A deviated septum is a curve in the wall that divides the nose into two passages and the most common cause of a long-standing blocked nose. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, assesses the deviation with endoscopic examination and a decongestant test, and identifies associated causes such as enlarged turbinates or allergy. If the structural deviation causes symptoms, the treatment is septoplasty, which is done inside the nose and does not change its outward shape.
What is a deviated septum?
A deviated septum is a curve to one or both sides of the wall of cartilage and bone (the septum) that divides the nose into left and right passages. Mild deviations are common and most cause no problems; treatment is considered when the deviation clearly affects breathing.
The deviation may be present from birth, develop during growth or result from an injury to the nose. It is often not visible from the outside: even if the nose looks straight, the septum inside can be markedly deviated.
What are the symptoms?
The most common symptom is a long-standing blocked nose on one or both sides. It may come with:
- Mouth breathing, sleeping with the mouth open and a dry mouth and throat in the morning
- Snoring and not feeling rested on waking
- A tendency to recurrent sinusitis and postnasal drip
- Dryness of the lining where the deviation sticks out, and nosebleeds
- Difficulty breathing through the nose during exercise
How to recognise the symptoms at home is explained in the article how to tell if your septum is deviated.
Is the septum the only cause of a blocked nose?
No. A blocked nose is often the sum of several causes. Turbinate hypertrophy, allergic rhinitis, sinus conditions, narrowing of the nasal valve and, in children, adenoids cause similar symptoms. Correcting only the septum may not give the expected relief if an associated cause is missed. An overview of these causes is in the article common causes of a blocked nose.
How is it assessed at the consultation?
The diagnosis is made by an ear, nose and throat examination. At Op. Dr. Süleyman Kumbasar’s consultation the following steps are taken:
- Examination of the inside of the nose with a light and an endoscope: the position and degree of the deviation and its effect on the airway are assessed.
- Decongestant test: a decongestant is applied in the nose to tell how much of the blockage is due to swelling of the lining and how much to the structural deviation.
- Checking the turbinates, nasal valve and nasopharynx
- Standardised questionnaires, such as the NOSE scale, to measure how severe the symptoms are
- A CT scan if sinus disease is suspected
How is a deviated septum treated?
A structural deviation cannot be corrected with medicines; they can only reduce the associated swelling of the lining and allergy symptoms. If the symptoms are clear and match the structural deviation, the treatment is septoplasty. In a randomised trial carried out in the Netherlands, in adults with a blocked nose due to a deviated septum, septoplasty gave a greater improvement in blockage-related quality-of-life scores than follow-up without surgery.
How is septoplasty done?
The operation is done through the nostrils; there are no external incisions. The lining covering the septum is lifted, the deviated parts of cartilage and bone are corrected or removed, the cartilage needed to support the nose is preserved and the lining is put back in place. Septoplasty on its own does not change the outward shape of the nose. If the turbinates are also enlarged, they can be reduced in the same session.
Can it be done together with rhinoplasty?
Yes. If there is also a cosmetic concern, septoplasty and rhinoplasty can be planned in the same operation; this combined surgery is called septorhinoplasty. There is then one anaesthetic and one recovery period.
What are the risks?
In addition to the general risks of bleeding, infection and anaesthesia, specific to septoplasty are a collection of blood in the septum (haematoma), rarely a hole in the septum (perforation), temporary changes in sensation in the upper teeth and palate, and the blockage not clearing completely. Persistent blockage is usually related to an associated allergy or enlarged turbinates. These risks are explained before the operation and written informed consent is obtained.
The surgical process
Usually general anaesthesia; in selected cases, local anaesthesia with sedation. Decided at the consultation and the anaesthetic assessment.
Septoplasty alone usually takes 45 to 90 minutes; adding turbinate reduction makes it longer.
Most patients go home on the same day or the next day.
Whether packing or hollow silicone internal splints are used depends on the surgical plan; if used, they are usually removed within 1–7 days.
The incisions are inside the nose. Septoplasty alone does not change the outward shape and bruising around the eyes is not usually expected.
Recovery timeline
A feeling of fullness and blockage, with slightly bloodstained discharge. Keeping the head raised and not blowing the nose is recommended.
Packing or splints are removed and the inside of the nose is cleaned. Saline rinses are started. Returning to office work is usually possible between days 3 and 5.
Crusting decreases and breathing starts to open up. Strenuous exercise and lifting heavy objects while bending are avoided.
Most of the internal healing is complete; returning to sport is planned with the doctor’s check.
Healing of the lining is complete; the breathing result is assessed during this period.
Frequently asked questions
Does a deviated septum correct itself?
No. A deviated septum is structural and does not improve over time. Nasal sprays and antihistamines can ease symptoms by reducing the associated swelling of the lining, but they do not remove the deviation.
Does septoplasty change the outward shape of the nose?
Septoplasty alone does not change the outward shape; the whole procedure is done inside the nose. If a change in appearance is also wanted, the operation is planned as a septorhinoplasty.
Is packing used after septoplasty?
It depends on the case. In some patients, hollow silicone splints that allow some breathing through the nose are used instead of packing. The method and when they are removed are discussed before the operation.
When can I go back to work after septoplasty?
Most people return to office work between days 3 and 5. Heavy physical work and sport should wait at least two weeks; the exact time is set at the check-up.
Does a deviated septum cause snoring?
A blocked nose can contribute to snoring, but snoring usually has more than one cause. Septoplasty can improve nasal breathing; if snoring or sleep apnoea is suspected, a sleep assessment may be needed. Details are on the snoring and sleep apnoea page.
Is septoplasty done in children?
Because the face and nose are still developing, septoplasty in children is usually postponed until growth has finished. If there is severe blockage with associated problems, limited surgery that does not affect development may be considered.
Related treatments
Articles on this topic
Sources
- Han JK et al. Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction. Otolaryngology–Head and Neck Surgery, 2015.
- van Egmond MMHT et al. Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial. The Lancet, 2019.
- Stewart MG et al. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngology–Head and Neck Surgery, 2004.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.