Deviated septum

Encyclopedia of Medicine, Apr 06, 2001 by J. Ricker Polsdorfer

The nasal septum is a thin structure, separating the two sides of the nose. If it is not in the middle of the nose, then it is deviated.

The nasal septum is composed of two parts. Toward the back of the head the nasal septum is rigid bone, but further forward the bone becomes cartilage. With one finger in each nostril this cartilage can easily be bent back and forth. If the nasal septum is sufficiently displaced to one side, it will impede the flow of air and mucus through the nose. This condition, called a deviated septum, can cause symptoms and disease.

A deviated septum can be a simple variation in normal structure or the result of a broken nose. Any narrowing of the nasal passageway that it causes will threaten the drainage of secretions from the sinuses, which must pass through the nose. It is a general rule of medicine that when flow is obstructed, whether it is mucus from the sinuses or bile from the gall bladder, infection results. People with allergic rhinitis (hay fever) are at greater risk of obstruction because their nasal passageways are already narrowed by the swollen membranes lining them. The result is sinusitis, which can be acute and severe or chronic and lingering.

It is easy to see that a septum is deviated. It is more difficult to determine if that deviation needs correction. It is common for a patient to complain that he/she can breathe through only one nostril. Then the diagnosis is easy. A deviated septum may also contribute to snoring, sleep apnea, and other breathing disorders.

The definitive treatment is surgical repositioning of the septum, accomplished by breaking it loose and fixing it in a proper place while it heals. Decongestants like pseudoephedrine or phenylpropanolamine will shrink the membranes and thereby enlarge the passages. Antihistamines, nasal cortisone spray, and other allergy treatments may also be temporarily beneficial.

As a palliative, saline drops and sprays are very helpful in loosening mucus in the obstructed side and preventing drying in the other side, where all the air blows. Hot peppers, such as jalapenos, can produce enough tears and discharge to flush out many a stopped-up nose. An even more effective treatment is called a nasal lavage, often done using a small pot with a spout. Saline solution is poured into one nostril and allowed to flow out the other nostril. Then, the process is repeated in reverse. These therapies are all useful to take care of symptoms, but do not correct the problem. Nasospecific, a procedure where a deflated balloon is inserted in the nostril and inflated to a large enough degree to adjust the septal deviation, can be an alternative to surgery. A trained practitioner in the nasospecific procedure is necessary.

Surgical repair is curative and carries little risk. Chronic infection can be painful and lead to complications until it is resolved. If there is continued obstruction, the infection will very likely return.

Avoidance of virus colds, airborne dusts, air pollution and known allergens will minimize the irritation and swelling of the membranes lining the nasal passages.

• Books
• Ballenger, John Jacob. Disorders of the Nose, Throat, Ear, Head, and Neck. Philadelphia: Lea & Febiger, 1991.