A deviated septum occurs when the thin wall of cartilage and bone that separates your two nostrils—known as the nasal septum—is displaced to one side. Ideally, this septum is positioned in the center, providing balanced airflow through both nostrils. However, when it is crooked or off-center, airflow can be obstructed on one or both sides, leading to breathing difficulties and other complications.

Though it may sound uncommon, nearly 80% of people have some degree of septal deviation. For many, the condition goes unnoticed due to mild or nonexistent symptoms. However, for others, a deviated septum can significantly impact quality of life, making it difficult to breathe, sleep, or manage chronic sinus problems. Understanding what causes a deviated septum, how it’s diagnosed, and the various treatment options available is crucial in managing this condition effectively.

Symptoms

The symptoms of a deviated septum can range from negligible to severe, depending on the extent of the deviation and whether there are any accompanying nasal or sinus issues. People with a severely deviated septum often notice:

  • Nasal obstruction: Difficulty breathing through one or both nostrils, especially when lying down.

  • Frequent nosebleeds: A crooked septum can dry out nasal tissues, increasing the risk of bleeding.

  • Recurring sinus infections: Improper airflow and mucus drainage may lead to frequent sinusitis.

  • Snoring and sleep disturbances: Obstructed nasal airflow can cause noisy breathing during sleep.

  • Headaches or facial pain: Caused by pressure in nasal passages and sinuses.

  • Postnasal drip: Excess mucus flowing down the throat due to inadequate drainage.

  • Mouth breathing: Especially noticeable during sleep or physical activity.

Sometimes, a deviated septum worsens the symptoms of underlying allergies or upper respiratory infections. It’s also common for individuals to experience a heightened sense of discomfort in dry or polluted environments.

Causes

A deviated septum can result from multiple causes, and understanding the origin helps in managing and possibly preventing its progression. The main causes include:

  • Congenital condition: Some individuals are born with a deviated septum due to abnormal fetal development. In these cases, the misalignment is present from birth.

  • Trauma: Injury to the nose—whether from sports, car accidents, falls, or even minor incidents—can displace the septum. In fact, nasal fractures are among the most common causes.

  • Childbirth injury: In some infants, a deviated septum can develop due to trauma during delivery.

  • Aging process: Natural aging can worsen a mild deviation as the nasal structures gradually change.

  • Genetics: The shape and structure of your nose, including the nasal septum, can be inherited from your parents.

It’s important to note that not all nasal trauma is immediately evident. Minor injuries from childhood might only become symptomatic years later.

Risk Factors

Several factors can increase the risk of developing a deviated septum or worsening an existing one. These include:

  • Participation in contact sports: Sports like football, basketball, wrestling, and martial arts increase the likelihood of nasal injuries.

  • Failure to use protective gear: Not wearing helmets, face guards, or seatbelts can lead to facial trauma.

  • Family history: If other family members have a deviated septum or nasal issues, there’s a higher chance of inheriting the trait.

  • Nasal infections and chronic inflammation: Repeated infections can worsen nasal congestion and airflow.

  • Living in polluted or dry environments: This can irritate nasal passages, exacerbating symptoms.

Minimizing risks through safety practices and early medical consultation can prevent complications associated with a deviated septum.

Diagnosis

Diagnosing a deviated septum typically begins with a visit to an ear, nose, and throat (ENT) specialist. The process involves a combination of physical examination and imaging techniques to assess the condition accurately.

  • Visual examination: The doctor uses a nasal speculum and bright light to inspect the inside of the nose.

  • Nasal endoscopy: A small, flexible camera (endoscope) is inserted into the nostrils to get a detailed view of the septum and surrounding structures.

  • Imaging tests: In complex cases, a CT (computed tomography) scan may be used to visualize internal nasal anatomy and detect any complications like sinus inflammation or polyps.

  • Breathing tests: In some instances, airflow measurements help determine how much obstruction the septum is causing.

Early diagnosis is key to managing symptoms and preventing further health issues.

Non-Surgical Treatments

For people with mild to moderate symptoms, non-surgical management can be quite effective. These options aim to reduce nasal inflammation and improve breathing:

  • Nasal corticosteroid sprays: Help reduce inflammation in the nasal lining, which can improve airflow temporarily. Examples include fluticasone and mometasone.

  • Antihistamines: These relieve allergy-related symptoms that can worsen nasal obstruction. Popular options include cetirizine and loratadine.

  • Decongestants: Oral or nasal decongestants like pseudoephedrine help narrow swollen nasal blood vessels. However, long-term use of nasal sprays can lead to rebound congestion.

  • Saline nasal irrigation: A gentle rinse using a neti pot or saline spray helps clear mucus, allergens, and irritants.

  • Avoiding triggers: Reducing exposure to cigarette smoke, pet dander, and dust mites can help control symptoms.

Although these therapies don’t correct the deviation itself, they can significantly improve comfort and quality of life.

Surgical Treatment (Septoplasty)

When symptoms persist despite medical treatment, or if the septum is severely deviated, surgery may be recommended. The most common procedure is septoplasty, which involves correcting the alignment of the nasal septum.

  • Procedure details: The surgeon makes an incision inside the nose to access the septum, removes or reshapes bone and cartilage, and repositions it centrally.

  • Anesthesia: Local or general anesthesia may be used depending on the case.

  • Outpatient surgery: Septoplasty usually takes about 1 to 2 hours, and most patients go home the same day.

Post-operative care:

  • Temporary swelling and congestion

  • Avoiding strenuous activity for 1–2 weeks

  • Sleeping with head elevated to reduce swelling

  • Using prescribed nasal sprays or saline rinses

Results: Most patients notice improved breathing, reduced nasal obstruction, and fewer sinus infections. Success rates are high, with 80–90% of people reporting satisfaction with outcomes.

In some cases, septoplasty may be combined with rhinoplasty (cosmetic nose surgery) or turbinate reduction to further enhance breathing.

Prevention

While congenital deviations cannot be prevented, trauma-related cases can be minimized through safety measures:

  • Always wear seatbelts: Prevents facial injury in car accidents.

  • Use protective gear: Helmets and face masks during sports and physical work.

  • Avoid physical altercations: A punch or fall to the face can permanently alter septum alignment.

  • Encourage safe play for children: Supervise activities and educate about safe practices.

  • Treat nasal infections early: Managing sinusitis or rhinitis promptly reduces inflammation that can worsen breathing issues.

Being proactive with nasal care and general safety can lower your risk of complications from a deviated septum.

Complications

If left untreated, a significantly deviated septum can cause various complications:

  • Chronic sinusitis: Inadequate drainage increases the risk of persistent infections.

  • Sleep disorders: Including obstructive sleep apnea, characterized by disrupted breathing during sleep.

  • Nasal polyps: Swelling and inflammation over time may lead to the growth of benign polyps.

  • Middle ear problems: Eustachian tube dysfunction due to improper air pressure balance.

  • Voice changes: Nasal obstruction may cause a nasal-sounding voice.

  • Decreased quality of life: Constant mouth breathing and poor sleep can affect energy, focus, and overall health.

Managing the condition early helps prevent long-term health impacts and supports better respiratory function.

Living With a Deviated Septum

For people with mild deviation, daily life is manageable with some adjustments:

  • Use a humidifier: Adds moisture to dry air, relieving congestion and irritation.

  • Stay hydrated: Helps thin mucus, making it easier to breathe.

  • Maintain clean air: Air purifiers and regular cleaning reduce allergens.

  • Manage allergies: Avoid allergens and use prescribed medications as needed.

  • Prioritize good sleep posture: Sleeping on one side may ease airflow in partially blocked nostrils.

If symptoms interfere with your life or worsen despite these measures, consult an ENT specialist. Surgery, although more invasive, offers a long-term solution that many find life-changing.

Taking care of your nasal health with regular checkups and being aware of symptoms can make a significant difference in your well-being. With appropriate treatment—whether conservative or surgical—most individuals with a deviated septum can return to normal breathing and improved quality of life.