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Deviated Nasal Septum: Symptoms, Assessment, and Management

Key takeaways

  • A deviated nasal septum is a condition where the nasal septum is displaced to one side, which may affect airflow through the nose, resulting in symptoms such as nasal blockage, difficulty breathing, recurrent sinus infections, nosebleeds, snoring, or facial discomfort.
  • The degree of symptoms varies based on the extent of the deviation and contributing factors, such as nasal inflammation or sinus disease. Assessment typically involves a clinical examination and, where appropriate, endoscopic evaluation or imaging.
  • Management depends on symptom severity and the condition's impact on daily life, with options including medical treatment for inflammation or symptoms, and surgical correction in severe cases where structural blockage is significant.
  • Evaluation by an ENT specialist is important to confirm the diagnosis and discuss appropriate management options, including the possibility of surgery.
View the full summary text

A deviated nasal septum refers to a condition where the nasal septum, the structure separating the two nasal passages, is displaced to one side, which may affect airflow through the nose. This can result in symptoms such as nasal blockage, difficulty breathing through one or both nostrils, recurrent sinus infections, nosebleeds, snoring, or facial discomfort.

The degree of symptoms varies between individuals and depends on the extent of the deviation and the presence of other contributing factors, such as nasal inflammation or sinus disease. Assessment typically involves a clinical examination of the nasal passages and, where appropriate, endoscopic evaluation or imaging to determine the severity and impact of the deviation.

Management depends on symptom severity and how much the condition affects daily activities or quality of life. Options discussed include medical treatment to manage associated inflammation or symptoms, and surgical correction in selected cases where structural blockage is significant. Evaluation by an ENT specialist may be considered to confirm the diagnosis and discuss appropriate management options.

This summary is for general education and does not replace personalised medical advice.

Overview of the Nose and its Function

The nose is part of the respiratory system that allows you to breathe. It filters the air, removing debris, allergens, and other irritants. In addition, it humidifies and warms the air so it can adequately go through the respiratory system. The nose provides you with a sense of smell, impacts the way you sound when you speak, and contributes to your overall facial appearance.

A deviated nasal septum may cause breathing difficulties, nasal obstruction, or recurrent sinus issues. These are conditions often managed in an ENT clinic in Singapore, where an ENT specialist can provide an evaluation.

Common Nasal Conditions

Certain ailments and conditions can affect the nose and its proper functioning, such as: 

  • Allergic rhinitis 
  • Trauma or injury 
  • Nasal polyps
  • Upper respiratory infection
  • Enlarged turbinates
  • Nosebleeds
  • Nasopharyngeal cancer
Another common condition of the nose is what is known as Nasal Septum Deviation, wherein one nasal passage is smaller because the bone and cartilage dividing the nose are not centrally aligned. Understanding nasal septum deviation is crucial because it can significantly affect one’s overall health and well-being. It can cause breathing difficulties, affect sleep quality, increase the risk of sinus infections and nasal congestion, cause facial pain, and more.

What is Nasal Septum Deviation?

Nasal septum deviation happens when the wall between your nasal passages (known as the nasal septum) is displaced to one side. When this is off-centre (otherwise known as ‘deviated’), it will result in one nasal passage being smaller in size than the other.

Treatment for a deviated septum depends on the severity of symptoms. At our ENT clinic in Singapore clinic, an ENT specialist can assess your condition and discuss suitable management options.

Incidence of Nasal Septum Deviation Among Adults and Children

Nasal septum deviation has a wide range of prevalence. An international study published in 2008 showed almost 90% of ENT patients in different geographic regions globally had one of the seven types of septal deformities. Meanwhile, the American Academy of Otolaryngology – Head and Neck Surgery estimates that 80% of people have a septum that is off-centre to a certain degree. 

Nasal septum deviation in children can occur during fetal development. Sometimes, it is a result of injury to the child’s nose. A 2019 study cites that the incidence of deformity in the nasal septum among the paediatric population ranges between 0.93% and 55%. Moreover, it differs according to age and type of deformity.

What Causes a Deviated Septum?

Nasal septum deviation is caused by the displacement of the nasal septum in the nose, which can happen due to injury or, as in many cases, simply from birth. However, it should be noted that having a deviated septum is very common. Contact sports with a high risk of trauma to the face, such as competitive fighting, rugby, and ice hockey, can result in injury to the nose and, as a result, displace the septum. Other sources of injury include falling and vehicle-related accidents.

Living with a Deviated Septum

People with slight septum deviation rarely have symptoms and might be unaware of the uneven nasal passages they might have. Symptoms such as breathing difficulties will only occur more frequently in severe cases of septum deviation.

The afflicted person can have difficulty breathing through the nose and might have to rely on using the mouth to breathe more often. They might also find breathing through one side of the nose easier. Other symptoms include an increased risk of sinus infections or sinusitis, leading to nasal congestion and obstruction.

Additionally, a deviated septum may be associated with other nasal conditions like obstructive sleep apnoea.

In some cases, the uneven airflow generated by a deviated septum can cause dryness in one nostril. This can cause crusting around the septum, which may lead to nosebleeds (epistaxis).

In some rare cases, a deviated nasal septum may also result in headaches (Sluder’s neuralgia). In severe cases, facial pain may be experienced.

It is recommended to visit your doctor or ENT specialist to seek medical advice if you have breathing difficulties or frequently encounter the above symptoms, impacting your quality of life.

How is a Deviated Septum Diagnosed?

The process for diagnosis involves an examination of your nostrils. The doctor uses a nasal speculum to check the placement of the septum within the nose. The focus is on how the septum’s current position affects the size of your nostrils and nasal passages.

The doctor will also ask questions about symptoms experienced, such as the quality of sleep and snoring, frequency and degree of sinus problems, and difficulty in breathing.

In most cases, there is no need for treatment or medical advice as it presents little to no problems in daily life. However, should your quality of life be affected, seeking a professional opinion from a doctor or ENT Specialist is recommended.

How is a Deviated Septum Treated?

Often, surgical treatment is not required. Symptoms can be managed through medication meant to improve the quality of life in most people with a deviated septum. Common medications include decongestants, antihistamines, nasal steroid sprays, and nasal strips.

Should the symptoms fail to improve with medication or other attempts at treating them, your doctor or ENT specialist may suggest a type of reconstructive surgery for your nose and deviated septum, known as Septoplasty.

What is Deviated Septum Surgery (Septoplasty)?

Septoplasty is the surgical correction of the deviated septum and is usually performed under general anaesthesia. The correction has to be performed with extreme precision to avoid affecting the support structure of the nose. Otherwise, rare complications such as saddle nose deformity can occur. Generally, most patients will do well after surgery with minimal problems. It is a straightforward “day surgery” procedure.

During the surgery, the surgeon cuts the septum and removes the excess cartilage and/or bone. This process straightens the passages in the nose and septum. The incision is then closed with sutures.

It is advised to avoid medication such as aspirin or ibuprofen for two weeks before and after surgery, as such drugs may increase the risk of bleeding. If you have a smoking habit, it is highly encouraged to quit smoking during this period as it may hamper the healing process.

Illustration of nasal passages and sinus inflammation related to allergic rhinitis and hay fever treatment by ENT specialist in Singapore.

ENT Specialist · Facial Plastic Surgeon

Dr. Dennis Chua

BOARD CERTIFICATION
Double Board Certified Facial Plastic & Reconstructive Surgeon (International & European Boards – IBCFPRS & EBCFPRS)

Qualifications

Years experience
0
Awards received
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Global

Conference speaker

A highly regarded ENT specialist with a fellowship at the University of Virginia under Professor Stephen Park (Past President, American Academy of Facial Plastics & Reconstructive Surgery). Previously Chief of Facial Plastics & Reconstructive Service at Tan Tock Seng Hospital and Honorary Secretary of the Singapore Society of Otolaryngology.

Trained in Da Vinci robotic ENT surgery in South Korea and serves as ENT Lead Tutor at Lee Kong Chian School of Medicine. Has presented at international conferences across America, China, Europe, and Southeast Asia.

Notable awards

2013 Health Manpower Development Award — Ministry of Health
2011 Service with a Heart Award
2009 Singhealth Best Doctor Award
2009 Best Oral Presentation, Singapore–Malaysia ENT Meeting
2005 Best ENT Free Paper — 11th ASEAN ORL Head & Neck Congress

Areas of focus