Deviated Septum Symptoms: What to Know

What is a deviated septum?

The nasal septum is the thin wall of cartilage and bone that divides the nasal cavity into two passages. When the septum is significantly off-center — bowing into one side or the other — it is called a deviated septum. Mild deviations are extremely common and cause no symptoms; only significant deviations require evaluation 2Ref 2Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Structural factors including septal deviation as contributors to impaired sinus drainage and recurrent sinusitis.

Septal deviation can be present at birth or result from a broken nose or other facial trauma. Many people do not know they have a deviated septum until nasal symptoms prompt an ENT evaluation.

What are the main symptoms?

A significantly deviated septum can cause a range of nasal symptoms:

• Nasal obstruction — the most common symptom. One nostril may be consistently more blocked than the other; both sides can be affected when the deviation is S-shaped. The sensation often worsens with nasal congestion during a cold.
• Recurrent or chronic sinus infections — the deviation can impair drainage from the sinuses into the nasal cavity, creating conditions that promote bacterial overgrowth and recurrent sinusitis 2Ref 2Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Structural factors including septal deviation as contributors to impaired sinus drainage and recurrent sinusitis.
• Nosebleeds (epistaxis) — the deviated septum can alter airflow in ways that dry the nasal mucosa, and the prominent portion of the deviation may be prone to minor bleeding 1Ref 1Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, et al. (2020).Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary.Deviated septum as a structural risk factor for recurrent nosebleeds; epistaxis management principles.
• Snoring and sleep disturbance — reduced airflow through a narrow nasal passage can contribute to mouth breathing, snoring, and in some cases sleep-disordered breathing.
• Nasal discharge and post-nasal drip — altered airflow dynamics can increase nasal secretions and drainage down the back of the throat.
• Facial pressure or headache — less common; may occur when the deviation causes contact between nasal structures.

What symptoms are NOT caused by a deviated septum?

A deviated septum does not by itself cause: - Facial pain or pressure — these are more characteristic of sinusitis or dental problems - Loss of smell — smell loss suggests mucosal disease (allergies, polyps, or sinusitis) rather than a mechanical obstruction - Runny or dripping nose — a clear running nose is more typical of allergic or vasomotor rhinitis than a septum deviation

Many people attribute all their nasal symptoms to a deviated septum they've been told they have, when allergic rhinitis or chronic sinusitis is the greater contributor. A thorough evaluation by an ENT separates these causes.

How is a deviated septum diagnosed?

Diagnosis is clinical — an ENT examines the inside of the nose using a speculum and light, or a nasal endoscope, to directly visualize the septum and its relationship to the nasal walls and turbinates. Imaging is not required for diagnosis, though a CT scan may be ordered if chronic sinusitis is also suspected.

A useful self-assessment: press one nostril closed gently with a finger and breathe through the other, then switch. Significant asymmetry in airflow between the two sides — when your nose is not congested from a cold or allergy — can suggest septal deviation.

When does treatment make sense?

Not every deviated septum needs treatment. Many people with mild deviations live without significant symptoms and need no intervention.

Conservative management — nasal corticosteroid sprays and saline irrigation can reduce congestion and improve airflow even when a structural deviation is present. These are usually the first intervention when symptoms are mild to moderate 2Ref 2Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Structural factors including septal deviation as contributors to impaired sinus drainage and recurrent sinusitis.

Septoplasty — surgical straightening of the nasal septum — is appropriate when symptoms are significant, persistent, and have not adequately responded to medical treatment. The procedure is done under general anesthesia, typically as an outpatient operation. It can be combined with turbinate reduction or, if cosmetic correction is also desired, rhinoplasty (a septorhinoplasty).

An ENT assessment determines whether the degree and location of your septal deviation account for your symptoms, and whether surgery is likely to help. Gale can help coordinate an ENT referral and prepare your symptom history for the appointment.