Deviated Nasal Septum.Care & specialists in New Zealand

A deviated nasal septum is a sideways shift of the cartilage and bone wall that separates the right and left nasal cavities. The deviation makes one airway narrower than the other and can cause one-sided blockage, mouth breathing, snoring, recurrent nosebleeds, or repeated sinus infections.

Measurable deviation appears in roughly 75-90% of adults on CT or cadaveric studies, but only 12-18% have symptoms severe enough to seek treatment. Men are affected 2-3 times more often than women among those who need surgery.

Surgery is reserved for patients whose symptoms do not improve after 4-8 weeks of intranasal corticosteroid and saline irrigation, or who have visible external deformity, recurrent epistaxis, or sinus disease driven by the deviation. Most patients with mild deviation manage well without surgery.

Septoplasty is a 30-60 minute outpatient operation under general anaesthesia in which the surgeon repositions or removes the deviated parts of the cartilage and bone through a small incision inside the nose. The external shape of the nose is not changed. Most patients return to work within a week.

Standard septoplasty does not change the external shape of the nose because the dorsal and caudal cartilage that support the nasal pyramid are preserved. If both breathing and shape need to be corrected, a combined functional septorhinoplasty is performed.

Splints are removed at 5-7 days and most people return to desk work within a week. Light exercise resumes at 2 weeks. Final airflow improvement takes 4-8 weeks as swelling settles, and contact sport should be avoided for 6 weeks. Saline rinses help during recovery.

Randomized trials show 75-85% of properly selected patients report significant or complete relief of nasal obstruction at 6-12 months after septoplasty, with a 25-30 point improvement on the NOSE quality-of-life score that is sustained at 5 years.

A severe deviation increases nasal resistance and contributes to obstructive sleep apnoea but is rarely the only cause. Septoplasty alone usually does not cure moderate-severe OSA but can improve CPAP tolerance and reduce snoring when combined with sleep-medicine management.

Deviations that are stable in adulthood usually do not progress, but compensatory turbinate hypertrophy, allergic rhinitis, and ageing mucosa can make a stable deviation feel worse over years. New trauma or surgery can also alter septal alignment.

Mild and moderate symptoms often respond to intranasal corticosteroid sprays, saline irrigation, treatment of allergic rhinitis, and nasal dilator strips. These do not straighten the septum but reduce mucosal swelling and improve airflow enough to avoid surgery in many patients.

Modern septoplasty is performed under general anaesthesia and most patients report mild to moderate discomfort, pressure, and congestion rather than sharp pain. Simple analgesics (paracetamol with or without ibuprofen) control symptoms in over 90% of cases.

A septal hematoma is a collection of blood under the lining of the septum after trauma, appearing as a bluish bulge on one or both sides. It must be drained within 72 hours to prevent cartilage necrosis and a permanent saddle-nose deformity, which is why any nasal injury with swelling needs prompt review.

Septoplasty in children is reserved for severe symptomatic deviation after age 6-8 because of concerns about midfacial growth. Limited cartilage-sparing techniques are preferred, and surgery is often delayed until adolescence unless obstruction is severe or post-traumatic.

Most insurers cover septoplasty when documented symptomatic nasal obstruction has failed at least 4-8 weeks of medical therapy, with structural deviation confirmed on examination or CT. Purely cosmetic rhinoplasty is not covered. Pre-authorization is usually required.

Diagnosis is clinical, based on history, anterior rhinoscopy with a nasal speculum, and nasal endoscopy. The NOSE quality-of-life questionnaire scores severity. CT of the sinuses is added only when sinus disease, complex deformity, or revision surgery is suspected.

Yes, when a septal spur contacts the lateral nasal wall it can trigger contact-point headaches and referred facial pain. Local anaesthetic applied to the contact site typically abolishes the pain within minutes; endoscopic spur removal is curative for selected patients.

A severe deviation that raises nasal resistance often contributes to snoring by promoting mouth breathing during sleep. Septoplasty reduces snoring loudness in 50-70% of patients but rarely eliminates it when oropharyngeal collapse coexists.

Severe deviations can block airflow to the olfactory cleft and reduce smell on the affected side. Smell usually improves after septoplasty, especially when allergic rhinitis and nasal polyps are also treated, but pre-existing chronic anosmia from olfactory nerve damage does not reverse.

Septoplasty is safe in experienced hands but carries a small risk of septal perforation (0.5-3%), bleeding, infection, persistent obstruction, transient olfactory disturbance, and saddle-nose deformity from over-resection. Revision rates are 5-10% in published series.

Untreated symptomatic deviation does not reverse and can lead to chronic mouth breathing, recurrent sinusitis, snoring, worsening sleep apnoea, and reduced quality of life. In children, persistent obstruction may alter facial growth. Asymptomatic deviation needs no treatment.

Allergic blockage is usually bilateral, fluctuates with seasons, comes with sneezing and itching, and improves with antihistamines or steroid spray. Septal deviation produces predominantly one-sided fixed blockage that persists after decongestion. An ENT examination distinguishes them definitively.