A crooked nasal septum is referred to as a deviated septum. The nasal septum deviates from its normal central position within the nose. The entire nasal septum may be crooked, or only parts of it, such as a so-called septal spur.
In medicine, this condition is also referred to as a deviated nasal septum.
A deviated nasal septum can be congenital or caused by trauma to the nose.
A deviated nasal septum is a common facial malformation. Among anatomical variations of the nose, a deviated septum is the most common.
Clinical examination of the nose reveals a deviation of the septum in 60 to 80 percent of all people.
However, only 25 to 50 percent of people feel that their deviated nasal septum is causing them problems. This is where the difficulty lies in interpreting the diagnosis of “deviated nasal septum.” Therefore, a critical and careful selection of patients is absolutely essential to ensure that both the patient and the surgeon have the same expectations regarding the surgery.
The primary symptom of a deviated nasal septum is a stuffy nose. This is caused by obstructed airflow. Not only does the narrowing of the nasal passage contribute to the symptoms, but so does the resulting turbulence of the airflow within the nose.
For this reason, some patients with an “empty nose”—for example, as a consequence of excessive endonasal resection of the septum and/or the turbinates—also complain of a feeling of nasal congestion. Persistent obstruction of nasal breathing can also lead to drying of the nasal mucosa, resulting in increased nosebleeds. This is due to the acceleration of airflow (Venturi effect).
Impaired ventilation of the paranasal sinuses can lead to recurrent rhinosinusitis and sinus infections.
Headaches, on the other hand, are a relatively rare consequence of a deviated nasal septum. They occur primarily when the deviation comes into contact with the middle turbinate or the lateral nasal wall. If the deviated nasal septum narrows access to the olfactory cleft in the nose, this can impair the sense of smell.
A watery runny nose, however, is not a typical symptom of a deviated septum.
Many people with this condition report persistent difficulty breathing through the nose, which they notice significantly in their daily lives. In some cases, the restricted nasal breathing leads to a shift toward mouth breathing. Over time, this can dry out the mucous membranes and cause discomfort.
It can also lead to snoring, a reduced sense of smell, or a feeling of pressure in the nasal area.
Accurate diagnosis is crucial for reliably identifying a deviated nasal septum and ruling out other causes of nasal breathing obstruction.
The first step is a thorough clinical examination of the nose. During this examination, the doctor assesses the shape and structure of the nasal septum, the turbinates, and the nasal mucosa.
A rhinoscopy is often performed as well. During this examination, the inside of the nose is viewed using special instruments. An endoscope may also be used to visualize areas that are difficult to see.
Functional testing of nasal breathing also plays an important role. Rhinomanometry is used to measure the extent to which airflow through the nose is restricted.
In some cases, imaging techniques are used. A computed tomography (CT) scan can provide detailed information about the structure of the nasal septum, the paranasal sinuses, and the surrounding tissue.
These procedures help identify and specifically rule out possible comorbidities such as rhinitis, chronic rhinosinusitis, or enlarged turbinates.
During the diagnostic process, other causes of obstructed nasal breathing—such as
- allergies,
- excessive use of decongestant nasal drops,
- chronic sinusitis (inflammation of the paranasal sinuses) with or without polyps, etc.,
be identified and ruled out.
To complete the diagnosis of a deviated nasal septum, an X-ray of the nose and paranasal sinuses is required.
Not every deviated septum requires treatment. If the deviation is only mild and there are no symptoms, treatment is generally not necessary.
Treatment for obstructed nasal breathing caused by a deviated septum involves surgical straightening of the nasal septum. This procedure is also known as septal correction or septoplasty. During this procedure, the surgeon straightens the septum.
In otolaryngology, septoplasty is one of the most commonly performed surgeries. During the procedure, the bent or displaced portions of the nasal septum are straightened, and excess tissue is removed. The goal is to adjust the internal shape of the nose so that airflow can once again pass evenly through the nostrils.
In some cases, the surgery is combined with a reduction of the nasal turbinates. During a conchotomy, parts of the turbinates are reduced to widen the airway.
The goal of surgical treatment is to optimize nasal breathing, improve nasal function, and alleviate existing symptoms.
In the early days of nasal surgery, large sections of the nasal septum were removed for this purpose. This destructive surgical technique is no longer used today. Modern surgical techniques limit the removal of parts of the nasal septum to what is absolutely necessary.
In addition, after straightening, the removed tissue is reinserted into the nose for reconstruction. This has minimized the complications that were once typical of the procedure. These complications included the so-called “empty fluttering septum,” characterized by endonasal, breathing-dependent displacement and the resulting obstruction of nasal breathing.
The possible causes of a deviated septum are varied. Genetic factors often play a role, as the structure of the nose is partly genetically determined.
A deviation can also result from injuries. Sports injuries or falls, in particular, can cause a fracture of the nasal bones, especially the os nasale. Such injuries can lead to permanent changes.
Growth processes during development can also play a role. If the bone and cartilage in the area of the septum develop at different rates, a misalignment can develop over time.
As with any surgery, this surgical treatment carries a certain degree of risk. Overall, however, the procedure is considered safe and is frequently performed in ENT surgery.
Possible complications include postoperative bleeding, tissue infection, or recurrent bleeding in the nasal area.
In rare cases, changes to the external shape of the nose may occur. An unsatisfactory functional outcome is also possible if nasal breathing does not fully improve after the procedure.
Experience shows that a recovery period of about 14 days can be expected after surgery.
Nasal packing is typically inserted after surgery. It is usually removed two days after the procedure. During this time, a breathing tube attached to the packing can help facilitate nasal breathing.
Without nasal packing, there is a risk of more frequent postoperative bleeding. Therefore, postoperative nasal packing is recommended both to reduce the risk of postoperative bleeding and to provide internal support for the nasal skeleton.
After the surgery, careful nasal care with nasal rinses and nasal ointment is recommended.
The nose is fully healed about four weeks after surgery. By then, it will be clear whether the procedure was successful and whether the patient’s symptoms have improved.
You should refrain from physical activity for 14 days following the surgery. Contact sports that carry a risk of injury to the recently operated nose are not recommended for four to six weeks.
What is a deviated septum?
A deviated septum is a deviation or curvature of the nasal septum. In this condition, the nasal septum deviates from its normal central position, which can impair nasal breathing.
What are the symptoms of a deviated septum?
Typical symptoms include, above all, a stuffy nose, difficulty breathing through the nose, nosebleeds, and recurrent inflammation of the nasal sinuses. Snoring may also occur. An ENT specialist diagnoses bony or cartilaginous changes through a thorough examination. (Medical term: deviation of the nasal septum)
When is surgery necessary?
Corrective surgery is recommended when the deviated septum causes difficulty breathing through the nose and conservative treatments are insufficient. The goal is to facilitate breathing and restore the patient’s quality of life.
How successful is septoplasty?
Septoplasty is considered an effective surgical procedure. In many cases, it alleviates symptoms and permanently improves nasal breathing.
Can a deviated septum resolve on its own?
Once a nasal septal deviation has developed, it generally does not resolve on its own. If symptoms occur, medical treatment may be necessary.
