A deviated septum occurs when the thin wall of cartilage and bone, known as the nasal septum, separating the right and left nasal passages is displaced or off-center. This common condition means the two sides of the nasal cavity are unequal, leading to reduced airflow in the narrower passage. While a slight deviation is present in a large percentage of the population and causes no issues, a more severe displacement can obstruct breathing and impact quality of life. The diagnostic journey begins when a person experiences persistent symptoms suggesting a structural issue.
Recognizing the Signs
Persistent difficulty breathing through the nose, often more pronounced on one side, is a primary sign of a deviated septum. This chronic nasal congestion worsens during colds or seasonal allergies as the nasal lining swells, further narrowing the constricted passage. Frequent nosebleeds can also occur because turbulent airflow across the deviated wall dries out the mucosal surface, making it susceptible to irritation. Some individuals experience facial pain or pressure, thought to be related to the septum making contact with the inner wall of the nose. Noisy breathing during sleep, such as loud snoring or signs of obstructive sleep apnea, is also common due to reduced nighttime airflow.
The Initial Medical Consultation
Most people begin their diagnostic process by scheduling an appointment with their Primary Care Provider (PCP) due to chronic nasal symptoms. The PCP conducts an initial evaluation to determine the cause of the complaints. This starts with a detailed medical history, including questions about symptom onset, prior nasal trauma, and whether breathing difficulty is constant or intermittent.
The PCP performs a visual inspection of the nose using a nasal speculum to gently widen the nostril and view the front part of the septum. This examination helps rule out issues like allergic rhinitis or acute infection, which can be managed with medication. If the PCP suspects a structural problem or if symptoms do not respond to conservative treatment, the next step is a referral to a specialist for a definitive assessment.
Confirmatory Diagnosis by a Specialist
The definitive diagnosis of a deviated septum is made by an Otolaryngologist, or Ear, Nose, and Throat (ENT) doctor. This specialist has the training and equipment necessary to fully evaluate the entire nasal cavity and septum. The ENT performs a comprehensive physical examination, which involves using a nasal speculum and a bright headlight to examine the anterior portion of the nasal passage.
Nasal Endoscopy
To visualize deeper structures, the specialist performs a nasal endoscopy. This procedure involves inserting a thin tube equipped with a camera and light, called an endoscope, into the nostril after applying a topical decongestant and anesthetic. The endoscopy allows the ENT to inspect the posterior part of the septum, identify the extent of the deviation, and assess related structures like the turbinates.
Imaging (CT Scan)
In complex cases, or when evaluating associated conditions, imaging technology may be used. A Computed Tomography (CT) scan creates detailed cross-sectional images of the bone and cartilage within the nose and surrounding sinuses. While a CT scan is not typically performed solely for a septal deviation, it helps the specialist plan for potential surgery by providing a map of the internal anatomy and ruling out other pathologies.
Next Steps After Diagnosis
A confirmed diagnosis of a deviated septum does not lead directly to surgical intervention; the treatment path depends on the severity of symptoms and their impact on daily life. For individuals with minor symptoms, the initial approach is conservative management aimed at symptom relief. This may involve using medications such as nasal steroid sprays, antihistamines, or decongestants to reduce inflammation and swelling of the nasal lining, temporarily improving airflow.
If the deviation significantly impairs breathing, causes chronic sinus infections, or contributes to sleep disorders, the ENT specialist will discuss surgical correction. The procedure to straighten the septum is called a septoplasty, which physically reshapes or repositioning the cartilage and bone. The decision to proceed with surgery is made after conservative measures have failed to provide adequate relief.