What is a Deviated Septum?

Continuing our video series, Dr. Jerome Hester explains “What is a Deviated Septum?”

The septum is a wall of bone and cartilage that separates the nose into left and right sides. A deviated septum simply means that the septum itself is crooked. Many of us have mildly deviated septums just as part of our normal anatomy. However, the septum itself can be caused to be more crooked by even mild trauma. For example, as a child running around the front room, falling down, bumping one’s nose is enough to crack the septum which will lead it to be crooked and this can get worst over time. Certainly, more major trauma can also be a cause. In some individuals, we believe they are born with a septum that is somewhat crooked or deviated.

Many people are not bothered by this deviation or others will accommodate to it over time. In other words, it has been there since they were very young therefore they don’t notice necessarily that they’re not breathing as well as they could. In other cases, the individual is actually told that they may have allergies and this is the cause for nasal obstruction especially if the nasal cavity itself has not been examined. However, it is a major cause of impeding normal nasal airflow. The human body we now know performs at its best when breathing to the nose is easy and unimpeded. The nasal cavity serves a function of warming and humidifying the air as it comes in and out which allows it to perform better as it is going through daily activities.

A diagnosis of a deviated septum is relatively simple for a trained professional. It is simply a nasal examination. In other words, just looking inside of one’s nose. X-rays are generally not indicated. More significant test such as a CAT scan also generally are not indicated to diagnose a deviated septum. If the septum is deviated, it can cause problems as outlined as far as nasal obstruction. It has also been attributed to certain types of headaches and leading to the increased risks of sinus infections.

The only true treatment for a deviated septum is surgical repair. The surgery itself is performed through the nasal cavity without any outside incisions. There is no need to break the major nasal bones at the top of the nose to perform a septoplasty or repair of the deviated septum and so this is usually a fairly short outpatient surgery. In today’s world, it is uncommon that it is necessary to pack the nose. This was a treatment that was used at the end of septoplasty where gauze packing was packed inside the nasal cavity to stabilize. Unfortunately, this was extremely uncomfortable for the patient in the three to five days it was in place and lead to the significant morbidity of that procedure. We now are in most cases able to avoid the need for packing.

One also does not have any cosmetic change, not immediately after the surgery. In other words, there’s no black and blue after the surgery and the surgery itself does not change the shape of the nose. Finally, when this surgery is done for the right reason, and what I mean by that, when the surgery is done in order to improve nasal breathing in an individual who has a deviated septum, it generally is very successful as it opens the airway and allows the airflow to go through.

When the procedure is done for more obscure reasons such as headaches, many times the successful rate is a little more suspect. It is difficult to predict this success rate ahead of time and the patient should be counseled that the surgery is being done in an attempt to relieve these symptoms but without any promise.

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