Deviated septum in the nose (nasal septal deviation)

The most common sign 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 polyps. They make it even more difficult to breathe through the nose.

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. Breathing through your mouth can sometimes cause snoring, making your sleepless restful.

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 inflammation 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 computed tomography (CT) or magnetic resonance imaging (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 that can be used for complications like sinusitis or for 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. Studies have shown that this operation can help relieve the symptoms. But there hasn’t been enough research to say for sure whether it helps in the long term. The potential complications include bleeding and infection.

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 healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.