The nasal septum is the wall that separates the right and left side of the nasal passage of the nose, and consists of cartilage, bone, and mucosa. A deviated septum is defined as a nasal septum that bends, or is displaced, to one or both sides of the nose. This can cause the nasal airway to become narrowed. There are many variations of septal deviations, but all are characterized by their shape, location, and degree of airway narrowing it causes.
A normal septum (left) compared to a deviated septum (right)
Categorizing Deviated Septums
SHAPE
Curved
Localized (i.e., a bone spur)
Combined curved and localized
S-shaped septum
LOCATION
One side of the nose, or both sides
Front of the nose (caused by a bend in the cartilage)
Back of the nose (caused by a bend in the bone)
DEGREE OF AIRWAY NARROWING
Mild (under 50% nasal obstruction)
Moderate (50-99% nasal obstruction)
Severe (100%, touching the opposite nasal wall)
A severely deviated septum causing complete obstruction of the nasal cavity (red asterisk)
What causes a deviated septum?
Most commonly, a deviated septum is something that you are born with and can gradually worsen as you age. Another common cause is facial trauma at some point during your life. This can cause one area of the nasal septum to become weak and bend over time. In others, the injury can cause the septum to fracture or displaced it off the midline.
What are the most common symptoms of deviated nasal septum?
Up to 80% of the population unknowingly lives with a deviated septum, but only a fraction of them will actually present with symptoms. The main symptoms of a deviated septum include:
Obstruction of one or both sides of the nose A deviated septum can make it very difficult to breath since it becomes a physical barrier preventing proper nasal airflow. Allergies or the common cold can make breathing through the nose even more difficult by causing swelling of the lining of the nose, further narrowing the airway.
Need to blow nose If the septum is deviated so much so that it is touching the other side, this can cause a mucous “recirculation” event. The nasal mucosa is comprised of cellular hairs that beat in a predicable direction to constantly clear out debris. If there is contact between two areas of the nose, the mucous can recirculate around and around the same area without ever being cleared, producing a sensation to constantly blow your nose.
Snoring or noisy sleeping A deviated septum can cause you to be noisy sleeper at night, as the air passage through the nose can cause vibrations in the soft tissue. In others, blockage of the nose due to a deviated septum forces mouth-breathing during sleep, causing your jaw to relax and fall backwards which can make snoring very loud. Dry mouth or disturbed sleep patterns can also be a result of one’s inability to breathe properly at night.
Preference of sleeping on one side or the other The nasal mucosa tends to swell with gravity, and if the nasal passages are already narrowed on one side, you may find yourself sleeping on one particular side in order to breathe more easily during sleep.
Nosebleeds A deviated septum can alter the flow of air through your nose, causing particular areas to dry out and crack. This can lead to a higher occurrence of nosebleeds.
How do you treat a deviated nasal septum?
In mild cases, topical sprays are typically used to control the amount of swelling in the nose as to optimize airflow through the nose. In moderate or severe cases, medication is often ineffective alone and will require surgery in order to correct the crooked portions of the septum. This is called a septoplasty, and permanently resolves symptoms, depending on how badly the septum is deviated.
