What Is a Deviated Septum? 5 Signs You Have One

What is a deviated septum?

Breathing is one of the traditionally more thoughtless bodily functions for many people. If you are healthy, breathing usually just sort of happens without much effort.

People with specific lung conditions, like asthma or COPD, can have difficulty breathing in general or due to certain triggers. Others may have trouble breathing just through their nose due to a cold, allergies, or other problems. People with a deviated septum are in the latter group.

A deviated septum, or nasal septum deviation, is the displacement of the wall between the nostrils. It makes it tough for people to breathe through their nose.

This wall of bone and cartilage divides the inside of the nose in half, with a nostril on each side. In the ideal scenario, both sides are even. However, a deviated septum means one nasal septum leans sideways or is off-center, making one nostril bigger than the other.

“The septum is an important internal structure of the nose,” explains Amit Kochhar, MD, a double board-certified otolaryngologist and head, neck, facial, and reconstructive surgeon of Providence Saint John’s Health Center, in Santa Monica, California. “The septum serves to not only separate the right and left side of the nose, but it also supports the bridge and tip of the nose.”

No one’s septum is perfectly midline, or straight, and about 80 percent of all septums are deviated to some degree.

Here’s what you need to know about the symptoms of a deviated septum, as well as treatments and surgery that can help correct the problem if you have one.

How does a septum deviate?

Some people are born with a deviated septum. It may also occur as the nose grows, since the septum also grows. These are typical reasons for a deviated septum.

In other cases, a deviated septum occurs after injury to the nose from things like contact sports or car accidents, for example.

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Deviated septum symptoms

People with a minor or a slight deviated septum may not experience symptoms. More severe deviations could cause the following symptoms or signs of a deviated septum:

• difficulty breathing
• headaches
• nosebleeds
• sinus infections
• dryness in one nostril
• snoring, loud breathing during sleep, sleep apnea
• nasal congestion or pressure
• facial pain
• sleep apnea

How to tell if you have a deviated septum

Doctors, usually an otolaryngologist or an ear, nose, and throat (ENT) doctor, diagnoses a deviated septum after a nostril and nose examination. They may look at the septum’s placement and how it impacts the size of the nostrils.

Questions about sleep, snoring, sinus problems, and difficulty breathing also help doctors indicate whether or not someone has a deviated septum.

Although there isn’t one surefire test to do at home, Dr. Kochhar says you can do a few things to possibly determine if you have a deviated septum.

Your nose

First, you can look at your nose in the mirror to see if your nose looks straight.

“One finding that is commonly seen in patients when they have a deviated septum is that the outside of their nose may also be crooked,” he says.

Your nostrils

Another way to see if your septum is deviated is to photograph your nostrils.

Although it won’t be your next profile picture, it could indicate an issue.

If one nostril is significantly larger than the other, that may be a clue that something is deviated internally, per Dr. Kochhar.

Your breathing habits

Many people with a deviated septum also complain of trouble breathing through their nose. While it is normal for one side to breathe better, this usually alternates between right and left.

However, if only one side breathes better all the time, that may be a clue that something is blocking the non-breathing side like a deviated septum, according to Dr. Kochhar.

Sinus infections

People with a deviated septum can be at risk for nasal congestion, which can cause face pain and repeat sinus infections.

Your sleeping habits

“Lastly, if you note that when lying or sleeping on your side that you cannot breathe on one side all the time, that can also be an indication that you should see a physician to look into your nose to assess how straight your septum is,” Dr. Kochhar says.

How to fix a deviated septum

Symptom management is the name of the game when it comes to treatments for a deviated septum. Your doctor might recommend over-the-counter medicine to help relieve symptoms like congestion or headaches.

Dr. Kochhar also says another option for improving nasal breathing includes using external Breath Right strips. These nasal strips help lift the sides of the nostrils to open the nasal passages and increase airflow.

Steroid nasal sprays are also an option, like fluticasone (Flonase), mometasone (Nasonex), and triamcinolone (Nasacort).

People may also choose to undergo in-office procedures to reduce swelling of the septum or turbinates, the thin, bony plates inside the nose.

“These typically involve radiofrequency ablation or other types of thermal (heat) energy,” he says.

Deviated septum surgery

If symptoms don’t improve, septoplasty, a type of reconstructive surgery, is an option.

People who opt for this surgery usually have a deviated septum that obstructs one side of their nasal airway and/or frequent sinus infections.

The surgery consists of cutting the septum and removing excess cartilage or bone to straighten the septum and nasal passage. In some cases, the surgeon adds silicone splints in each nostril for septum support.

Your doctor might also recommend additional surgeries like sinus surgery (to open the sinuses) or a rhinoplasty (nose job), at the same time. That combination is called septorhinoplasty.

Like any surgery, septoplasty has risks and benefits.

The risks and potential complications of the procedure include bleeding, infection, and damage to the septum that can lead to scarring or possibly a perforation (a hole in the nose), says Dr. Kochhar.

However, the risk is very low, especially when done by an experienced surgeon.

“In the majority of cases, patients have minimal pain and experience a noticeable improvement in breathing two to three weeks after surgery when the internal swelling reduces,” Dr. Kochhar says.

And Dr. Kochhar finds that most patients who undergo septoplasty wish they had done it much sooner.

“The improvement in nasal breathing provides a huge impact on quality of life,” he says.

Bottom line

Dr. Kochhar notes that although a deviated septum may contribute to nasal obstruction and difficulty breathing through your nose, it’s not the only potential cause.

“Other causes of nasal obstruction include nasal valve stenosis (narrowing), turbinate hypertrophy and nasal polyps, or chronic sinusitis,” he says.

That’s why, if you suffer from nasal obstruction, an evaluation by a head and neck surgeon with expertise in facial plastic surgery or rhinology is key.

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