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Nasal Septum Deviation: Causes, Types and Treatment

Close-up of a human nose
Contents

Photo by LBPics, CC BY-SA 3.0, via Wikimedia Commons

Overview

The nasal septum is the thin wall of bone and cartilage that divides the inside of the nose into two halves. The back part is made of bone, while the front part is cartilage covered by a moist lining. The front part is flexible and can move a little.

A deviated nasal septum means the septum is off-center, which can make one or both nasal passages narrower. According to Cleveland Clinic, about 8 in 10 people have a septum that is slightly off-center, and many never notice it. When the deviation is larger, it can block the nose and make breathing difficult.

Causes of Nasal Septum Deviation

  • Trauma

A blow to the nose can push the septum out of place. Nose injuries can happen at any age, from sports, falls or car accidents. A difficult delivery can also injure a baby’s septum. A mild injury may go unnoticed and show up later as a deviated septum.

  • Developmental malformation

The most common cause is simply growth: as the nose develops, the septum can lean to one side. Some people are born with a deviated septum. It can also occur with cleft lip and palate.

  • Aging

A slightly deviated septum can become more off-center over time as the nose changes with age.

  • Genetic predisposition:

The shape of the nose can run in families, so family history may play a role.

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: the front cartilage of the septum is bent or shifted, often after an injury.
  • 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

Blockage may affect one or both sides of the nose. It is often worse on one side, and it may get worse with a cold or allergies.

2- Headache

Dehydration Headache

Some people with a deviated septum have facial pain or headache. How often the septum itself causes headaches is debated, so other causes should be checked.

3- Epistaxis

A deviated septum can dry out the lining of the nose, especially where air flows hardest. Dry lining can crust and bleed, which leads to nosebleeds.

4- Sinusitis

Deviated nasal septum can contribute to sinusitis by blocking the openings that drain the sinuses.

5- Middle Ear Infections

In children, a deviated septum may be linked to frequent or long-lasting ear infections.

6- Noisy Breathing

The person may breathe noisily or snore during sleep because air can’t move freely through the nose.

7- Postural Sleep

Some people prefer to sleep on one side, which can make breathing through the nose easier.

8- Loss of Smelling Ability

Some people with a deviated septum notice a reduced sense of smell.

Risk Factor for Deviated Nasal Septum

Injury is a common risk factor. Others include

  • Family history of DNS
  • Vehicle injuries
  • Sports injury
  • Birth trauma
  • Falls

Complications of DNS

  • Mouth breathing
  • Dry mouth
  • Dry nose and nasal crusting
  • Rhinitis
  • Sinusitis
  • Difficulty in sleeping or sleep apnea
  • Snoring
  • Nasal obstruction

Treatment Options

A mild deviation with few or no symptoms is very common and needs no treatment. Treatment is only needed when it causes symptoms such as blocked breathing.

Your doctor will take your history and examine the inside of your nose. Most of the time, a deviated septum is diagnosed with this exam alone.

Medicines can ease symptoms but cannot straighten the septum. Options include antihistamines, nasal steroid sprays and decongestants. Don’t use decongestant nasal sprays for more than three days in a row, because they can cause rebound congestion.

Surgery is the only way to correct the septum. There are two main approaches.

1. Submucous Resection Operation (SMR)

This older operation removes large parts of the bent cartilage and bone after lifting the lining on both sides of the septum. It has largely been replaced by septoplasty, which removes less tissue.

2. Septoplasty

According to MedlinePlus, the surgeon makes a cut inside one side of the nose and lifts the lining. They then reshape, reposition or remove the bent cartilage or bone, and put the lining back in place.

Most people have general anesthesia and go home the same day. Surgeons usually wait until the nose has finished growing, around the mid-teens. If a child has a severe blockage, a limited, conservative operation may be done earlier.

When to Seek Medical Help?

Most of the time nasal septum deviation is not severe and needs no treatment. Mild symptoms can often be managed with medicines.

See a doctor if you have a blocked nose that won’t go away, frequent nosebleeds, repeated sinus infections (nasal sinuses that become inflamed), loud snoring or a lost sense of smell. A doctor can find the cause and help you choose the best treatment.

Sources

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