Managing symptoms

Initial treatment of a deviated septum may be directed at managing the symptoms of the tissues lining the nose, which may then contribute to symptoms of nasal obstruction and drainage. Your doctor may prescribe:

• Decongestants. Decongestants are medications that reduce nasal tissue swelling, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray. Use nasal sprays with caution, however. Frequent and continued use can create dependency and cause symptoms to be worse (rebound) after you stop using them. Decongestants have a stimulant effect and may cause you to be jittery as well as elevate your blood pressure and heart rate.
• Antihistamines. Antihistamines are medications that help prevent allergy symptoms, including obstruction and runny nose. They can also sometimes help nonallergic conditions such as those occurring with a cold. Some antihistamines cause drowsiness and can affect your ability to perform tasks that require physical coordination, such as driving.
• Nasal steroid sprays. Prescription nasal corticosteroid sprays can reduce inflammation in your nasal passage and help with obstruction or drainage. It usually takes from one to three weeks for steroid sprays to reach their maximal effect, so it is important to follow your doctor's directions in using them.

Medications only treat the swollen mucus membranes and won't correct a deviated septum.

Surgical repair (septoplasty)

If you still experience symptoms despite medical therapy, you may consider surgery to correct your deviated septum (septoplasty).

Septoplasty is the usual way to repair a deviated septum. During septoplasty, your nasal septum is straightened and repositioned in the center of your nose. This may require your surgeon to cut and remove parts of your septum before reinserting them in the proper position.

The level of improvement you can expect with surgery depends on the severity of your deviation. Symptoms due to the deviated septum — particularly nasal obstruction — often completely resolve. However, any accompanying nasal or sinus conditions affecting the tissues lining your nose — such as allergies — can't be cured with only surgery.

Reshaping your nose

In some cases, surgery to reshape the nose (rhinoplasty) is performed at the same time as septoplasty. Rhinoplasty involves modifying the bone and cartilage of your nose to change its shape or size or both.

Preparing for an appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred directly to an ear, nose and throat specialist.

Your time with your doctor is limited, so preparing for the doctor's questions to you as well as creating a list of questions to your doctor can help you make the most of your time together.

For a deviated septum and its complications, some questions your doctor may ask include:

• How long has your nasal obstruction been present?
• How much of the time are you aware of the nasal obstruction?
• Is one side of your nose worse than the other?
• Is the obstruction mild, moderate or severe?
• Have you had any trauma to your nose?
• Do you have allergies affecting your nose?
• Do you have a decreased sense of smell?
• Do you have problems with sinusitis?
• Do you have nosebleeds?
• Is there anything else that makes the obstruction worse?
• Is there anything you do that relieves the symptoms?
• What medications have you used previously for this?
• What medications are you currently taking for this?
• Does decongestant spray help?
• Are you currently using decongestant spray every day?
• Does using a nasal adhesive strip help?
• Is your nasal obstruction worse when you are lying down?
• Have you had any nasal surgery?

Some basic questions you might ask your doctor include:

• What is likely causing my symptoms or condition?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask further questions during your appointment.

Overview

A deviated septum happens when the thin wall between the nasal passages, called the nasal septum, is off to one side. The nasal septum being off-center, called deviated, makes one side of the inside of the nose smaller.

A deviated septum can block one side of the nose. The reduced airflow can make it hard to breathe. A deviated septum also can lead to a nose that looks crooked in some people.

Medicines might reduce the swelling inside the nose. Surgery is needed to correct a deviated septum.

Symptoms

Most deviated septums have no symptoms. You might not know you have a deviated septum. But sometimes a deviated septum can cause the following:

• Blockage in one or both nostrils. This blockage can make it hard to breathe. This might be worse during colds or allergies that can cause nasal passages to swell and narrow.
• Nosebleeds. The surface of the nasal septum might become dry. This can raise the risk of nosebleeds.
• Noisy breathing during sleep. A deviated septum or swelling of the tissues in the nose can be one of many reasons for noisy breathing during sleep.
• Needing to sleep only on one side. Some people sleep on a certain side to ease breathing through the nose at night if one nasal passage is narrowed.

When to see a doctor

See a healthcare professional for:

• A blocked nostril that doesn't clear up with treatment.
• Frequent nosebleeds.

Causes

A deviated septum is caused by a few conditions. A deviated septum happens when the thin wall that separates the right and left sides of the nose, called the nasal septum, is pushed to one side.

A deviated septum can be caused by:

• A condition present at birth. In some cases, a deviated septum happens when the fetus is in the womb. It can be seen at birth.

• Injury to the nose. A deviated septum can also be the result of an injury that causes the nasal septum to move out of place.

  In infants, such an injury may occur during childbirth. In children and adults, a wide array of accidents may lead to a nose injury and deviated septum. Trauma to the nose most commonly occurs during contact sports, rough play such as wrestling or automobile accidents.

Aging can affect nasal structures. So a deviated septum can get worse over time.

Swelling and irritation of the nasal cavities or sinus cavities from an infection can narrow the nasal passage even more. The result can be nasal blockage.

Risk factors

A deviated septum can have several risk factors. For some people, a deviated septum is present at birth — happening during fetal development or due to injury during childbirth. After birth, a deviated septum is most commonly caused by an injury that moves the nasal septum out of place. Risk factors include:

• Playing contact sports.
• Not wearing a seat belt while riding in a motor vehicle.

Complications

A badly deviated septum that blocks the nose can lead to complications such as:

• Dry mouth. This is from breathing through the mouth.
• Disturbed sleep. This is from not being able to breathe well through the nose at night.
• Repeated nosebleeds. Air passing through the nostrils can dry out the surface of the nasal septum.

Prevention

To help prevent the nose injuries that can cause a deviated septum:

• Wear a helmet or a midface mask when playing contact sports, such as football and volleyball.
• Wear a seat belt when riding in a motor vehicle.

Diagnosis

To diagnose a deviated septum, a healthcare professional does a physical exam. An exam involves looking inside the nose using a bright light and sometimes a tool to spread open the nostrils. A long tube-shaped scope with a bright light at the tip can show farther back in the nose, if needed.

Treatment

A deviated septum that is causing symptoms is treated with surgery. Surgery is the only way to fix a deviated septum. A deviated septum that causes no symptoms needs no treatment.

If allergies or sinus problems are making symptoms worse, a healthcare professional might suggest using decongestants, antihistamines or nasal steroid sprays to manage symptoms.

Surgical repair

People who still have symptoms after treatment with medicines might think about surgery to correct the deviated septum. This surgery is called septoplasty.

During a typical septoplasty, the surgeons straightens the nasal septum and puts it in the center of the nose. This may require the surgeon to cut and remove parts of the septum before putting them in the right place.

Reshaping the nose

Sometimes, surgery to reshape the nose, called rhinoplasty, is done at the same time as the repair of the deviated septum. Rhinoplasty involves changing the bone and cartilage of the nose to change the shape or size of the nose or both.

Preparing for your appointment

You're likely to start by seeing your family healthcare professional. But you might be referred to an ear, nose and throat (ENT) specialist.

Making a list of questions to ask during your appointment and being ready to answer questions can help you make the most of your appointment.

For a deviated septum, some questions your healthcare professional might ask include:

• How long have you had a blocked your nose?
• How often are you aware that it is blocked?
• Is it harder to breathe through one side of the nose than it is the other?
• Is the blockage mild, moderate or severe?
• Have you injured your nose?
• Do you have allergies that affect your nose?
• Have you lost some of your ability to smell?
• Do you have problems with sinusitis?
• Do you have nosebleeds?
• Is there anything that makes the blockage worse?
• Is there anything you do that relieves the symptoms?
• What medicines have you used for this?
• What medicines are you now taking for this?
• Does decongestant spray help?
• Do you use decongestant spray every day?
• Does using a nasal adhesive strip help?
• Is your nasal blockage worse when you are lying down?
• Have you had nasal surgery?

Some questions you might ask include:

• What is likely causing my symptoms or condition?
• What is the best course of action?
• What other actions could I try?
• I have these other health conditions. How can I best manage them together?
• Do I need to restrict activities?
• Should I see a specialist?

Be sure to ask all the questions you have about your condition.