Most nasal bone spurs do not need to be removed. A spur is a sharp, bony or cartilaginous projection along the nasal septum, and many people have one without ever knowing it. Removal becomes a real conversation only when a spur is actively causing problems: blocked breathing, recurring sinus infections, headaches from internal contact pressure, or trouble tolerating a CPAP machine. The decision hinges almost entirely on whether the spur is producing symptoms that meaningfully affect your daily life and whether those symptoms have resisted simpler treatments first.
What a Nasal Spur Actually Is
The nasal septum is the wall of cartilage and bone that divides your nose into left and right sides. A spur is a ridge or spike that juts out from that wall into one of the nasal passages. These projections usually form where the cartilage of the septum meets the bony components deeper in the nose, and they tend to be made of both cartilage and bone fused together into a sharp process.1PubMed Central. Reducing local tension to repair nasal septal deviation and spur At the site of a spur, there is often a tongue of cartilage extending several centimeters beyond where the cartilage and bone normally join, and that extension consistently appears on the same side as the spur itself.2PubMed. Consistent ipsilateral development of the posterior extension of the quadrangular cartilage and bony spur formation in nasal septal deviation
Spurs are not the same as a deviated septum, though they often come with one. A deviated septum is a broader bend or shift of the entire wall. A spur is more localized: a pointed shelf sticking out into the airway. You can have a deviated septum without a spur, a spur without much deviation, or both at once. The distinction matters because a spur that jabs into the side wall of the nose or into a turbinate can cause very specific, localized problems that a gentle curve of the septum might not.
How Common Are They?
Spurs are a routine finding on CT scans ordered for other reasons. In one study of adults undergoing computed tomography, about 12% had a visible septal spur.3International Archives of Otorhinolaryngology. Variations of the Nasal Septum in Adult Nigerians: Computed Tomography Study Another study examining deviated septum variants found that spur-type deviations were the single most common pattern among all types of septal deviation in the adult population studied.4Journal of Advanced Oral Research. Computed Tomographic Study of Variants of Deviated Nasal Septum in Adult Population: A Descriptive, Cross-sectional, Hospital-based Study The takeaway is that spurs are common enough to be considered a normal anatomical variant in many people. A radiologist noting one on your scan does not, by itself, mean anything needs to happen.
When a Spur Starts Causing Problems
A spur sitting quietly in a wide nasal passage may never bother you. The trouble starts when the spur is large enough, or positioned just right, to narrow the airway or press against neighboring tissue. The symptoms that actually push people toward treatment tend to fall into a few categories.
Blocked Airflow
A spur projecting into a nasal passage acts like a speed bump in a hallway. Air has to squeeze around it, and the turbulence that creates can make one side of your nose feel permanently stuffed. Computational modeling of different septal deviation types shows that deviations involving sharp projections and spurs substantially increase airflow resistance and peak air velocity inside the nose, altering how air distributes between the two sides.5PubMed. Impact of Varying Types of Nasal Septal Deviation on Nasal Airflow Pattern and Warming Function: A Computational Fluid Dynamics Analysis That kind of chronic one-sided congestion doesn’t respond well to decongestant sprays because the obstruction is structural, not inflammatory. If you’ve been using nasal sprays for months with little relief and one side always feels worse, a spur may be the reason.
Contact Point Headaches
This is one of the more underappreciated consequences of a spur. When a bony ridge presses against the lateral nasal wall or against a turbinate, the mucosal contact can trigger a specific type of headache called rhinogenic contact point headache. It tends to feel like pressure or aching around the nose, forehead, or between the eyes, and it happens without any sign of sinus infection. Septal spurs are among the most commonly observed anatomical causes of these headaches.6PubMed. Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment They can be tricky to diagnose because the pain mimics a tension headache or migraine, and many people go through rounds of pain medication before anyone looks inside the nose. A hallmark clue: the headache reliably improves after applying a topical anesthetic (like lidocaine on a cotton pledget) to the area where the spur contacts the opposite wall. If the pain disappears temporarily, the contact point is likely the culprit.
Recurring Sinus Infections
The sinuses drain through narrow openings along the lateral nasal wall. A spur that pushes into or near these drainage pathways can physically narrow them, trapping mucus and creating a breeding ground for bacteria. There’s also a subtler effect: by disrupting the normal airflow pattern, a spur can impair the tiny hair-like cilia that sweep mucus out of the sinuses, further encouraging stagnation and infection.7PubMed Central. Sinusitis and its association with deviated nasal septum at a tertiary hospital: A retrospective study If you keep getting sinusitis on the same side despite finishing antibiotics, a structural issue like a spur deserves investigation.
The CPAP Connection
People with obstructive sleep apnea who use a CPAP machine sometimes find that nasal obstruction makes the treatment miserable. High resistance in the nose forces the machine to push harder, which means higher pressures, more mask leak, and a louder, less comfortable experience. A systematic review pooling data from multiple studies found that after nasal surgery (including septoplasty for spurs and deviations), average therapeutic CPAP pressures dropped meaningfully, and device use went up. Among patients who were not using their CPAP at all before nasal surgery, roughly nine out of ten subsequently accepted, adhered to, or tolerated the device after their nasal obstruction was corrected. Nightly hours of use also increased in the short term.8PubMed Central. The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis This doesn’t mean nasal surgery cures sleep apnea, but it can make CPAP tolerable for people who otherwise abandon it, and that indirectly has a big impact on their health.
What Surgery Looks Like
When a spur does need to come out, the procedure is some form of septoplasty. The surgeon lifts the mucosal lining off the septum, removes or reshapes the offending bone and cartilage, and lays the lining back down. It’s typically done under general anesthesia as a same-day outpatient procedure, and most people go home a few hours afterward.
The traditional approach, called conventional septoplasty, uses a headlight and direct vision through an incision just inside the nostril. The newer alternative, endoscopic septoplasty, uses a small camera threaded into the nose, which gives the surgeon a magnified view of exactly where the spur is. A study comparing the two in patients specifically with posterior spurs or posterior deviations found that the endoscopic approach had shorter operating times, less blood loss, less post-operative pain, and less numbness afterward. Nasal obstruction scores improved dramatically in both groups, but patients in the endoscopic group reported higher satisfaction.9PubMed Central. Endoscopic Versus Conventional Septoplasty in Correction of Posterior Nasal Septal Deviation and Nasal Spur: Retrospective, Randomized Study Endoscopic septoplasty is particularly well-suited for isolated spurs sitting deep in the nose, since the camera can reach those areas without having to elevate the entire septal lining from front to back.
In a small series evaluating endoscopic septoplasty outcomes, average nasal obstruction scores dropped from a preoperative median of 85 out of 100 (severe) to 5 out of 100 (near-normal) after surgery, with patients noticing improvement within one to four weeks.10PubMed Central. Our approach to endoscopic septoplasty: Intra Nasal Endoscopic Septoplasty with NOSE score analysis Those numbers reflect carefully selected patients whose obstruction was clearly due to a septal problem, so they represent something close to a best-case scenario, but they show how effective the surgery can be when the indication is clear.
How Well Surgery Works for Contact Point Headaches
For people whose primary complaint is headache rather than congestion, the evidence is encouraging but comes with a caveat: you have to be confident the spur is the headache’s actual cause. Surgeons typically confirm with a lidocaine test first. In patients selected this way, one study found an overall success rate of about 88%, with roughly two-thirds of patients reporting complete relief and about a fifth reporting enough improvement that the headache was no longer significant. Around 12% saw no change.11The International Tinnitus Journal. Effect of Septoplasty On relieving contact point headache Another study found that headache reduction after removing mucosal contacts was more pronounced when a septal spur was the specific cause compared to a broader septal deviation.12PubMed Central. Surgical Treatment of Rhinogenic Contact Point Headache: An Experience from a Tertiary Care Hospital A separate trial comparing surgical removal to medical management alone showed significantly greater headache improvement in the surgical group.13American Journal of Otolaryngology. Is septal deviation effective rhinogenic headache in patients with isolated contact point between inferior turbinate and septal spur?
The caveat is that contact point headache is a diagnosis of exclusion. Migraine, cluster headache, and tension-type headache are all far more common, and finding a spur on a CT scan does not mean it’s causing your headaches. An ENT who operates purely because a scan shows a spur, without confirming the headache responds to local anesthetic, risks putting you through surgery that won’t help. The positive results in the literature come from studies that preselected patients carefully.
Risks and Downsides of Surgery
Septoplasty is generally safe, but it’s not risk-free. In a large analysis of over 5,600 patients who underwent septoplasty, septal perforation (a hole in the septum) occurred in about 2.3% of cases. Adhesions, where scar tissue forms between the septum and the side wall, were rare at around 0.6% when nasal splints were used routinely afterward.14PubMed Central. Complications in septoplasty based on a large group of 5639 patients Other possible complications include bleeding, infection, temporary numbness of the upper teeth or tip of the nose, and, very rarely, a change in the external shape of the nose if too much cartilage is removed from a supporting area.
A septal perforation deserves specific mention because it can be more annoying than the original problem. Small perforations cause a whistling sound during breathing. Larger ones lead to crusting, bleeding, and a paradoxical feeling of nasal obstruction despite the airway technically being wider. Perforations are difficult to repair surgically. This is one of the key reasons doctors don’t recommend removing a spur unless it is clearly symptomatic: trading a quiet spur for a whistling hole in your septum is a bad trade.
Why Doctors Try Medical Treatment First
Before anyone books you for surgery, most ENTs will have you try a period of medical management. That typically means nasal corticosteroid sprays (like fluticasone or mometasone), saline irrigations, and sometimes a short course of oral steroids or antibiotics if infection is involved. The rationale is straightforward: a spur narrows the airway, but swollen mucosa on top of that narrowing makes it worse. If medication can reduce the swelling enough that air flows adequately around the spur, surgery becomes unnecessary.
Medical treatment is especially worth trying when the obstruction is mild or intermittent. If your nose only blocks up during allergy season or with colds, the spur may be a contributing factor rather than the sole cause, and controlling the inflammation might be enough. Surgery makes more sense when the obstruction is constant, unilateral, and unresponsive to at least a few months of consistent medical therapy.
Spurs in Children
Nasal septal surgery in children is handled more cautiously than in adults. The septum contains growth centers, and removing cartilage from a still-developing nose can potentially affect how the midface grows. This has made pediatric septoplasty controversial in the field.15PubMed Central. Quality of life in children following nasal septal surgery: A review of its outcome Most surgeons prefer to wait until a child is closer to skeletal maturity, typically mid-to-late adolescence, before operating on the septum unless the obstruction is severe enough to affect breathing, sleep, or development. In younger children, conservative measures like nasal sprays and monitoring are the default approach. If a child has a spur causing serious sleep-disordered breathing that doesn’t respond to other treatments, a limited, conservative procedure may be considered, but it’s not taken lightly.
How to Know If Your Spur Is Worth Worrying About
The simplest way to think about it: if you didn’t know the spur was there, it probably doesn’t need to come out. Spurs found incidentally on imaging for something else (a dental scan, a head CT after a fender bender) rarely need treatment. The spur becomes relevant when it maps onto symptoms you’re already experiencing. Constant one-sided congestion that doesn’t respond to sprays, headaches localized to the nose or forehead that vanish with topical anesthetic, three or four sinus infections a year on the same side, or an inability to use your CPAP machine: these are the kinds of situations where removal has a clear benefit.
If you do have symptoms, an ENT will typically start with a nasal endoscopy, threading a thin camera through your nose while you’re awake. This lets them see exactly where the spur is, whether it’s touching the opposite wall or a turbinate, and how much of the airway it’s blocking. A CT scan may follow if sinus disease is suspected or if surgery is being planned, since it shows the bony anatomy in detail and helps the surgeon map their approach.
When the Answer Is Clearly Yes
There are situations where the case for removal is strong and most ENTs would agree surgery is appropriate. A large spur creating near-total obstruction of one side, a spur confirmed as the source of contact point headaches via anesthetic testing, recurrent same-side sinusitis that keeps coming back despite appropriate medical treatment, or a nasal obstruction preventing effective use of CPAP for diagnosed sleep apnea are all scenarios where the benefits of surgery clearly outweigh the modest risks. The evidence for improvement in all of these categories is solid, particularly when patients are properly selected.
On the other end, if your spur is small, your breathing is fine on both sides, and the spur was discovered by accident, you have no reason to seek surgery. Many people live their entire lives with a septal spur and never experience any consequence from it. The spur itself is not dangerous, it isn’t a growth, and it won’t become cancerous. It’s just bone and cartilage that grew in an inconvenient shape.
Endoscopic Techniques and the Trend Toward Less Invasive Approaches
Septoplasty has been evolving steadily toward more targeted, less disruptive procedures. The traditional operation often involved removing a large portion of the septum and replacing it in a straightened position. Modern endoscopic techniques allow surgeons to remove only the spur itself, or a small portion of the septum immediately around it, while leaving the rest of the structure intact. This matters because preserving septal cartilage maintains nasal support and reduces the chance of saddle-nose deformity, a cosmetic complication where the bridge of the nose collapses inward.
The endoscopic approach has practical advantages for recovery as well. With less tissue disruption, some surgeons skip nasal packing altogether, or use softer silicone splints instead of the traditional gauze strips that patients universally dread. Many people return to desk work within a few days, though physical activity is usually restricted for two to three weeks to minimize the risk of bleeding. Full healing of the internal lining takes about six to eight weeks, and swelling may cause the nose to feel slightly worse before it feels better during the first week or two.
For people with an isolated posterior spur that isn’t part of a broader septal deviation, these focused endoscopic techniques are well-matched to the problem. Rather than straightening the entire septum, the surgeon can go directly to the spur, shave or chisel it off, and leave everything else alone. Recovery from this kind of limited procedure tends to be faster and less uncomfortable than a full septoplasty.