Deviated Septum

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a deviated septum?

A deviated septum is a condition in which the nasal septum is off-center. The septum is a thin wall of bone and cartilage that separates the nostrils. Ideally, it should run straight down the middle, making the two nostrils the same size. When the septum deviates—or shifts—to one side, one nostril is larger and the other one is smaller than it should be.

Having a deviated septum is very common. About 80% of people have a septum with some degree of displacement. However, most people don’t notice it because the shift is slight. When it is very crooked, the deviated septum can change how air flows through the nostrils. In some cases, it can block airflow completely on one side. In the other nostril, it exposes the blood vessel-rich skin over the septum to too much airflow, causing drying and even cracking. This kind of deviated septum causes swelling, frequent nose bleeds, recurrent sinus infections, noisy breathing, and other problems.

Sometimes a deviated septum is congenital—you are born with it because it developed that way in the womb. In other cases, the septum moves off of its center position due to trauma. However, even in this case, many people don’t remember sustaining an injury that could have caused it. The septum is relatively flexible, especially during childhood years. Sports and playground contact may be enough to move the septum. In adults, more trauma is generally necessary to deviate the septum. This includes injuries like a blow to one side of the nose or a car accident.

If symptoms aren’t present or bothersome, deviated septum treatment may not be necessary. When a deviated septum causes problems, treatment may include medicines to relieve congestion and swelling; surgery may be necessary in some cases. Deviated septum surgery is called septoplasty. It involves repositioning the septum into the middle of the nose.

See your doctor if you have deviated septum symptoms. Seek immediate medical care if you have a severe facial injury or sustain a blow to the head or face. The emergency room or urgent care doctor can examine your facial and nasal bones for damage.

What are the symptoms of a deviated septum?

A deviated septum doesn’t always cause noticeable symptoms. As a result, many people who have a deviated septum don’t realize it. Generally, slight displacements don’t cause symptoms. The more severe the deformity, the more likely it is to experience symptoms.

Common symptoms of a deviated septum

Common deviated septum symptoms include:

  • Difficulty breathing through the nose or complete blockage of one side of the nose. Sometimes, this manifests as being aware of the ‘nasal cycle.’ This is a normal cycle in which the nostrils alternate being dominant (airflow is greater in one side, then the other side, etc.). Most people aren’t conscious of this. Noticing it may be a sign of a blockage.
  • Facial pain or headaches
  • Frequent nose bleeds
  • Noisy breathing, especially during sleep, or preference for sleeping on one side to improve breathing

You may be able to see a bump on the side of the nose or the nose may appear crooked looking straight at it.

If you have any of these symptoms that persist and aren’t getting better, see your doctor for a thorough evaluation. Persistent or severe noisy breathing during sleep or snoring in a child needs to be evaluated by a pediatrician. It could be a sign of obstruction from a deviated septum, adenoids or tonsils. Your doctor may refer you to an ear, nose and throat specialist (ENT doctor, or otolaryngologist). Depending on your health insurance coverage, you may be able to see an ENT directly without a referral from your primary care doctor.

What causes a deviated septum?

A deviated septum can either be congenital—meaning it’s a defect present at birth—or acquired. A congenital deviated septum can be the result of a problem during development or a facial injury during the birth process.

Injuries are the main cause of an acquired deviated septum during childhood, adolescence or adulthood. These injuries can include car accidents, sports contact, rough play, or any kind of blow to one side of the face. Since the septum consists of cartilage along with bone, it is somewhat flexible. Impacts to the nose can bend the septum to one side.

What are the risk factors for a deviated septum?

The main risk factors for getting a deviated septum after birth are injuries from physical trauma, not wearing a seatbelt in the car, or not wearing a protective helmet or face shield during contact sports.

Reducing your risk of a deviated septum

It’s not always possible to prevent injuries that can result in a deviated septum. But you can take steps to protect your face from impacts that could affect your septum. This includes wearing a seatbelt every time you get in a car and wearing appropriate protective gear while playing contact sports.

How is a deviated septum treated?

Treating a deviated septum isn’t always necessary. You may not need to do anything if the displacement is mild and there are few or no symptoms. If symptoms are bothersome, your doctor may recommend medicines to decrease swelling and congestion. This includes antihistamines, decongestants, and corticosteroid nasal sprays. These medicines won’t fix the physical defect, but they can help relieve mild or moderate symptoms.

If symptoms don’t respond well enough to medicines, surgery may be an option. Surgery to repair a deviated septum is called septoplasty. Generally, doctors recommend it when symptoms cause difficulty breathing normally or when snoring disrupts your sleep. The procedure involves repositioning the septum to the midline. This may require cutting and removing parts of the septum in order to realign the pieces. Some people combine a septoplasty with a rhinoplasty—or nose job—to reshape the outer appearance of the nose.

It can take a few weeks to a few months to fully recover from deviated septum surgery. Eventually, most people have significant improvement of their breathing symptoms. In some cases, surgery may fully resolve the obstructed airflow.

What are the potential complications of a deviated septum?

The main complications of a severely deviated septum relate to the blockage. When air can’t efficiently move through the nose, the body compensates with mouth breathing. This can lead to dry mouth, gum disease, and other dental and orthodontic problems. Being unable to breathe through your nose can also lead to sleep disruption, which can affect your quality of life.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 4
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