The nasal septum is the wall that separates the left and
right nasal cavity into halves, dividing the two nostrils. It is composed of a
central supporting skeleton of bone and cartilage, which is covered on each
side by mucous membrane. The front portion of the nasal septum is a firm but
bendable structure made of cartilage and is covered by skin that has a rich
supply of blood vessels.
A perfectly aligned nasal septum should be exactly in
the midline, separating the left and right sides of the nose into passageways
of the exactly same size. So, apart from when someone suffers from a heavy cold
or allergy, he or she should experience no breathing or other associated nasal
blockage problems. This would be the ideal septum alignment, but in reality some
level of misalignment is very common –there are estimates that 70-80 percent of
adults have off-centered nasal septum, a condition that is described as a
“deviated nasal septum”. However, majority of people with the septum slightly
shifted away from the midline do not generally notice any breathing problems and
are completely unaware of the problem.
A symptomatic deviated septum occurs when the septum is
severely shifted away from the midline. The most common symptom from a badly
deviated nasal septum is difficulty breathing through the nose. There are a
number of reasons for deviated septum to arise. For instance, a deviated septum
can be caused by blunt trauma to the face: if you are hit on the nose, not only
you can end up with a broken bones, but there is a fair chance the impact will
cause damage to the cartilage of the septum. A deviated septum can also occur
during childbirth from compression of the baby’s nose as the baby passes
through the birth canal, during teenage years due to its irregular growth
spurt, or be a part of a congenital birth defect such as a cleft palate or
cleft lip. Sometimes the deformity of the septum can be seen on the ridge of
the nose or felt, but more frequently the deviation is further back inside
nasal cavities and can’t be seen by the patient. Only a complete examination of
the nose after spray of a decongestant can determine if the septum is deviated.
The most common symptom from a badly deviated or crooked
septum is difficulty breathing through the nose. People with a deviated septum
are often noisy breathers. The symptoms are usually worse on one side, and
sometimes actually occur on the side opposite the deviation. Restricted airflow
through one nostril can cause loud breathing, particularly in children and
babies. In adults it can lead to other problems, specifically chronic snoring
and development of obstructive sleep apnea.
Congestion and blockage of the nose can interfere with
the drainage of the sinuses and lead to recurrent sinus infections because
mucous cannot drain away as would normally happen. Therefore, repeated sinus
infections can be the symptom of a deviated nasal septum. A person with a
mildly deviated septum can have symptoms only when he or she also has a “cold”.
In these people, the respiratory infection causes inflammation and swelling of
nasal mucosa that temporarily amplifies any mild airflow problems related to
the deviated septum.
Finally, it is not uncommon that some people with deviated
septum suffer from infrequent headaches! Blocked sinuses and a blocked nose
cause these headaches. The pain may be felt across the forehead and sinuses and
around the eye sockets.
Next time, I can write more about a “septoplasty” - a
relatively simple surgical procedure aimed to straighten a misaligned nasal
septum…
Dr.
Sasa Janjanin is double European Board-certified in ENT and Facial Plastic
Surgery. He extensively trained in complete surgical and medical treatment of
patients with disorders and diseases of the head and neck. However, his major
expertise is in facial plastic, aesthetic and reconstructive surgery; problems
related to thyroid and parathyroid glands; skin cancer; kid’s ENT problems; nose,
sinus and snoring complaints; and sport and diving-related ENT problems.
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