In Pakistan, deviated Nasal Septum is managed by ents. A deviated nasal septum is a displacement of the wall of cartilage and bone that divides the nasal cavity into two airways, causing one nostril to be narrower than the other. Cadaveric and CT studies show measurable septal asymmetry in 75-90% of adults, but only 10-25% experience symptoms severe enough to seek care.
A deviated nasal septum (ICD-10: J34.2) is a structural deformity in which the partition between the right and left nasal cavities — composed of the quadrangular cartilage anteriorly and the perpendicular plate of the ethmoid and vomer posteriorly — lies off the midline. The deviation may be C-shaped, S-shaped, spurred, or dislocated from the maxillary crest, and may involve cartilage, bone, or both. The dorsal and caudal septum support the external nose, so anterior deviations distort the nasal tip and columella while posterior deviations compromise airflow without external change. Functionally, deviation narrows one nasal valve, alters airflow vectors, and disrupts the natural nasal cycle of alternating congestion, producing the sensation of one-sided obstruction.
The key symptoms of Deviated Nasal Septum are: Persistent one-sided nasal obstruction that does not resolve with decongestants and worsens during sleep on the affected side., Alternating nasal blockage that swaps sides with the natural nasal cycle but stays predominantly on the deviated side., Mouth breathing during sleep, dry mouth on waking, and snoring loud enough to disturb a bed partner., Recurrent unilateral epistaxis from drying of the mucosa over the most prominent deviated edge, especially in heated or air-conditioned rooms., Repeated sinus infections affecting the same side, with facial pain over the cheek or forehead, postnasal drip, and cough lasting more than 10 days., Headache or referred facial pain from a septal spur contacting the lateral wall (contact-point headache), often relieved by topical lidocaine., Loss of smell on the obstructed side, particularly when airflow cannot reach the olfactory cleft..
Diagnosis combines a careful history, anterior rhinoscopy, and nasal endoscopy. The clinician asks which side is more blocked, whether the obstruction is constant or fluctuates, what makes it worse (lying down, exercise, allergy season), how nasal sprays affect it, and whether there has been previous trauma or surgery. Examination begins with anterior rhinoscopy using a nasal speculum to inspect the caudal septum, mucosa, turbinates, and any visible spur. Nasal endoscopy with a 2.7 mm or 4 mm rigid scope (sometimes flexible) inspects the middle meatus, posterior septum, choanae, and adenoid pad, ruling out polyps, masses, and adenoid hypertrophy. Decongestion with topical oxymetazoline differentiates fixed structural obstruction from reversible mucosal swelling. Cottle's manoeuvre and modified Cottle's manoeuvre assess internal nasal valve collapse. Patient-reported outcome scoring with the Nasal Obstruction Symptom Evaluation (NOSE) scale provides a baseline that the surgeon can compare with after surgery; scores above 30/100 generally indicate moderate to severe symptoms. CT of the paranasal sinuses is reserved for suspected rhinosinusitis, complex deformity, post-traumatic assessment, or pre-operative planning; routine CT for uncomplicated septal deviation is not recommended. Polysomnography is requested when sleep apnoea is suspected. Acoustic rhinometry and rhinomanometry quantify nasal resistance but are not required for diagnosis in routine practice.
Outcome is excellent when patient selection and surgical technique are sound. Randomized trials (Bugten et al. 2016, van Egmond et al. SCHIN 2019) show that septoplasty produces a mean 25-30 point improvement in NOSE score at 6 and 12 months, with 75-85% of patients reporting symptom resolution and durable benefit at 5 years. Failure is most often due to unrecognized internal nasal valve collapse, untreated allergic rhinitis, or persistent compensatory turbinate hypertrophy, all of which are now routinely assessed preoperatively. Revision septoplasty rates are 5-10% in tertiary series. Untreated symptomatic deviation does not reverse and may progress as adjacent structures remodel; chronic mouth breathing in children alters facial growth, and severe obstruction contributes to sleep apnoea, hypertension, and reduced quality of life. Septal perforation is the most common surgical complication (0.5-3%), followed by saddle-nose deformity, septal hematoma, and persistent obstruction. Mortality is extremely rare.
An otolaryngologist or facial plastic surgeon can distinguish structural deviation from mucosal disease, identify coexisting turbinate hypertrophy, valve collapse, and sinus disease, and quantify obstruction with endoscopy and NOSE scoring. Specialist referral is essential when symptoms persist after a trial of intranasal corticosteroid, when there is a visible external deformity, or when sleep apnoea is suspected.
Find specialists →Most patients return to desk work within 7 days and to non-contact exercise at 2 weeks. Internal splints are removed at 5-7 days. Nasal breathing improves over 4-8 weeks as swelling resolves; final result at 3-6 months. Contact sport, heavy lifting, and high-altitude travel should be avoided for 6 weeks.
Aerobic exercise is encouraged; mouth breathing during high-intensity work is normal and not harmful. Avoid contact sports for 6 weeks after septoplasty and consider a protective face mask if returning to combat or impact sports. Internal nasal dilator strips may help symptomatic obstruction during running and cycling.
Choose a surgeon who performs at least 50 septoplasties or septorhinoplasties a year, uses validated outcome measures (NOSE, SCHNOS), and has subspecialty training in rhinology or facial plastic surgery. Ask about cartilage-preserving techniques, revision rates, and concurrent management of valve and turbinate problems.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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