Deviated septum in the nose (nasal septal deviation)

At a glance

  • The nasal septum is a thin wall in the nose that divides the air passage into two halves.
  • Nasal septal deviation is when the septum bends away (deviates) from the middle line.
  • It can cause snoring, headaches and trouble breathing through the nose.
  • Infections like sinusitis and mouth or throat infections may also be more common in people with a deviated septum.
  • Surgery is considered in severe cases.


Photo of a woman

The nasal septum is a thin wall that divides your nose into a right and a left nasal cavity (air passage). Usually, it’s roughly in the center of the nose, making both cavities about the same size. Nasal septal deviation is when the septum bends (deviates) away from the middle line.

Most people’s nasal septum isn’t completely straight. A slight bend (deviation) doesn’t normally cause any problems. But depending on where the septum deviates – and how much – it can lead to snoring, headaches, nosebleeds and trouble breathing through the nose. Recurring colds, sinus problems and mouth or throat infections can also occur.

If this becomes a real problem in daily life, surgery is considered. The surgeon straightens the septum to make it easier to breathe through the nose and to prevent other medical problems. But there isn’t enough high-quality research to say whether surgery can provide long-term relief.


The most common symptom of a deviated septum is difficulty breathing through the nose. This happens if one or both nasal cavities are obstructed (blocked) because they’re too narrow. As a result, less air flows through the nose and into the sinuses when you breathe in. Often, the soft tissue lining the nose is also swollen, causing the turbinates (bony bumps covered by soft tissue) to become enlarged. Sometimes, there are small growths in the soft lining, known as nasal . They make it even more difficult to breathe through the nose.

Illustration: Straight and s-shaped nasal septum

Other typical symptoms include:

  • Headaches
  • Snoring
  • Tiredness during the day
  • Trouble smelling
  • Dry mucous membrane linings
  • Nosebleeds

The severity of these problems mainly depends on where the septum deviates and how much.

The nasal septum supports the entire nose and forms the bridge of the nose. So a deviated septum sometimes makes the nose look “crooked” from the outside.


A deviated nasal septum often forms during growth. It is made up of two parts: a front part made of cartilage and a back part made of bone. If these two parts and the bones in the face grow at different speeds, the septum usually bends into an S or C shape.

The deviation can also be caused by injury – for example, during birth or due to a broken nose. When this happens, the deviation is often less smooth. Sometimes the whole nose bends to one side.

A deviated septum is more likely to cause problems if

  • the bend is at the entrance to or in the front of the nose,
  • the turbinates are enlarged as well, and
  • the nose has a particular shape (crooked, for example, or a tip that points downward).


As many as 80% of people have a deviated nasal septum. But it only causes problems in a small number of them.


If the passages between the nose, sinuses and middle ear are obstructed (too narrow), any fluid there can’t get out. This can lead to infections like recurring sinusitis or middle ear infections.

People who can’t breathe properly through their nose automatically breathe through their mouth more. So the air they breathe in isn’t moistened and warmed up like it is when we breathe in through our nose. But that’s important for the exchange of gases in the lungs. This can sometimes cause snoring. Your sleep may be less restful as a result.

The nose’s cleaning and protective functions are also affected. Usually, small dirt particles and germs stick to the tissue lining the nose. Tiny hair-like structures (cilia) then transport them to the throat. From there, they travel to the stomach and gut, where they are damaged to stop them doing harm. Eventually, they leave the body. If you tend to breathe through your mouth a lot, the particles and germs are more likely to end up in your lower respiratory tract (windpipe and lungs), where they get stuck. Your mouth and throat will also dry out. This can cause damage to the teeth, chronic in the mouth and throat, and bronchitis.


The ENT (ear, nose and throat) doctor will first ask about your symptoms and any other illnesses, allergies or injuries you have. Then they’ll take a look at your nose and face from the outside, checking things like symmetry, your profile and the length and width of your nose.

This is followed by a rhinoscopy examination, where the doctor looks at the inside of your nose using a special instrument fitted with a light. That way, they can see whether the cartilage or bone in the septum are deformed in any way. To see better, they might use a nasal spray beforehand to reduce swelling in the tissue lining the nose.

You might have one or more of the following examinations too:

  • Rhinomanometry: This checks whether you can breathe through your nose properly. You wear a special mask that measures how well air flows through your airways – both before and after you’ve taken a solution to reduce swelling in the tissue lining the airways.
  • Olfactometry: This tests your sense of smell using various odors.
  • Acoustic rhinometry: This takes measurements of your nasal cavity using sound waves.
  • Allergy test: To rule out hay fever or any other allergies that might be causing your symptoms.
  • Scans: Sometimes a (CT) or (MRI) scan of your head and sinuses is needed too.
  • Polygraphy: If you snore heavily, the doctor might give you a device that you can take home with you to measure things like your breathing and heartbeat when you’re asleep. The aim is to find out whether you have breathing pauses at night (sleep apnea).

It is important to rule out other causes. For instance, sinus problems can cause swelling, which can make it harder to breathe through your nose.


Medications are only used in specific situations. These may include steroid nasal sprays to treat complications like sinusitis or enlarged turbinates. Sprays or drops to reduce swelling in the nose (decongestants) should only be used for a few days. They do make it easier to breathe through your nose – but only for a few hours. Prolonged use can cause your nose to get used to the medication (rebound effect).

A type of surgery known as septoplasty may be considered if the symptoms are severe and believed to be caused by a deviated septum. It is not usually recommended for children or teenagers because their noses are still growing.

The aim of this surgery is to make it easier to breathe through both nostrils. This is done by straightening the septum and moving it back to the middle of the nose. Then the breathed-in air can be moistened, warmed up and filtered better. The surgeon often reduces the size of the turbinates at the same time. Research suggests that this operation can help relieve the symptoms for some time. But there hasn’t been enough research to say for sure whether it helps in the long term. The potential complications include bleeding, infections and perforations (holes) in the nasal septum.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf und Hals-Chirurgie (DGHNOKHC). Formstörungen der inneren und / oder äußeren Nase (mit funktioneller und/oder relevanter ästhetischer Beeinträchtigung) (S2k-Leitlinie). AWMF-Registernr.: 017-070. 2020.

Papadopoulou AM, Chrysikos D, Samolis A et al. Anatomical Variations of the Nasal Cavities and Paranasal Sinuses: A Systematic Review. Cureus 2021; 13(1): e12727.

Pschyrembel Online. 2022.

Teixeira J, Certal V, Chang ET et al. Nasal Septal Deviations: A Systematic Review of Classification Systems. Plast Surg Int 2016; 2016: 7089123.

Thurnher D, Grasl MC, Erovic BM et al. HNO-Heilkunde: Ein symptomorientiertes Lehrbuch. Wien Springer; 2011.

Van Egmond MH, Rovers MM, Hannink G 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. Lancet 2019; 394(10195): 314-321.

Van Egmond MH, Rovers MM, Tillema AH et al. Septoplasty for nasal obstruction due to a deviated nasal septum in adults: a systematic review. Rhinology 2018; 56(3): 195-208.

Zenner HP. Kurzlehrbuch Hals-Nasen-Ohren-Heilkunde. Lernbuch für Studierende. Berlin: epubli; 2013.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Created on March 25, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.