Deviated Nasal Septum: What It Is, Types, and Symptoms

At an ENT appointment you heard: "You have a deviated nasal septum." Or you noticed yourself that for years you've been breathing through one nostril and breathing through your mouth in your sleep. Let's calmly sort out what this feature is and what it means in practice.

What the nasal septum is and how it's structured

The nasal septum is the wall that divides the nasal cavity into two halves, left and right. It is made of bone and cartilage, and on top it is covered by a mucous membrane — a specialized skin with many blood vessels. Ideally, the passages on the left and right are the same. The nose itself works as a filter: it removes dust, microbes, and irritants from the air, warms and humidifies it, and it also contains nerve cells responsible for the sense of smell.

What a deviated nasal septum is

A septal deviation is its displacement to one or both sides away from the midline. The numbers are reassuring: by some estimates, up to 80 percent of people live with a septum that is off-center. In many, this causes no symptoms and no intervention is needed. The problem arises when the displacement impairs nasal breathing or the drainage of secretions from the paranasal sinuses — then rhinitis, sinusitis, and maxillary sinusitis occur more often. So a crooked septum is not a sentence but an anatomical feature that sometimes gets in the way.

Types of deviation

By cause, doctors distinguish three types. Physiological — due to lack of space in the nasal cavity: the upper jaw is underdeveloped, the hard palate is high, narrow, and arched, and the septum has too little room; the degree of deviation is linked to the depth of the palate. Compensatory — the septum deviates under the influence of an irritant, such as a polyp or a foreign body. Traumatic — the result of a dislocation or fracture of the nose.

Why the septum can be crooked

The most obvious cause is nasal trauma: a blow, fracture, or dislocation. But even without past trauma, people with normal growth and development can also have a displaced septum. Sometimes it is pushed by a polyp or a foreign body.

Symptoms of a crooked nasal septum

The most common sign is difficulty breathing through the nose, and usually it is worse on one side. A person unknowingly starts breathing through the mouth during sleep and snores; in infants and young children, breathing becomes noisy. If the displacement impairs drainage from the sinuses, recurrent sinusitis develops. What else can occur:

• difficulty breathing through the nose on one or both sides, up to complete obstruction;
• dryness in the nose and nosebleeds;
• frequent rhinitis, sinusitis, maxillary sinusitis;
• reduced sense of smell, headache, ear pain;
• snoring and mouth breathing during sleep.

If the septum shifted after trauma, the external shape of the nose may also change. How pronounced the symptoms are depends on the degree of deviation: a small displacement often causes nothing at all.

How deviation is diagnosed and when to see a doctor

First, a conversation: the doctor will ask about breathing, snoring, bleeding, trauma, and nasal surgeries. Then they will examine the nose outside and inside, and if necessary suggest additional tests — for example, nasal endoscopy. Next comes a visit to an ENT specialist (otolaryngologist): they assess whether the septum is really the issue or whether something else is involved — enlarged inferior turbinates, an air bubble in the middle turbinate, a weak nasal valve, sinusitis. If symptoms are pronounced and interfere with life, the doctor may discuss surgical correction of the septum; in young children it is usually postponed until facial growth is complete, except in severe cases.

A deviation on its own is not a reason to call an ambulance; 103/112 — for a life-threatening condition or serious injury.

This material is for reference and does not replace a doctor's consultation: if in doubt, show your nose to an ENT — they will figure it out better than the internet.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer