How To Know If I Have A Deviated Septum? Tips

Breathing through your nose should be effortless. When it is not, a deviated septum is often the first thing people wonder about. The septum is the wall of bone and cartilage that divides your nose into two passages. When it is straight, air flows evenly on both sides. When it is bent, or deviated, it can block airflow and cause a range of symptoms. You can suspect a deviated septum if you have persistent nasal congestion on one side, frequent nosebleeds, or noticeable facial pain, but a doctor must confirm the diagnosis with a physical exam.

What Exactly Is a Deviated Septum?

The nasal septum runs down the middle of your nose. It is made of cartilage in the front and thin bone in the back. A deviated septum means this wall is off-center. It might be bent to one side, have a sharp bend or spur, or have a combination of twists.

Many people have some degree of septal deviation. Studies suggest that up to 80 percent of people have a septum that is slightly off-center. Most of these people never notice it. The deviation only becomes a problem when it is severe enough to narrow the airway or block the drainage of the sinuses.

A deviated septum is not a disease. It is an anatomical variation. It can be present at birth, or it can develop after an injury to the nose. It does not get worse over time on its own, though the symptoms can feel worse as you age because the cartilage can stiffen and the nasal tissues can change.

What Are the Most Common Symptoms?

The symptoms of a deviated septum come from the physical blockage it creates. When the septum is bent, one nasal passage is narrower than the other. Air has to work harder to get through that side.

The most common symptom is nasal congestion that is worse on one side. This congestion often switches sides when you lie down. When you lie on your right side, the right nasal passage can become more congested. This is because blood pools in the lower side of your nose, swelling the tissues and making the already narrow passage even tighter.

Other common symptoms include:

• Frequent nosebleeds, especially from the side that is more deviated
• Facial pain or pressure, often on the side of the blockage
• Noisy breathing during sleep or snoring
• Mouth breathing, especially at night
• Recurrent sinus infections
• Reduced sense of smell
• Headaches that seem to come from the front of the face

Not everyone with a deviated septum has all of these symptoms. Some people only have mild congestion. Others have severe symptoms that interfere with daily life. The severity of symptoms does not always match the severity of the deviation. A small bend in the wrong place can cause more trouble than a larger bend in a less critical spot.

How Can I Check My Nose at Home?

You can get a general sense of your nasal structure at home, but you cannot diagnose a deviated septum yourself. The internal structures are too deep to see without proper lighting and instruments.

One simple check is the mirror test. Look into a bright mirror and tilt your head back slightly. Gently press the tip of your nose upward with your finger. You can see the opening of each nostril. A deviated septum might be visible as a bend in the wall that divides the two nostrils. However, this only shows the front portion of the septum. Many deviations are deeper inside the nose where you cannot see them.

Another home check is the breathing test. Block one nostril with your finger and breathe in through the other. Then switch sides. Most people notice a slight difference between sides. This is normal. The nasal cycle causes the tissues in your nose to swell and shrink on alternating sides throughout the day. A significant difference that is always on the same side, regardless of position, is more suggestive of a structural problem.

These tests are not diagnostic. They give you information to discuss with a doctor. Many people with a visibly bent septum have no symptoms at all, while others with a nearly straight septum have severe symptoms.

When Should I See a Doctor?

You should see a doctor if nasal congestion interferes with your sleep, your work, or your daily activities. You should also see a doctor if you have frequent nosebleeds, recurrent sinus infections, or facial pain that does not go away.

An ear, nose, and throat doctor, called an ENT, is the specialist who diagnoses and treats septal deviations. The diagnosis is straightforward. The doctor uses a nasal speculum to open the nostril and a light to look inside. This is called anterior rhinoscopy. In many cases, the doctor also uses a thin flexible scope called an endoscope to see deeper into the nasal passages.

The exam is quick and painless. The doctor looks at the shape of the septum, the size of the nasal passages, and the condition of the tissues lining the nose. They also check for other problems that can cause similar symptoms, such as enlarged turbinates, nasal polyps, or chronic sinusitis.

What Else Could Be Causing My Symptoms?

A deviated septum is not the only cause of nasal obstruction. Several other conditions produce the same symptoms. This is why a medical exam matters.

Allergic rhinitis, or hay fever, causes swelling of the nasal tissues and congestion. Unlike a deviated septum, this congestion usually affects both sides equally and comes and goes with exposure to allergens. The nasal tissues often look pale or bluish on exam.

Enlarged turbinates are another common cause. The turbinates are small bony structures inside the nose that warm and humidify the air you breathe. When they are enlarged, they can block airflow even when the septum is straight. Some people have both a deviated septum and enlarged turbinates.

Nasal polyps are soft, painless growths on the lining of the nose. They can block the nasal passages and reduce the sense of smell. Polyps are more common in people with asthma, allergies, or chronic sinusitis.

Sinus infections cause congestion, facial pain, and pressure. The symptoms can mimic a deviated septum, but they usually improve with treatment of the infection.

How Is a Deviated Septum Treated?

Treatment depends on how much the deviation affects your life. Many people need no treatment at all. If the symptoms are mild, conservative measures can help.

Nasal saline rinses keep the nasal passages moist and clear. Decongestant sprays can open the airway temporarily, but they should not be used for more than a few days at a time. Longer use can cause rebound congestion, making the problem worse. Antihistamines help if allergies are also present. Steroid nasal sprays reduce inflammation and can improve airflow, though they do not straighten the septum.

For people with significant symptoms that do not respond to medication, surgery is an option. Septoplasty is the surgical procedure to straighten the septum. The surgeon makes an incision inside the nose, lifts the lining off the septum, removes or reshapes the bent portions, and puts the lining back. The surgery is done through the nostrils, so there are no visible scars.

Septoplasty is generally effective. Research consistently shows that most people who have the surgery report significant improvement in nasal breathing. However, it is not guaranteed to make the nose perfect. Some people continue to have some congestion after surgery, especially if they also have enlarged turbinates or other nasal conditions.

Septoplasty is not cosmetic surgery. It is performed to improve function. The outer shape of the nose does not change unless a separate procedure called rhinoplasty is done at the same time.

Could I Have a Septal Perforation Instead?

A septal perforation is a hole in the septum. It is a different condition from a deviation, but it can cause similar symptoms. The most common symptom of a perforation is a whistling sound when you breathe. You may also have crusting inside the nose, nosebleeds, and a feeling of nasal blockage even though the airway is actually open.

Perforations can be caused by previous nasal surgery, trauma, chronic nose picking, or the use of certain illegal drugs. Some are caused by autoimmune conditions. A doctor can easily see a perforation during a routine nasal exam.

Treatment for a perforation depends on its size and cause. Small perforations may not need treatment. Larger ones may require surgery to close the hole, though this surgery is more complex than a septoplasty.

Can a Deviated Septum Cause Sleep Apnea?

A deviated septum can contribute to obstructive sleep apnea, but it is rarely the sole cause. Sleep apnea is a condition where breathing repeatedly stops and starts during sleep. The airway collapses or becomes blocked, which reduces oxygen levels and disrupts sleep.

Nasal obstruction from a deviated septum makes it harder to breathe through the nose at night. This can lead to mouth breathing, which can make the airway more likely to collapse. However, most people with sleep apnea have obstruction at multiple levels of the airway. The nasal passage is only one part.

Research indicates that septoplasty can improve sleep apnea in some people, particularly those whose apnea is mild and primarily related to nasal blockage. But septoplasty is not a standard treatment for sleep apnea. The first-line treatments are continuous positive airway pressure, called CPAP, oral appliances, and weight loss when appropriate.