Hit it on the nose: Deviated septum Q&A

Your nose is front and center on your face. It serves many functions, including humidifying and cleaning the air you breathe; delivering tone to your voice; and providing a sense of smell, which is important for taste, identification and memory. Love or loathe it, your nose is also a key part of your visual identity.

One of the most common nose deformities is a deviated septum. About 70% to 80% of people have a septal deviation noticeable to an examiner. In many cases, the deviation is minor and causes no symptoms. A deviated septum that is moderate to severe, however, can lead to nasal obstruction and require treatment.

Here are answers to some common questions about this nasal condition:

What is a deviated septum?

A deviated septum occurs when your nasal septum ― the thin wall between your nasal passages ― is displaced to one or both sides. In some people, the nasal septum is off-center and can make one or both nasal passages smaller. Depending on the severity of the deviation, it can reduce airflow, causing difficulty breathing through one or both sides of your nose.

What causes a deviated septum?

Some people are born with a deviated septum. This could be develop before birth or it may occur during delivery. Sometimes the cartilage of the septum can bend and deform with age. For others, their deviated septum is the result of an injury, such as bumping their nose while a toddler, during contact sports, an auto accident or rough play.

Could I have a deviated septum but not know it?

Yes, it's possible not to know that you have a deviated septum or other septal issues, especially if you are not experiencing any symptoms. Talk with your primary care provider if you are concerned about any nasal symptoms or the appearance of your nose.

What are the symptoms of a deviated septum?

Signs and symptoms of septal issues, such as a deviated septum, include:

• Blockage of one or both nostrils
  This blockage can make it difficult to breathe through the nostril or nostrils. You may notice this more when you have a cold or allergies that can cause your nasal passages to swell and narrow.
• Nosebleeds
  The surface of your nasal septum may become dry, increasing your risk of nosebleeds.
• Facial pain
  There is some debate about the possible nasal causes of facial pain. A possible cause of one-sided facial pain could be a severely deviated septum where surfaces within the nose touch and cause pressure.
• Noisy breathing during sleep
  A deviated septum or swelling of the intranasal tissues can be one of the many reasons for noisy breathing during sleep.
• Awareness of the nasal cycle
  It's normal for the nose to alternate being obstructed on one side and then change to being obstructed on the other. This is called the nasal cycle. This cycle is normal, but being aware of the nasal cycle isn't typical and can indicate nasal obstruction.
• Preference for sleeping on a particular side
  Some people may prefer to sleep on a particular side to optimize breathing through the nose at night if one nasal passage is narrowed.
• Crooked or uneven nose
  In more severe cases, a deviated septum can change the external look of the nose, causing an uneven or crooked appearance.

Can deviated septums heal on their own?

No. Deviated septums will not heal over time. While this shouldn't be a concern if you are not experiencing symptoms, it's important to talk with your primary care provider if you are having issues. Don't wait for symptoms to resolve on their own.

Do deviated septums cause sinus infections?

The most common cause of upper respiratory tract infections are viruses, such as those that cause the common cold, whereas bacteria typically cause sinus infections. If you have a deviated septum, you may be more susceptible to nasal blockage, which could lead to developing nasal polyps. These are painless, noncancerous growths on the lining of your nasal passages or sinuses that make you more vulnerable to sinus infections in the future.

Do deviated septums cause headaches?

A deviated septum can cause a headache in addition to a blocked nose. This may occur when the septum contacts sensitive nasal tissue and causes pain along the sensory nerve leading to your brain.

Can medications help a deviated septum?

Often, the first treatment options for a deviated septum focus on managing symptoms with medication. You may be prescribed decongestants or nasal steroid sprays. These medications can reduce nasal tissue swelling to help with drainage and keep the airways on both sides of your nose open. It's important to follow the directions carefully, decongestants can cause dependency, side effects or worsen symptoms after you stop using them. Nasal steroid sprays can cause blood-tinged nasal mucus, which can be managed by applying petroleum jelly in the nostril before spraying.

If you have seasonal allergies, your health care team may prescribe antihistamines that can prevent or lessen allergy symptoms, and help with drainage.

Can a nose job fix a deviated septum?

You may read about celebrities saying the reason they had a nose job, also called rhinoplasty surgery, was to correct a breathing problem. While this may be partially true, rhinoplasty alone does not correct a deviated septum.

The most common surgery to correct a deviated septum is called a septoplasty. During this procedure, your nasal septum is straightened and repositioned in the center of your nose. This may require your surgeon to cut and remove parts of your septum, which are sometimes reinserted in the proper position. Septoplasty does not significantly change the shape or size of your nose, or correct other nasal or sinus conditions you may have, such as allergies.

If you are interested in reshaping your nose, a rhinoplasty can be performed at the same time as a septoplasty. This surgical procedure modifies the bone and cartilage of your nose to change its size, shape or both.

Do deviated septums worsen with age?

Like the rest of your body, your nasal structures change over time. This may or may not make your deviated septum worse. Your symptoms could become more intense or bothersome, and you could see changes to the appearance of your nose as well.

Talk with your primary care provider or an ear, nose and throat specialist if you are concerned about your nasal passages, or the shape or size of your nose.

Gregory Jones, M.D., is an ear, nose and throat specialist in Owatonna, Minnesota.