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Deviated nasal septum

OVERVIEW

What is a Deviated Nasal Septum?

A deviated nasal septum refers to an abnormal shape of the nasal septum, where it is off-center or curved, leading to symptoms such as difficulty breathing, headaches, and nasal congestion[1].

The nasal septum is the tissue that divides the nasal cavity into left and right parts. It consists of a framework of bone and cartilage covered with mucous membrane. Most people's nasal septum leans slightly to one side rather than being perfectly centered. Therefore, when the nasal septum is off-center or has localized protrusions but causes no discomfort, it is not considered a disease and is referred to as a physiological deviated nasal septum.

Only when this structural abnormality causes nasal dysfunction or symptoms (nasal congestion, headaches, nosebleeds) is it called a pathological deviated nasal septum, requiring medical treatment, often through surgical correction.

Is the Incidence Rate of Deviated Nasal Septum High?

Yes. According to statistics, the incidence rate of deviated nasal septum ranges from 16% to 79%[2].

Most people's nasal septum is not perfectly straight or centered, but the deviation is minor and not visually noticeable. In other words, the nose may appear normal externally, but one nasal passage is wider while the other is narrower. Without repeated external stimuli—such as frequent colds, trauma, or foreign objects entering the nasal cavity during childhood—there are usually no obvious clinical symptoms. This condition is collectively referred to as a physiological deviated nasal septum and does not require treatment.

Only when a deviated nasal septum causes nasal dysfunction or symptoms (nasal congestion, headaches, nosebleeds) is it considered pathological and requires medical intervention, typically surgical correction.

SYMPTOMS

What are the symptoms of a deviated nasal septum?

  1. Nasal congestion: The most common symptom, unlike a cold that improves in a few days, it often presents as persistent nasal congestion.
  2. Headache: Patients may experience pain around the forehead or temples, sometimes accompanied by dizziness or a feeling of heaviness in the head. Common pain relievers like aspirin or other NSAIDs are often ineffective, and headaches tend to recur, usually related to nasal congestion and worsening as congestion intensifies.
  3. Nosebleeds: In areas where the septum is significantly deviated, the mucosa over the protruding part is thinner. If the air is very dry or the nose is frequently rubbed or picked, these areas can easily become irritated and bleed.
  4. Snoring: Due to narrowed nasal passages and poor airflow, individuals with a deviated septum may snore during sleep.
  5. Affected adjacent structures: For example, if the deviation obstructs sinus drainage, it can lead to sinusitis, worsening nasal congestion, purulent nasal discharge, and loss of smell[1,3].

What are the types of deviated nasal septum?

Based on etiology, it can be classified as physiological or pathological. According to shape, deviations are categorized as C-shaped, S-shaped, or other complex types—meaning leaning to one side, both sides, or more complicated configurations[3].

These variations in cause, shape, and location of the deviation influence the patient's symptoms and the complexity of surgical treatment.

CAUSES

What are the causes of deviated nasal septum?

The causes of deviated nasal septum include developmental deformities, trauma, and secondary deviations caused by certain conditions.

  1. Uneven nasal development: The growth of nasal septum bones and cartilage in children is uneven with the development of maxillofacial bones.
  2. Trauma: Often seen in nasal injuries, leading to nasal septum fractures or even dislocation, forming sharp bends or the nasal septum cartilage deviating to one side, resulting in a crooked nose.
  3. Tumor compression: Tumors in the nasal cavity or sinuses, or large nasal polyps pressing on the nasal septum[3].

Who is more prone to deviated nasal septum?

People more susceptible to deviated nasal septum include those with a history of nasal trauma, a family history of deviated nasal septum, and patients with nasal polyps or tumors in the nasal cavity and sinuses[3,4].

Is deviated nasal septum related to genetics?

Yes, due to genetic factors, some people are born with a deviated nasal septum[4].

If parents have a deviated nasal septum, they should pay more attention to their child's nose and surrounding organs, including symptoms like snoring during sleep, excessive nasal discharge, or recurrent otitis media.

Is deviated nasal septum contagious?

Since deviated nasal septum is not caused by pathogen infection, it is not contagious. Close contact or living with someone who has a deviated nasal septum will not lead to the condition.

Why does deviated nasal septum cause nosebleeds?

The front lower part of the nasal septum has abundant blood vessels and a superficial position. When the nasal septum cartilage is deviated, the mucosa attached to the deviated cartilage becomes more tense and fragile, making it more prone to bleeding upon contact.

The convex side of the deviated nasal septum has thinner and more tense mucosa, which is more likely to rupture and bleed under dry air, inflammation, or mechanical stimulation like nose-picking. If the convex side is located in the front lower part of the nasal septum (the common bleeding area), recurrent bleeding is more likely[3]. Dry air, forceful nose-blowing, and frequent nose-picking are common triggers. Sometimes, even strenuous activities like lifting heavy objects can cause nosebleeds.

If bleeding occurs, avoid tilting the head back and swallowing blood. Instead, lower the head and firmly press the bleeding nostril from the outside toward the center for 10–15 minutes to stop the bleeding. Applying a cold compress or ice pack to the neck on the bleeding side for 30–60 minutes can help constrict blood vessels and reduce bleeding. If bleeding persists, seek medical attention at an ENT department.

Are patients with deviated nasal septum more prone to rhinitis or sinusitis?

Yes, patients with deviated nasal septum are indeed more susceptible to rhinitis and sinusitis.

Normally, nasal airflow and drainage are smooth, and even under inflammatory stimulation like infections, the nasal cavity has self-cleaning and resistance capabilities. In people with deviated nasal septum, the nasal structure affects airflow and drainage, hindering the normal discharge of mucosal secretions. The self-cleaning and resistance functions are also compromised, making them more prone to rhinitis and sinusitis compared to the general population[3].

DIAGNOSIS

What tests should be done for suspected nasal septum deviation?

For suspected nasal septum deviation, typical and obvious deviations can be detected through anterior rhinoscopy or nasal endoscopy. These examinations can reveal the type and severity of the deviation, as well as the anatomical relationship of the nasal septum within the nasal cavity and its impact on airflow through the respiratory tract.

For complex cases of nasal septum deviation, atypical symptoms, or suspected concurrent nasal diseases, further sinus CT scans may be required to confirm the diagnosis and differentiate it from other conditions such as tumors, sinusitis, or nasal polyps[3].

What is the difference between anterior rhinoscopy and nasal endoscopy?

The main differences lie in the examination method and scope.

  1. Examination method:
    • Anterior rhinoscopy involves the doctor gently spreading the nostrils with a nasal speculum in an outpatient setting, using light reflected from a forehead mirror to observe the nasal structures through the anterior nostrils.
    • Nasal endoscopy is an endoscopic examination, available in rigid and flexible fiberoptic forms. A slender instrument with a light source and camera at the tip is inserted into the nostril. The camera captures detailed images of deep nasal structures, allowing the doctor to view the interior on a screen[3].
  2. Examination scope:
    • Anterior rhinoscopy has limited visibility due to the natural curvature of the nasal cavity, making it impossible to directly observe the superior turbinate, superior meatus, or middle meatus, thus lacking comprehensive detail.
    • Nasal endoscopy, with its multi-angle and wide field of view, allows thorough examination of all nasal areas and is a key diagnostic tool. Suspicious lesions found during endoscopy can be biopsied for pathology, and bleeding sites can be treated immediately.

Patients typically undergo anterior rhinoscopy first, and the doctor may decide whether nasal endoscopy is necessary based on the findings.

What should nasal septum deviation patients pay attention to during nasal endoscopy?

Nasal endoscopy is usually performed after applying a local anesthetic spray. The patient remains fully awake during the procedure. The patient should lie supine or sit upright, relax as much as possible, and breathe calmly. When the endoscope is inserted, inhaling gently is recommended.

The examination usually takes less than 10 minutes. If discomfort becomes unbearable, the patient can signal the doctor by raising a hand or tapping the examination table. Speaking is also allowed, but pulling the doctor’s arm holding the endoscope should be avoided to prevent nasal mucosa injury.

Is nasal septum deviation related to snoring during sleep?

Possibly.

Snoring at night is mainly caused by airflow obstruction in the respiratory tract. The nasal cavity is the primary passage for airflow during breathing. If nasal septum deviation leads to structural abnormalities and poor ventilation, it may result in snoring or even sleep apnea.

If these symptoms occur, a medical examination is recommended[1,5].

Why is syphilis testing necessary for nasal septum deviation?

Doctors may request syphilis testing to rule out syphilitic rhinitis when diagnosing nasal septum deviation.

Syphilitic rhinitis can cause nasal mucosa ulcers with thick secretions, leading to nasal congestion and breathing difficulties. These symptoms can resemble nasal septum deviation, making differentiation challenging based solely on appearance. Testing for syphilis antibodies in the blood helps ensure an accurate diagnosis[6].

TREATMENT

Which department should I visit for a deviated nasal septum?

Otorhinolaryngology (ENT).

If my nasal septum is noticeably deviated to one side but causes no discomfort, do I need medical attention?

Most people's nasal septum is not perfectly centered. Generally, if there are no symptoms like nasal congestion, headaches, frequent nosebleeds, or recurrent sinusitis, medical treatment is unnecessary[3].

If the deviation is discovered during a physical exam but causes no discomfort, further examination at a hospital may be needed to rule out conditions like nasal tumors or polyps. Follow the doctor's advice for further treatment.

How is a deviated nasal septum treated?

Surgical correction is the only treatment. Procedures like septoplasty or submucous resection of the nasal septum may be performed, depending on the patient's condition[3].

Is medication effective for a deviated nasal septum?

Medication can only temporarily control infections and relieve symptoms like nasal congestion or nosebleeds. It does not cure the condition—only surgical correction can provide a permanent solution[1,3].

Is surgery for a deviated nasal septum painful?

Most modern surgeries use local anesthesia and endoscopic techniques. While patients may experience some discomfort during the procedure, it is generally tolerable. The incision is small, and postoperative swelling or bruising may occur, but pain is usually mild and resolves within two weeks. Severe pain or abnormal bleeding should prompt immediate medical attention[1].

When is surgery necessary for a deviated nasal septum?

Surgery is recommended if conservative treatments (e.g., nasal sprays, painkillers) fail and any of the following apply:

  1. Persistent long-term nasal congestion due to deviation;
  2. Recurrent sinusitis or chronic sinusitis unresponsive to standard treatment due to impaired sinus drainage;
  3. Frequent nosebleeds caused by the deviation;
  4. Headaches attributable to the deviation;
  5. Snoring or sleep apnea related to the deviation[3,4].

Who should avoid surgery for a deviated nasal septum?

Surgery is contraindicated or should be postponed in the following cases:

  1. Acute nasal infection;
  2. Untreated or improperly managed sinusitis;
  3. Severe systemic diseases (e.g., diabetes, tuberculosis, uncontrolled hypertension, heart failure, blood disorders);
  4. Women during menstruation;
  5. Patients under 18 years old[1].

Why is surgery not recommended for patients under 18 with a deviated nasal septum?

Younger patients (under 18) have incomplete nasal septum ossification, making the septum softer and surgery more difficult. This increases the risk of complications (e.g., perforation, hematoma, saddle nose). Additionally, patients under 15 may still experience nasal development changes. Therefore, surgery is usually deferred until adulthood, with medication used for symptom control[1,4].

Is dry mouth normal after deviated septum surgery?

Yes, it is very common. Nasal packing forces mouth breathing in the initial days, causing dryness. Patients should drink plenty of water (1500–1700 mL daily) and maintain humid air. Symptoms resolve after packing removal without special treatment.

What are the possible complications of deviated septum surgery?

  1. Septal perforation: Requires surgical repair depending on size and location.
  2. Septal hematoma: Small ones may resolve; large ones need drainage.
  3. Septal abscess: Often secondary to hematoma infection, requiring drainage and antibiotics.
  4. Saddle nose: Due to structural compromise, surgical repair may be needed.
  5. Intracranial complications: Rare but serious; requires aggressive treatment if infection spreads[4,7].

What if nasal congestion persists after surgery?

Residual congestion may indicate concurrent issues like chronic rhinitis or turbinate hypertrophy, requiring further evaluation and treatment[4].

Will allergic rhinitis improve after deviated septum surgery?

No, but improved nasal airflow may alleviate congestion. Allergic rhinitis involves immune reactions to allergens (e.g., pollen, dust) and requires allergen avoidance and antihistamines. Surgery does not cure it but may aid symptom management[3].

Can a nose bridge augmentation be done during deviated septum surgery?

No. Septoplasty (ENT) and rhinoplasty (cosmetic) are separate procedures. Augmentation can be considered 2–3 months post-septoplasty, depending on recovery.

Can anesthesia for deviated septum surgery affect intelligence?

No. Properly administered anesthesia in hospitals is safe, reversible, and fully metabolized. Neither local nor general anesthesia impacts intelligence.

How much does deviated septum surgery cost?

Costs vary by region and severity. In top-tier hospitals, total expenses (surgery, medication, tests) range from ¥5000–8000. Confirm pricing locally.

DIET & LIFESTYLE

What should be noted in daily life after nasal septum deviation surgery?

  1. Avoid trauma: Prevent external impact or injury to the nose; avoid blowing the nose[7,8].
  2. Avoid strenuous exercise: Refrain from intense activities such as lifting heavy objects, running, or hiking for two weeks[7,8].
  3. Postoperative care:
    • Due to significant mucosal reactions after surgery, apply anti-inflammatory or lubricating ointment inside the nose after removing the packing. Nasal sprays with hemostatic effects can also be used to control postoperative bleeding and reduce swelling[7];
    • Avoid catching a cold or sneezing after surgery. If sneezing is unavoidable, gently pinch the nose and open the mouth;
    • Minimize prolonged bending over to reduce the risk of nosebleeds.
  4. Monitor symptoms: Minor blood or clots in nasal discharge or phlegm within two weeks is normal. Seek medical attention immediately if heavy nosebleeds, blood in phlegm, fever, or severe nasal pain occur.
  5. Follow-up visits: Take prescribed medications on time and attend scheduled follow-ups as directed by the doctor.

What dietary precautions should be taken after nasal septum deviation surgery?

  1. Due to mouth breathing and dry mouth after surgery, increase water intake. Adults should drink about 1,500–1,700 ml daily (equivalent to three standard bottles of mineral water).
  2. Avoid overly spicy or irritating foods (e.g., hot pot, barbecue) to prevent wound pain in some patients[8].
  3. Strong-smelling foods (e.g., mustard) may trigger sneezing or nasal discharge; avoid them during recovery.
  4. Consume soft, nutrient-rich foods like oatmeal or pork bone and spinach soup.
  5. Avoid alcohol and smoking for two weeks to prevent wound redness, itching, or delayed healing[8].

PREVENTION

How to Prevent Deviated Nasal Septum?

Non-physiological deviated nasal septum is most closely related to trauma, so it is crucial to actively prevent nasal injuries[1].

During early childhood, parents should closely supervise children to prevent foreign objects from entering the nasal cavity. At all ages, nasal trauma should be avoided by taking protective measures, such as using proper protective gear during sports, and correctly utilizing seat belts or child safety seats when driving or riding in vehicles.

If persistent nasal discomfort (e.g., congestion, runny nose, or nosebleeds) occurs over an extended period, seek medical attention promptly to detect and address underlying conditions that may lead to a deviated septum, such as nasal polyps or sinonasal tumors.