Thursday, November 8, 2012

What is a deviated nasal septum?



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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