A deviated septum occurs when the thin wall of cartilage and bone, known as the nasal septum, is displaced off-center, making one nasal passage significantly smaller than the other. This displacement can be present from birth or result from an injury to the nose later in life. A slight deviation is common and often causes no issues, but a severe misalignment can lead to persistent symptoms. Common complaints include difficulty breathing through the nose, chronic nasal congestion, frequent nosebleeds, and noisy breathing during sleep.
Starting Point: Primary Care Providers
The first step for a patient experiencing chronic nasal symptoms is to consult a Primary Care Provider (PCP), such as a general practitioner or family doctor. The PCP’s role is to conduct an initial screening and determine the most likely cause of the breathing difficulty. They examine the nasal passages using a handheld nasal speculum and a light source to assess the internal structure.
This initial visit allows the PCP to rule out more common, non-structural issues that mimic deviated septum symptoms, like seasonal allergies or a persistent cold. For milder symptoms, the PCP recommends conservative treatments to reduce inflammation and manage congestion. These treatments often include over-the-counter or prescription options like nasal steroid sprays, antihistamines, or decongestants.
The PCP functions as a gatekeeper in the healthcare system, monitoring the patient’s response to medical therapy. If the patient’s breathing problems persist, if the symptoms are severe, or if the initial conservative measures fail to provide sufficient relief, the PCP initiates a referral. This referral directs the patient to a specialist equipped to handle complex diagnoses and surgical interventions.
The Specialist: Otolaryngologist (ENT)
The specialist who manages a persistent deviated septum is an Otolaryngologist, commonly referred to as an Ear, Nose, and Throat (ENT) doctor. These specialists have advanced training focused on the anatomy and function of the head and neck, with expertise in nasal and sinus structures. This specialized knowledge is essential for detailed diagnosis and corrective procedures.
Upon referral, the ENT performs a more in-depth examination, often utilizing advanced diagnostic tools. This may include a nasal endoscopy, which uses a thin, lighted tube with a camera to visualize the deviation and surrounding structures in detail. A CT scan may also be ordered to provide cross-sectional images of the bone and cartilage, revealing the full extent of the deviation and identifying coexisting sinus issues.
When non-surgical management is unsuccessful, the ENT performs the corrective procedure, known as a septoplasty. During this operation, the surgeon works through incisions inside the nose to trim, reshape, and reposition the misaligned cartilage and bone. The procedure moves the septum back to the center of the nasal cavity. This is often performed in conjunction with a turbinate reduction if the turbinates, which humidify air, are also enlarged and contributing to the obstruction.
Non-Surgical vs. Surgical Decisions
The decision to proceed with surgery considers the severity of the structural issue and the patient’s quality of life. Non-surgical options, such as nasal sprays and decongestants, manage symptoms but cannot physically straighten the septum. These approaches are appropriate for patients with mild deviations or those whose symptoms are manageable with medication.
Surgery becomes the indicated course of action when symptoms like chronic, severe obstruction, recurrent sinus infections, or significant sleep disruption persist despite consistent medical therapy. Septoplasty is reserved for cases where the deviation structurally causes a functional impairment by actively restricting airflow. For patients who have failed conservative treatment, septoplasty significantly improves quality of life and nasal airflow.