The nasal septum is a wall of cartilage and bone that divides the inside of the nose into two separate passages. Ideally, this structure sits exactly in the center, ensuring equal airflow through both nostrils. A deviated septum occurs when this wall is significantly shifted away from the midline, causing one nasal passage to be narrower than the other. While many people have some degree of misalignment, a deviation is only considered a medical concern if it causes noticeable symptoms. The diagnostic process moves from a discussion of symptoms to a physical inspection, determining the anatomical cause of breathing difficulties.
Recognizing Symptoms That Require Testing
A patient usually seeks medical testing after experiencing persistent symptoms that suggest an obstruction of the nasal passages. The most common indication is difficulty breathing through the nose, which is often noticeably worse on one side. This unilateral or bilateral blockage can feel like chronic congestion that does not respond to typical cold or allergy medications.
A significant deviation can dry out the septal surface, making a person prone to frequent nosebleeds. Other indicators include chronic facial pain or headaches, which may be related to pressure changes or recurrent sinus infections caused by poor drainage. Disruptive sleep patterns, such as loud snoring or obstructive sleep apnea, are common reasons to consult a physician. These symptoms warrant a physical examination to confirm an underlying structural issue.
The Standard Medical Examination
The diagnostic process begins with a detailed medical history, where the physician inquires about the onset, severity, and nature of the patient’s symptoms, including any history of nasal trauma. A visual inspection is then performed to check for any external misalignment of the nose that might suggest an internal structural problem.
The initial internal view of the nasal passages is typically accomplished using a nasal speculum and a bright light, a procedure known as anterior rhinoscopy. This allows the doctor to see the front portion of the septum and check for any obvious displacement or septal spurs, which are sharp projections of bone or cartilage. To prepare for a more thorough examination, the physician often applies a combination of a topical decongestant and an anesthetic spray.
The decongestant’s purpose is to shrink the turbinates—the structures that humidify air—to reduce any swelling that might be mimicking the degree of septal deviation. After the tissues have shrunk, a nasal endoscope is used to gain a more detailed view of the nasal cavity. This thin, lighted tube is maneuvered deeper into the nose to inspect the posterior sections of the septum, which can be missed by anterior rhinoscopy alone.
The endoscope allows for a systematic evaluation of the entire structure, paying close attention to how the deviation affects the airflow and the openings to the sinuses. This comprehensive visual assessment is considered the primary method for confirming a deviated septum and determining its functional impact. The doctor usually divides the nose into horizontal thirds for a systematic assessment of the upper, middle, and lower sections to precisely document the severity and location of the bend.
When Advanced Imaging is Necessary
While the physical and endoscopic examination is usually sufficient for a diagnosis, advanced imaging is sometimes required, especially when surgery is a possibility. A Computed Tomography (CT) scan provides detailed cross-sectional images of the bone and soft tissues within the nasal cavity and sinuses. This technology is useful for assessing the bony components of the septum and for identifying complex deviations that extend into the posterior nasal cavity.
CT scans are employed to rule out other potential causes of nasal obstruction, such as chronic rhinosinusitis, nasal polyps, or other sinonasal pathologies. Although a CT scan clearly shows the anatomy, the degree of deviation does not always correlate with the patient’s subjective experience of nasal blockage. Therefore, imaging is most beneficial for detailed surgical planning, helping a surgeon anticipate the exact nature of the required repair.
Understanding Treatment Options
Once a deviated septum is diagnosed, the recommended next step depends on the severity of the symptoms. For patients with mild symptoms, the initial approach focuses on non-surgical management to relieve inflammation and improve airflow. This includes the use of nasal steroid sprays to reduce swelling, antihistamines to manage allergy-related congestion, or saline nasal irrigation to clear mucus and moisturize the passages.
When symptoms are severe, or when conservative medical treatments fail to provide adequate relief, a surgical procedure called septoplasty is recommended. The goal of this procedure is to straighten and reposition the septal cartilage and bone, moving it back to the center of the nasal cavity to establish clear and balanced airflow. Septoplasty addresses the structural problem itself, offering a lasting solution for improved breathing.