Deviated Septum

What Is It?

The nasal septum is the wall between the left and right sides of the nose. It is firm, but bendable, and it is covered by skin that has a rich supply of blood vessels. Ideally, the nasal septum should lie exactly in the center, so that the left and right sides of the nose are of equal size. In about 80 percent of us, however, the nasal septum is a little off-center, although most of us never notice. Less often, the septum is more dramatically off-center. This is called a deviated septum.

In people who have a deviated septum, one side of the nose is wider than normal and one is narrower. This alters the normal pattern of airflow in the nose and sometimes blocks the narrowed side. In some cases, sinus openings can be blocked, triggering a sinus infection (sinusitis) that lasts a long time or keeps returning. The altered airflow pattern within the nose can cause the skin of the nasal septum to become dry and cracked, which can cause frequent nosebleeds.

Some people are born with a deviated septum because this is simply the way that the nose developed before birth. More often, however, a deviated septum is caused by injury to the nose during birth. Later in life, a deviated septum can be caused by trauma, although adults and teenagers often cannot remember the specific injury that caused the problem. In most cases, however, it was probably a blow to the side of the nose — often during contact sports, playground games, or a traffic accident — that knocked the nasal septum out of its normal center position.

Symptoms

Symptoms of a deviated septum can include:

• Blockage of one or both nostrils
• Nasal congestion, sometimes on one side
• Frequent nosebleeds
• Frequent sinus infections
• Facial pain, headaches, postnasal drip
• Noisy breathing during sleep in infants and young children

In some cases, a person with a mildly deviated septum has symptoms only when they also have a cold or other upper respiratory tract infection. In these people, the respiratory infection causes nose tissues to swell, which can make airflow problems worse. Once the cold goes away, the symptoms of a deviated septum often go away, too.

Diagnosis

After reviewing your symptoms, the doctor will ask you whether you have ever broken or severely injured your nose and whether you have ever had nasal surgery. Next, your doctor will look at your nose and the position of your nasal septum. Then, your doctor will use a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril. In most cases, you will not need any special tests.