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Urgent
NASAL DEVIATED SEPTUM – SILENT CAUSE OF PROLONGED NASAL CONGESTION AND SINUSITIS
The nasal septum is the wall separating the two nasal cavities, including cartilage and bone. When the septum is not positioned along the midline but is deviated or deformed, it can cause narrowing on one side or abnormal airway resistance, leading to nasal congestion, shortness of breath, and impaired sinus ventilation.
Classification
By shape: generally deviated, S-shaped, with spur, or deep groove.
By severity level: mild, moderate, severe – corresponding to the level of impact on air flow and sinus drainage mechanics.
By location: anterior deviation (nasal valve region), mid-septum deviation, or posterior deviation.
Identification of the deviated type and location is important for providing strategic treatment instruction (medical or surgical).
Causes
1. Congenital / Developmental causes
The septum could progress to be deviated during the fetal or growth stages due to uneven development between cartilage and bone.
During delivery, external pressure could deform cartilage’s structure (birth molding).
2. Acquired causes
Nasal trauma: direct-nose-affected accident, crash are common causes causing deviated septum or fracture.
Chronic rhinosinusitis: prolonged inflammation could cause edema, scarring; or tissue contraction could pull or bend the septum over time.
Previous rhinoplasty: unskilled technique could lead to secondary septal deformity.
Age-related structural change: cartilage and bone tissue could decrease elasticity and stability with age, contributing to further deviation.
Symptoms
A deviated septum might not cause noticeable symptoms if the impact is minimal. Some common symptoms, if present, are:
Nasal congestion or sensation of one-sided blockage
Shortness of breath by nose, especially when lying down or exerting
Nasal discharge / post-nasal drip
Recurrent / chronic sinusitis – caused by restricted sinus discharge drainage.
Epistaxis – a deviated septum could cause mucosa to rub against the airflow or get dry easily, increasing the possibility of bleeding.
Headache or facial pressure.
Reduced olfaction if airflow to olfactory regions is affected.
Whitling sound when breathing due to airflow passing through the narrow passage.
For people with chronic sinusitis, the consequences of a deviated septum could contribute to reduced effectiveness of medical treatment.
Diagnosis
Precise diagnosis requires combination with clinical examination and imaging:
1. History record and clinical examination
Symptoms investigation: nasal congestion, nasal discharge, recurrent sinusitis, nosebleeds.
Trauma history / rhinoplasty history.
External nose observation (deviation, deformity)
2. Rhinoscopy
Using a flexible or rigid endoscope to directly visualize the septum, septal spurs, contact points, grooves, and surrounding mucosal tissues.
Looking for contact points or structures that obstruct airflow.
3. Computed Tomography (CT / CBCT scan of the sinus and nose)
Evaluating morphologically the septum, deviated degree, spurs, grooves, connection between septum and sinuses, nasal bone structure.
CT also helps detect sinusitis, polyps, and other abnormalities.
4. Assessment of nasal respiratory function
Rhinomanometry (measurement of nasal airflow)
Acoustic rhinometry (measurement of cross-sectional area of nasal cavity)
In advanced studies, CFD modeling can be used to simulate airflow and pressure
5. Evaluation of associated sinusitis
If the patient has symptoms of chronic sinusitis, sinus CT helps determine the severity of inflammation, sites of obstruction, and its connection with deviated septum.
Treatment
The treatment objective is to repair the airway, reduce symptoms, improve sinus drainage, and prevent recurrent sinusitis.
1. Medical treatment / supportive care
Use corticosteroid nasal spray to reduce mucosal swelling.
Take anti-histamines if combined allergic rhinitis is present.
Perform nasal irrigation with saline solution.
In chronic sinusitis, combined treatment for infection/inflammation (following Johns Hopkins instruction for chronic sinusitis).
Adjust environmental factors, avoid irritants
Note: These measures do not correct structural deviation; they only reduce symptoms and associated inflammation.
2. Surgical intervention
When symptoms are severe, affecting quality of life, or sinusitis is recurrent, septoplasty is considered.
Post-operative management
Use nasal splints and taping to stabilize the septum in the early period.
Monitor for bleeding and infection
Instruct on nasal irrigation and mucosal hydration
Follow-up after several weeks/months to assess healing and perform revisions if needed
Effectiveness and limitations
If surgery is successful, many patients experience significant improvement in nasal airflow and reduced sinusitis symptoms.
However, in revision cases or complex deviations, achieving optimal results requires high surgical expertise and detailed planning.
Possible complications: bleeding, scarring, new septal perforation, and persistent symptoms if the main cause is mucosal inflammation or allergy rather than structural deviation.
Reference:
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