Nasal septum deviation

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 22, 2016
StartDiseasesNasal septum deviation

It is estimated that roughly 80% of individuals have a misalignment to their nasal septum, most of whom do not even realize it. While this is very common, severe deviations of the nasal septum can lead to breathing problems, nosebleeds, and other issues and may require surgery to fix. With medication and/or surgery, nasal septum deviation is quite treatable.


Definition & Facts

The bone and cartilage in the center of the nose which separates the nostrils is known as the nasal septum. Normally the nasal septum is aligned in the center of the nose and allows for adequate airflow between both nostrils. When the nasal septum is off-center or deviates to one side more than the other, it can result in one nasal passageway being smaller or larger than the other. When this happens, individuals may experience breathing difficulties and need to address the issue with their doctor.

Symptoms & Complaints 

While most instances of nasal septum deviation go more or less unnoticed, severe cases may manifest with one or more of the following symptoms:

  • Nasal obstruction. One or more of the nasal passages may become blocked and make breathing difficult. This may be exacerbated further by allergies or a common cold. Frequent or ongoing nasal congestion may be a possible sign of a nasal septum deviation
  • Nosebleeds. As one nasal passage is left to receive more exposure to oxygen, the inside of the nasal passages may become dry and result in frequent or occasional nosebleeds or crusting inside the nose. 
  • Sinus infections. Frequent and recurring sinus infections is a possible sign of a deviated septum. People experiencing frequent or hard-to-treat sinus infections should consult with their physician right away
  • Chronic snoring. A person with a deviated septum may breathe loudly when sleeping, snore excessively, or even experience sleep apnea which is a serious medical condition in which an individual actually stops breathing during sleep. This is a serious medical condition and people experiencing sleep apnea should consult with their physician immediately. Individuals may also display a strong preference for sleeping on one side versus the other to compensate for nasal airflow. Many people may display this sleeping preference without realizing why. 
  • Post-nasal drip. An individual with a deviated septum may experience frequent or ongoing runny noses.
  • Pain. Individuals with a deviated septum may also experience headaches, as well as facial pain, and should see a doctor.


A deviated septum is either present at birth and is often the result of fetal development, or is the result of some form of injury or trauma to the nose. Most commonly, deviated septums occur when the nose is injured through an accident or contact sport, resulting in the movement or separation of the bone and cartilage in the nasal septum. Snorting of hard drugs such as cocaine or methamphetamine can also cause a deviated septum by wearing down and damaging the delicate nasal tissues.

Diagnosis & Tests

An individual experiencing symptoms of a deviated septum will be asked about his or his symptoms by their doctor. The physician will likely look inside the nose using a light and a nasal speculum. They may spray the inside of the nose with a decongestant nasal spray, and compare the differences of the nasal passageways before and after to help determine their openness. The physician then will usually be able to either go ahead with a diagnosis of a deviated septum if enough criteria is met, or will refer the patient to an ear, nose, and throat (ENT) specialist for further examination. 

Treatment & Therapy

Doctors may choose to begin treatment by symptom management with medications. These can include nasal decongestants, corticosteroid nasal sprays, and oral antihistamines that can help make the patients more comfortable by treating swelling, inflammation, and by opening nasal passages.

In cases where medications are not enough to combat the symptoms, particularly with serious symptoms such as breathing difficulties, surgery will be needed to correct the issue. The purpose of surgery is to reshape, resize, or realign the nasal septum. Surgery is usually reserved for individuals whose nose has stopped growing: typically people 15 years old or older.

Septoplasty is the name for the surgery in which doctors can reshape, resize, and realign the nasal septum, to correct differences in nasal airways, and reduce nasal obstruction. Sometimes, septoplasty is accompanied by rhinoplasty or surgery on the rest of the nose. Rhinoplasty may be included in septoplasty to target more cosmetic issues. When these two surgeries are performed in conjunction with one another it is referred to as septorhinoplasty.

Septoplasty, rhinoplasty, and septorhinoplasty are all usually performed in an outpatient surgery center, and take between one and three hours. Patients typically will be under general anesthesia but may use local anesthesia for smaller, less invasive procedures. After surgery, the nose will be filled with nasal packing and/or splints. The patient will need to revisit the surgeon in a few days to monitor progress and healing, and to have any nasal packing or nasal splints removed.

Prevention & Prophylaxis

Some nasal septums deviate in the womb or during childbirth and are unavoidable. Others occur as the result of an injury or trauma to the nose. Therefore, the best method of prevention is to protect the face. Always wear a helmet or face-mask during contact sports, and use safety and caution to avoid traumatic injury to the face and nose.

If traumatic injury to the nose occurs, see a physician immediately and pay attention to changes or symptom development. Occasionally, septum deviation can worsen with age as the shape and size of the nose naturally change. Sometimes an individual may have to undergo multiple septoplasty procedures over time.