What Can You Do About a Deviated Septum?
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What Can You Do About a Deviated Septum?

While playing his usual weekly game of pick up softball, Dan slid into home plate and was inadvertently whacked in the nose by the catcher. Initially he suffered some bleeding and a blackened eye, but over the next few months he started to notice a bit of difficulty breathing through his right nostril. At first, he ignored it.

Over time, though, he noticed a persistent stuffiness in his nose and that winter, he suffered five head colds within five months. Finally, Dan made an appointment with his doctor who, after a brief physical examination, discovered that Dan had a deviated septum.

The Role of the Septum in Your Nose

A septum is any wall that divides two cavities. In the nose, the septum runs down the center of the nose and divides the nose into two separate chambers. The septum itself is made up of two parts. Toward the far back of the nose, the septum is hard bone. At the middle and towards the tip, it is made of cartilage—a tough, semi-flexible material.

Breathing Problems

Virtually no one has a perfectly straight or centered septum, and a slight deviation one way or the other isn't usually problematic. If, however, the septum protrudes too far to one side or the other, it can interfere with the movement of air into and out of, as well as the draining of mucus from, the nasal cavity.

"Although a deviated septum can be genetic, it often results from some type of trauma—usually a broken nose," says David Caradonn, MD, DMD, of Boston's Beth Israel Deaconess Medical Center's Division of Otolaryngology. "If the protrusion [of the broken bone] into the septum is minor, it will generally go unnoticed and won't cause any problems. If, however, the protrusion is large enough to either greatly or completely block one of the nostrils, a number of problems and related symptoms can result."

Symptoms of a Deviated Septum

Symptoms of a deviated septum include the following:

  • Difficulty breathing through the nose
  • Snoring caused by resistance of airflow through the nose
  • Obstructive sleep apnea, a condition that is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation
  • Chronically stuffy nose

Treating a Deviated Septum With Mild Symptoms

Although normally invisible from the exterior, diagnosis of a deviated septum can easily be determined by a brief examination of the interior of the nose by an ear, nose, and throat specialist (Otolaryngologist). Recommended treatment will depend on the severity of the symptoms. Possible treatments include the following:

Medication

When the symptoms are minor (intermittent stuffy nose, minor snoring), treatment usually consists of antihistamines, nasal decongestants, cortisone containing nasal sprays, and/or antibiotics to clear and prevent excess mucus and trapped bacteria from building up in the nasal cavity.

Nasal Strips

Some doctors recommend the use of Breathe Right® Nasal Strips during sleep to help prevent or lessen snoring. These small, individual bandage-like tapes have small plastic springs running lengthwise through them, and are worn over the bridge of the nose. While the strips have no effect on the septum, they serve to spread the nostrils so that breathing through the nose is easier.

Alternative Therapies

Although they do not cure the problem, alternative treatments do address the symptoms. 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 through. Hot peppers, such as jalapeños, can produce enough tears and discharge to flush out 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.

Surgical Treatments for Persistent Problems

When symptoms become persistent and/or difficult to deal with (chronic sinusitis, breathing difficulty, extreme snoring, or sleep apnea), your doctor may recommend surgery to correct the deviated septum. The surgery can generally be done in one of two ways:

Submucous Resection (SMR) or Septoplasty

During this procedure, the doctor will push back the lining of the septum and cut away the portion of the cartilage that is protruding into the nostril. After the cartilage is removed, the lining is moved back into place. Tiny splints are placed inside the nose to keep the septum in place (usually for seven days) until the septum heals. SMR is usually performed as day surgery, with general or local anesthesia.

Complications From Surgery

Although surgical methods to repair a deviated septum are effective most of the time and usually result in no complications, postoperative complications (and/or a failure to correct the problem) sometimes occur. These postoperative complications can include:

  • Bleeding (sometimes severe)
  • Septal hematoma–blood collecting under the lining of the septum (this often requires draining)
  • Slight collapsing of the bridge of the nose, causing a deformity (a saddle nose)
  • Development of a hole in the septum between the nostrils, which can be difficult to repair
  • Anosmia (loss of smell), which is extremely rare, but is also quite difficult to repair

Before deciding on surgery to correct a deviated septum, consult with your physician or ENT specialist to talk about the possible severity of your symptoms as well as the possibility (although unlikely) of surgical complications.

RESOURCES:

American Academy of Facial Plastic and Reconstructive Surgery
http://www.aafprs.org/

American Academy of Otolaryngology–Head and Neck Surgery
http://www.entnet.org/index2.cfm

The Centers for Chronic Nasal and Sinus Dysfunction
http://www.nasal.net/index.htm

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Deviated septum. The Centers for Chronic Nasal and Sinus Dysfunction website. Available at: http://www.nasal.net/otolaryngology/deviated.htm.

Snoring: not funny, not hopeless. American Academy of Otolaryngology–Head and Neck Surgery website. Available at: http://www.entnet.org/snoring.html.



Last reviewed May 2008 by Elie Edmond Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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