Deviated Septum

Definition

The nasal septum is a thin structure, separating the two sides of the nose. If it is not in the middle of the nose, then it is deviated.

Description

The nasal septum is composed of two parts. Toward the back of the head the nasal septum is rigid bone, but further forward the bone becomes cartilage. With one finger in each nostril this cartilage can easily be bent back and forth. If the nasal septum is sufficiently displaced to one side, it will impede the flow of air and mucus through the nose. This condition, called a deviated septum, can cause symptoms and disease.

Causes and symptoms

A deviated septum can be a simple variation in normal structure or the result of a broken nose. Any narrowing of the nasal passageway that it causes will threaten the drainage of secretions from the sinuses, which must pass through the nose. It is a general rule of medicine that when flow is obstructed, whether it is mucus from the sinuses or bile from the gall bladder, infection results. People with allergic rhinitis (hay fever) are at greater risk of obstruction because their nasal passageways are already narrowed by the swollen membranes lining them. The result is sinusitis, which can be acute and severe or chronic and lingering.

Diagnosis

It is easy to see that a septum is deviated. It is more difficult to determine if that deviation needs correction. It is common for a patient to complain that he/she can breathe through only one nostril. Then the diagnosis is easy. A deviated septum may also contribute to snoring, sleep apnea, and other breathing disorders.

Treatment

The definitive treatment is surgical repositioning of the septum, accomplished by breaking it loose and fixing it in a proper place while it heals. Decongestants like pseudoephedrine or phenylpropanolamine will shrink the membranes and thereby enlarge the passages. Antihistamines, nasal cortisone spray, and other allergy treatments may also be temporarily beneficial.

Alternative treatment

As a palliative, 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. Hot peppers, such as jalapenos, 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. Then, the process is repeated in reverse. These therapies are all useful to take care of symptoms, but do not correct the problem. Nasospecific, a procedure where a deflated balloon is inserted in the nostril and inflated to a large enough degree to adjust the septal deviation, can be an alternative to surgery. A trained practitioner in the nasospecific procedure is necessary.

Prognosis

Surgical repair is curative and carries little risk. Chronic infection can be painful and lead to complications until it is resolved. If there is continued obstruction, the infection will very likely return.

Prevention

Avoidance of virus colds, airborne dusts, air pollution, and known allergens will minimize the irritation and swelling of the membranes lining the nasal passages.

Resources

BOOKS

Ballenger, John Jacob. Disorders of the Nose, Throat, Ear, Head, and Neck. Philadelphia: Lea & Febiger, 1991.

KEY TERMS

Allergen— Any substance that irritates people sensitive (allergic) to it.

Allergic rhinitis— Swelling and inflammation of the nasal membranes caused by sensitivity to airborne matter like pollen or cat hair.

Saline— A salt solution in water. Normal saline has the same salt concentration as the body, 0.9%.

Sinuses— The nasal sinuses, air-filled cavities surrounding the eyes and nose, like the nose itself are lined with mucus-producing membranes. They provide cleansing to the nose, resonance to the voice, and structure to the face.

Sinusitis— Infection of the sinuses.

Sleep apnea— A condition in which breathing is temporarily interrupted during sleep. It leads to high blood pressure, sleepiness, and a variety of other problems.