What Is a Deviated Septum?
A deviated septum occurs when the nasal septum, the wall of bone and cartilage dividing your nasal cavity, sits off-centre. This can narrow one or both nasal passages and restrict airflow.
Estimates suggest that up to 80% of people have some degree of nasal septum deviation. Many have a nasal septum that is only a little off-centre, with no noticeable symptoms or need for treatment. A mild deviation may only become troublesome when a cold or allergy causes additional swelling.
Deviated Septum Symptoms
The most common symptom of a deviated septum is difficulty breathing through the nose, often worse on one side.
The normal nasal cycle causes airflow to alternate between nostrils. A badly deviated septum may make one nasal passage feel consistently more blocked, although symptoms can fluctuate. Symptoms alone cannot confirm the diagnosis. You may notice:
- Persistent nasal congestion or a feeling of fullness, often worse on one side
- Mouth breathing and a dry mouth
- Snoring or noisy breathing, disturbed sleep or a preference for sleeping on one side
- Dryness and crusting inside a nostril, sometimes with recurrent nosebleeds from irritated blood vessels
- A decreased sense of smell when airflow is restricted
- Blockage and related symptoms that worsen during colds or allergy flare-ups
Why Symptoms Are Often Missed
Symptoms may be overlooked because other causes of nasal obstruction can feel similar. Allergic rhinitis causes inflammation, while turbinate hypertrophy involves enlargement of structures along the side walls of the nose. These problems can occur alongside a deviated septum. Nasal polyps can also cause blockage.
Nasal septum deviation can sometimes narrow sinus openings, impair drainage, and contribute to recurrent sinusitis, facial pressure, or postnasal drip. However, frequent sinus infections, facial pain and headaches may have other causes. An examination helps establish whether the septum is contributing.
Deviated Septum Causes
You may be born with a deviated nasal septum, or develop one as your nose grows or after a nasal injury. Causes include:
- Uneven formation of the septum during foetal development
- Injury during birth or childhood, which may not be remembered
- A broken nose or other trauma from contact sports, falls or accidents
- Changes in nasal cartilage and other structures during growth or ageing
When to See an ENT Specialist
See an ear, nose and throat (ENT) specialist if a blocked nose persists despite usual care or affects sleep, exercise or quality of life.
An assessment is also appropriate for recurrent nosebleeds, repeated sinus infections or a change in breathing after a nose injury. Loud snoring with witnessed breathing pauses, gasping or daytime sleepiness needs assessment for obstructive sleep apnea. Mention trouble breathing through the nose that makes CPAP difficult to use.
Deviated Septum Diagnosis
An ENT specialist diagnoses a deviated septum by reviewing your symptoms and performing a physical examination of your nose. Your history includes blockage patterns, allergies, sinus symptoms, previous injuries and treatments you have tried.
A nasal speculum gently opens the nostril so the doctor can inspect the nasal septum with a light. The doctor checks both nostrils and assesses how its position narrows the nasal passages. A nasal endoscope, a thin instrument with a light and camera, may be used to examine deeper areas of the nasal cavity.
A CT scan is not usually needed to diagnose septal deviation. Your healthcare provider may request one if sinus disease or complex anatomy needs assessment. Checking for swelling, enlarged turbinates, and other causes of obstruction helps guide care.
Can a Deviated Septum Be Fixed without Surgery?
A deviated septum can be treated without surgery to ease symptoms, but this cannot straighten it. If you have little or no discomfort, you may not need treatment.
These measures target any inflammation or swelling that adds to the structural narrowing:
- Saline nasal rinses clear mucus, allergens, and irritants while keeping the nasal lining moist. Use distilled, sterile or previously boiled and cooled water.
- Nasal steroid sprays reduce inflammation and swelling inside the nose. Regular use, as advised, can improve airflow when inflammation contributes to blockage.
- Antihistamines help when allergies worsen nasal congestion.
- Decongestants offer short-term relief. Follow the product instructions and your healthcare provider’s advice, as overusing decongestant sprays can cause rebound congestion. Oral decongestants are not a routine long-term alternative.
- Nasal strips or dilators may temporarily improve airflow at the nostrils but do not correct the septum.
When to Seek Urgent Care
Seek urgent care for severe difficulty breathing or a heavy nosebleed that will not stop. New, marked nasal blockage after an injury also needs prompt assessment. A collection of blood inside the septum, called a septal haematoma, needs urgent treatment.
Deviated Septum Treatment Options in Singapore
Deviated septum treatment depends on the severity of your symptoms, their effect on daily life and whether the blockage comes from structure, inflammation or both. Surgery called septoplasty may be recommended when significant obstruction persists despite appropriate non-surgical care. This surgical procedure reshapes or repositions the septal bone and cartilage.
Surgery may involve septoplasty alone or a combination with turbinate reduction. Septorhinoplasty combines septoplasty with external nose reshaping when both function and appearance need attention. Surgical correction of the septum improves airflow but does not cure allergies or chronic rhinitis, so medication may still be needed.
In a randomised trial of adults with at least moderate nasal obstruction, septoplasty improved symptoms, airflow and quality of life more than steroid and saline sprays. This supports discussing surgery when symptoms are substantial, but individual benefits and risks still need assessment.
Deviated Nasal Septum Surgery Recovery Time
For most patients, initial recovery after septoplasty takes about 1 to 2 weeks, although the internal healing process continues for several months.
This nasal surgery is usually performed under general anaesthesia as day surgery. Short-term congestion, swelling, discomfort and minor bleeding are common. Follow your surgeon’s advice on saline care, blowing your nose, and returning to normal activities and exercise.
Our septoplasty surgery and recovery guide explains preparation, the procedure and aftercare in more detail. A septoplasty typically costs $6,500 or more. This does not include initial consultation, assessment fees or follow-up appointments.
Risks and Recovery after Surgery
Potential complications include bleeding, infection, a hole in the septum, internal scar tissue, persistent blockage, changes in smell and temporary numbness of the upper teeth or lip.
Your surgeon will explain which risks apply to you. Follow-up checks healing and breathing; some people need further care. Wearing appropriate protective gear during contact sports helps protect your nose and reduce the risk of another injury.
How Barrie Tan ENT Can Help
Dr Barrie Tan assesses nasal blockage at Gleneagles Hospital, Singapore, to determine whether a deviated septum, inflammation or another condition is responsible. Your consultation includes an examination and discussion of medical care or surgery when appropriate.
Contact Barrie Tan ENT Head & Neck Surgery to arrange an assessment if a blocked nose is causing trouble breathing or disturbing your sleep.
FAQs about a Deviated Septum
Can a deviated septum get worse over time?
Nasal septum deviation usually persists, but symptoms can change. Age-related changes, another injury or swelling from allergies may cause breathing difficulties. A worsening blockage should be assessed rather than assumed to be caused by the septum.
Does a deviated septum affect sleep or snoring?
A deviated septum can contribute to snoring, mouth breathing and poor sleep. Nasal obstruction may aggravate obstructive sleep apnea or make CPAP harder to tolerate. Septoplasty alone is not a reliable cure for sleep apnea, which needs separate assessment and treatment.
Is a septoplasty medically necessary or considered cosmetic?
Septoplasty is usually performed to improve breathing through the nose or address other symptoms attributable to the septum. A visible deviation alone does not mean surgery is necessary. Cosmetic changes involve a separate discussion about rhinoplasty.
Will a deviated septum surgery change how my nose looks?
Septoplasty usually treats the internal septum and does not aim to change your nose’s shape. Septorhinoplasty may be considered if you also need to correct external shape or support. Your surgeon will explain any possible change in appearance.
