Overview
The nasal septum is a thin fibrocartilaginous structure that separates the nasal cavity into two halves. The posterior part which is the back part is made up of bone while an anterior part is made up of cartilage cover The skin. The anterior part is smooth and can be moved partially. The deviated nasal septum is a term used when nasal septum is displaced causing nasal passages to become small. In some circumstances deviated nasal septum is less severe to obstruct nasal passages while in other circumstances nasal septum deviation is large and it blocks nose, lessen Airway and cause difficulty in breathing.
Causes of Nasal Septum Deviation
Trauma
A blow on the nose main causes the displacement of the nasal septum. Injuries to the nose occur most commonly in children. Trauma may also occur during birth which causes birth asphyxia or difficulty in breathing at birth. When trauma is less significant to cause birth asphyxia it is often overlooked and can cause nasal septum deviation later in adulthood. Birth injuries should immediately be treated to prevent nasal septum deviation in later life.
Developmental malformation
A most common cause of nasal septum deviation is developmental malformation due to which nasal septum deviation may be present at birth. It is usually associated with cleft lip and cleft palate. In some cases, it is also associated with dental abnormalities.
Racial factors:
It is more common in Asians as compared to black Americans or Mongolians.
Genetic predisposition:
In some cases, nasal septum deviation is inherited and it runs in families. One or more family members may be affected.
Types of Deviated Nasal Septum
- C shaped deformity: nasal septum deviates with a simple curve to one side. One side of nasal passages is small while the other is large.
- Anterior deformity: nasal cartilage is displaced inside the nose anteriorly
- S-shaped deformity: S-shaped deformity is associated with nasal septum being in the shape of ‘S’. Both of the nasal passages are obstructed and it causes bilateral nasal obstruction.
- Thickening of septum: it may be due to blood clot deposits or overriding of fractured segments of the nasal septum.
Signs and Symptoms of Dns
1- Nasal Obstruction
Nasal obstruction may be of one side or both sides of the nose. One-sided nasal obstruction is usually present at birth but is missed as it causes less nasal obstruction and difficulty in breathing while bilateral if present at birth is easily identified and treated accordingly.
2- Headache
Deviated nasal septum presses on the outer wall of the nose and causes pressure symptoms to cause a headache. The patient presents again and again due to a headache.
3- Epistaxis
Bleeding from the nose is due to the exposure of nasal mucosa to air. This air causes dryness inside the nose and causes crusting of the nasal mucosa. these crusts cause an obstruction in breathing and when patients try to remove, it causes bleeding. Bleeding may also be due to one or two affected vessels inside the nose.
4- Sinusitis
Deviated nasal septum can cause sinusitis as it obstructs the ventilation of the sinuses.
5- Middle Ear Infections
Middle ear infections may be caused due to DNS.
6- Noisy Breathing
The patient has noisy breathing while he is asleep. this noisy breathing is due to edema and swelling of nasal tissue which causes difficulty in breathing and snoring.
7- Postural Sleep
The patient has a postal slip. He tries sleeping on the side which causes less obstruction to nasal passages so as to have easy breathing.
8- Loss of Smelling Ability
DNS is associated with mild or severe loss of smell.
Risk Factor for Deviated Nasal Septum
The most common risk factor for DNS is trauma. Others include
- Family history of DNS
- Vehicle injuries
- Sports injury
- Birth trauma
- Fall at the side of the road
Complications of DNS
- Adenoid formation due to constant mouth breathing
- Dry mouth
- Dry nose and nasal crusting
- Rhinitis
- Sinusitis
- Difficulty in sleeping
- Snoring
- Nasal obstruction
Treatment Options
Minor degree e of septal deviation with no or mild symptoms is commonly seen in patients and it requires no treatment. Treatment is required only when nasal septum deviation produces obstruction to breathing.
Your doctor will take your history and do a clinical examination. He might also prescribe you some tests if required. Most of the times deviated nasal septum is diagnosed when clinically. There is no medical treatment for permanent correction of Deviated Nasal Septum up till now however surgical methods are there to treat DNS permanently. There are two methods for correction of deviation and both are surgical.
1. Submucous Resection Operation (SMR)
It is done in adults and requires general anesthesia. The skin on both sides of the nasal septum is raised and the Incision is made on one side of the septum to correct the deflected parts of bone or cartilage. The skin is then positioned over septum.
2. Septoplasty
In this type of operation, the septum framework is not as much disturbed. It is a conservative approach for deviated nasal septum and only the most deviated parts of the septum are removed & the rest of the septum is left as such or is repositioned by some plastic means. A flap of skin is raised only from one site. This type of surgery is done at the age of 18 years so it does not interfere with the growth of nasal bones. However, if septum deviation is marked in childhood and causes severe nasal obstruction conservative surgery can be performed to ensure Airway.
When to Seek Medical Help?
Most of the times nasal septum deviation is not severe and requires no treatment. In some cases, it is mildly symptomatic and can be treated with conservative measures. In most cases, it causes complications like nasal obstructions, recurrent headache, Sinusitis which is inflammation of nasal sinuses, epistaxis which is bleeding from the nose, crusting of the nasal mucosa and middle ear infections. You should seek medical help immediately if you find the mild or complete loss of the ability of smell. Your doctor will examine you clinically and will help you to get the best treatment options to get rid of recurrent nasal obstruction due to deviated nasal septum.
