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Having a deviated nasal septum is relatively common. If you are affected, your septum, the middle part of the inside of your nose, divides the nostrils asymmetrically.
In mild cases, this causes no problems but some people with a deviated nasal septum have problems with a constantly blocked nose particularly if the nose deviates because of the septum. This can lead to problems with exercise, sleeping, eating and speaking.
A deviated nasal septum and other structural problems that affect the nose can arise due to disordered growth from birth or from an accident in childhood or later in life. Although structural nose problems are rarely life-threatening, they can cause symptoms that impact on the overall quality of life. Treatment is relatively straightforward, and usually involves nasal surgery – septoplasty or a septorhinoplasty.
What is the nasal septum?
The nasal septum is the internal tissue that separates the nose into two parts. It is a supporting structure to the lower two thirds of the nose and lies midway between the nostrils, and divides the nose into two broadly equal, symmetrical halves. It extends about 8cm back from the opening of the nostrils. From the front going backwards, it comprises: skin (the membranous septum), the quadrilateral cartilage and bone, both of which are covered with a mucous membrane.
What is a deviated nasal septum?
In most people the septum does not perfectly divide the nose into equal parts, but a small deviation from the centre usually causes no symptoms unless the problem is at the nasal valve region. Problems arise only when the deviation blocks airflow through one or both nostrils.
This can happen if the front part of the septum becomes detached from the nasal floor and moves to one side, narrowing that nostril; this restricts or even blocks airflow in and out of the nostril. It is also possible for the nasal septum to bend and take on an S shape; it doesn’t detach but the tissue is misaligned and can restrict or block airflow through one or both nostrils. This is particularly so if the deviation is in the first 3-4 cm of the nasal cavity and especially if the lower part of the external nose is not midline.
Causes of a deviated nasal septum
The most frequent cause is nasal injury. Injury to the septum can occur during birth, perhaps due to a prolonged labour or an assisted delivery. In many instances, however, no specific cause can be pinpointed. Children’s noses are mainly cartilaginous and falls or sporting injuries may produce small fractures that are unnoticed but then cause abnormal growth of the septum. The fractures can result in deviation or collapse of the septum (saddle deformity).
Symptoms and signs of a deviated nasal septum
Typical symptoms include difficulty in breathing through the nose and difficulty in clearing the nose, with a consequent build-up of mucous material. People with a deviated nasal septum often complain of a constantly blocked nose.
Other symptoms include:
- Snoring and sleep apnoea (when you stop breathing for a few seconds during your sleep)
- Difficulty sleeping through the night or only able to sleep on one side
- Nose bleeds
- Scabs within the nostrils
- Dry and sore nose
- Daytime tiredness
If both nostrils are blocked, this can make it difficult to speak clearly, and eating and swallowing food becomes less pleasurable as the sense of taste can be almost lost.
Problems related to a deviated nasal septum
Having nasal surgery to correct a blocked nose may seem drastic, but early correction of a deviated nasal septum can prevent more serious problems developing later on. Other problems related to a deviated nasal septum include:
- Turbinate enlargement: the turbinates are curved pieces of bone, each covered by blood vessels and mucous membrane. You have three on each side of your nose. They warm and moisturise air passing through your nose. Having enlarged turbinates can lead to difficulty breathing, a blocked nose, snoring, and a tendency to get repeated sinus infections. Having a deviated nasal septum is a major risk factor connected with turbinate enlargement, but it can also develop because of allergies, rhinitis, and recurrent sinus infections. Diagnosis involves endoscopic nasal inspection, often coupled with computer tomography (CT). Treatment involves medication to treat infection, identification and avoidance of allergens, endoscopic surgery, or a combination of all three.
- Nasal valve collapse: your nasal valves are a region situated immediately inside each of your nostrils. Valve collapse leads to partial or total closure of the nostril, making breathing difficult. The collapse can result from an injury but it is also associated with a deviated nasal septum and turbinate enlargement. Treatment involves rhinoplasty surgery in which cartilage grafts are put in place to support the nasal valve.
- Nasal polyps: these are growths within the nasal pathways. They are rarely sinister and are caused by infection and allergies, though genetic factors can be important in some people. They can occur at contact points inside the nose. Treatment almost always involves medication initially to treat allergies and/or sinus infection. Larger obstructing polyps usually require surgery performed by minimally invasive endoscopic techniques.
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