, as the shape of the nose is an important part of a face image.
As a result of the disturbed nasal breathing many problems can develop:
- Headache
- Disturbed sleep and fatigue
- Chronic congestion
- Sleep breathing disorders (SBD)
Prevention
It is important to remember simple preventive measures that will help to preserve the nasal septum and face in sports. Nowadays, each sport has safety requirements that are enforced for an organized training and games:
- Helmets
- Mouthguards
- Face shields
- Headguards
This protective gear should be worn during training and outdoor games to prevent nose injuries.
As allergy is a very common reason for the deviated septum, the families with allergies should consult an allergy clinic to find out about indoor allergy control and immunotherapy options.
Diagnosis
Diagnosis of the deviated septum is usually simple. You Pediatrician of an Internist may suspect the septum deviation during the nose exam with a hand-held otoscope. An ENT or Allergy specialists may use a rhinoscope – a flexible cord with the handle and camera that is inserted into the nose to see all internal structures of the nasal cavity. This is a simple minimally invasive procedure that is done in the office and will provide a doctor with a perfect view of the nasal septum within minutes.
A CT of the sinuses or MRI of the face can add needed details of the facial bone and cartilage structures. Cone-beam computed tomography (CBCT) is considered a very useful imaging procedure to rate a degree of the septal deviation and prepare for the surgery. It is also used to follow surgical procedures to see how well the correction worked.
It is important to have a consultation with a specialist if you have a deviated septum. While most of the small deviations do not need to be treated, sometimes it is crucial to fit it. Only a professional with a knowledge of the nasal function and diseases can tell you if you need to treat a deviated nasal septum.
References
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Prevalence of Nasal Septum Deviation Using Cone-Beam Computed Tomography: A Cross-Sectional Study. Moshfeghi M, Abedian B, Ghazizadeh Ahsaie M, Tajdini F.Contemp Clin Dent. 2020 Jul-Sep;11(3):223-228. doi: 10.4103/ccd.ccd_110_19. Epub 2020 Nov 26.PMID: 33776347 Free PMC article.
Relationship between the degree and direction of nasal septum deviation and nasal bone morphology. Serifoglu I, Oz İİ, Damar M, Buyukuysal MC, Tosun A, Tokgöz Ö.Head Face Med. 2017 Feb 28;13(1):3. doi: 10.1186/s13005-017-0136-2.PMID: 28245851 Free PMC article.
Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study. Janovic N, Janovic A, Milicic B, Djuric M.Braz J Otorhinolaryngol. 2020 Oct 10:S1808-8694(20)30157-9. doi: 10.1016/j.bjorl.2020.09.004. Online ahead of print.PMID: 33132090 Free article.
Nasal pathologies in patients with obstructive sleep apnoea. Magliulo G, Iannella G, Ciofalo A, Polimeni A, De Vincentiis M, Pasquariello B, Montevecchi F, Vicini C.Acta Otorhinolaryngol Ital. 2019 Aug;39(4):250-256. doi: 10.14639/0392-100X-2173. Epub 2019 Mar 25.PMID: 30933181 Free PMC article.
The Possible Associations of Nasal Septal Deviation with Mastoid Pneumatization and Chronic Otitis. Sistani SS, Dashipour A, Jafari L, Ghahderijani BH.Open Access Maced J Med Sci. 2019 Aug 8;7(15):2452-2456. doi: 10.3889/oamjms.2019.670. eCollection 2019 Aug 15.PMID: 31666846 Free PMC article.
Nasal septal deviation and external nasal deformity: a correlative study of 100 cases. Sam A, Deshmukh PT, Patil C, Jain S, Patil R.Indian J Otolaryngol Head Neck Surg. 2012 Dec;64(4):312-8. doi: 10.1007/s12070-011-0311-x. Epub 2011 Oct 5.PMID: 24294569 Free PMC article.