Deviated Septum: Symptoms, Causes and Treatment

01What

What is a deviated septum?

The septum is made of cartilage at the front and thin bone further back, covered with the lining of the nose. A deviation is a bend, curve or spur that pushes it toward one side. Studies suggest most adults have some degree of deviation. It only becomes a problem when it narrows the airway enough to reduce airflow, especially when combined with swelling of the turbinates, the structures on the side walls of the nose that swell with colds and allergies.

02Symptoms

Symptoms of a deviated septum

• One nostril that is always more blocked, or blockage that switches sides (the normal nasal cycle feels exaggerated).
• Difficulty breathing through the nose, especially during exercise or when lying down.
• Snoring and noisy breathing during sleep.
• Mouth breathing and a dry mouth in the morning.
• Nosebleeds, because airflow dries the lining over the bend.
• Facial pressure or headaches in some people.
• Repeated sinus infections if drainage is blocked.
• A preference for sleeping on one side.

03Causes

Causes

Some people are born with a deviated septum or develop it as the face grows. Others develop one after an injury such as a fall, sports contact or a car accident, sometimes years earlier. A deviation can worsen with age as tissues change. Many cases of “blocked nose” are not caused by the septum at all but by swollen turbinates, allergies, nasal polyps or chronic rhinitis, which is why proper examination matters.

04Diagnosis

How it is diagnosed

An ENT doctor asks about symptoms and examines the inside of the nose with a light, often before and after a decongestant spray to see how much blockage is due to swollen lining. A thin camera (nasal endoscopy) gives a view further back. CT scans are not needed to diagnose a deviation but may be used if sinus disease or surgery is being considered. Questionnaires such as the NOSE score measure how much the blockage affects you.

05Treatment

Treatment without surgery

• Saline sprays or rinses keep the lining moist and clear mucus.
• Steroid nasal sprays reduce swelling from rhinitis and allergies; they take one to two weeks to work.
• Antihistamines if allergies contribute.
• Decongestant sprays only for a few days, as longer use causes rebound blockage.
• Nasal strips or dilators may help at night or during sport.
• These treatments help the lining but do not change the shape of the septum. See our guide to a stuffy nose for more self-care tips.

06Surgery

Septoplasty: when surgery helps

Septoplasty is considered when a deviation causes persistent obstruction that affects quality of life despite medical treatment, or contributes to recurrent sinusitis or nosebleeds. The surgeon works through the nostrils to reshape or remove the bent cartilage and bone, usually under general anaesthetic and often as a day case. Turbinate reduction may be done at the same time. A Dutch randomised trial found that adults with nasal obstruction and a deviated septum who had septoplasty had better nasal breathing and quality of life at 12 and 24 months than those managed without surgery.

Septoplasty is different from rhinoplasty, which changes the outside shape of the nose; the two are sometimes combined.

07Recovery

Recovery after septoplasty

• Expect a blocked nose, mild pain and some bleeding for the first days.
• Splints or packs, if used, are usually removed within a week.
• Avoid blowing the nose, heavy lifting and strenuous exercise for about two weeks.
• Use saline rinses as advised to clear crusts.
• Most people return to desk work within a week; breathing improves gradually over several weeks as swelling settles.
• Possible complications include bleeding, infection, a hole in the septum and persistent blockage, all uncommon.

08Cases

Three common situations

• Old rugby injury, left nostril always blocked: a post-traumatic deviation is likely. If sprays have not helped after a proper trial, an ENT assessment for septoplasty is reasonable.
• Blocked nose that switches sides with hay fever: this is more often swollen lining than the septum. Allergy treatment and a steroid spray should be tried first.
• Snoring partner with a crooked septum: the septum may contribute, but snoring and sleep apnoea usually involve the throat too. A sleep assessment helps decide whether nasal surgery is worthwhile; see snoring remedies.

09Summary

Key points to remember

• A slightly deviated septum is normal and often causes no symptoms.
• Persistent one-sided blockage, snoring and nosebleeds are the main symptoms when it matters.
• Sprays treat the lining, not the bend.
• Septoplasty helps selected adults with significant obstruction.