Deviated septum symptoms: What are the early signs of a deviated septum?

Overview: What does a deviated septum look and feel like?

The nasal septum is a piece of cartilage and bone that runs down the center of the nose and separates the right nasal passage from the left nasal passage. Along the central ridge of the nose, from the bridge to the tip, you’ll feel the bony foundation of the nasal septum until you get to the halfway point. After that, the central ridge is made of cartilage. It is also rigid, but you can push it from side to side. The septum should be straight and vertical, pointing straight down to the chin from the bridge of the nose. Septal deviation occurs when the bony part of the septum, the cartilage part of the septum, or both, aren’t straight or don't align vertically with the face. If there's enough deviation, the nose will look crooked, bent, or off-center. Aside from cosmetic issues, a markedly deviated septum can cause breathing, congestion, and sinus problems. A severely deviated septum can partially or entirely block airflow through one of the nostrils. Breathing through the nose can be difficult. Secondary problems, such as low-quality sleep, sleep apnea, and dry mouth, may occur.

What are the early signs of a deviated septum?

The nose's appearance is the most evident early sign of a deviated septum, but a mild deviation may not be easily visible. The nose may look unstraight and may not align vertically with the rest of the face. A person with a deviated nasal septum may describe their nose as crooked, bent, not straight, or off-center. People with a badly deviated septum will find it difficult to breathe through one of their nostrils because of the narrowing of the nasal cavity. Breathing difficulty may increase due to allergies or nasal congestion. It also may be more difficult to breathe while sleeping, leading to decreased sleep quality.

Other deviated septum symptoms

Symptoms directly caused by a deviated septum include:

• Irregular shape or direction of the nose

• Partial or total block of one nasal passage

• Difficulty breathing

• Drying of the nasal septum

• Crusting and bleeding of the nasal septum

• Poor sinus drainage

Deviated septum symptoms can also lead to complications, such as:

• Sleep disturbances due to breathing difficulties

• Worsened sleep apnea symptoms

• Snoring due to breathing difficulties

• Sinus infections and chronic sinusitis due to poor sinus drainage

• Dry mouth due to increased mouth breathing

• Nosebleeds, headaches, or facial pain due to spur formation

Deviated septum vs. perforated septum symptoms

A perforated septum is a hole through the septum. It is usually caused by blood vessel damage and the subsequent death of the cartilage. Injuries, infections, cancer, cocaine use, nasal steroids, autoimmune diseases, or excessive nose-picking are the most common causes of the damage. Like a deviated septum, a small perforation in the septum doesn’t require treatment, but a more serious hole might. Outside of nasal blockage or problems breathing through the nose, the symptoms of a deviated septum and a perforated septum are very different. Most importantly, while septal deviation can change the shape of the nose, only the most severe septal perforations affect the nose’s appearance.

Types of deviated septum: How can I tell which one I have?

Healthcare providers classify deviated septum based on the nature of the deviation. In the most basic classification system, the three main types of septal deviation are:

• Caudal septal deviations: involve the nose being straight, but not vertically oriented to the face

• Concave dorsal deformities: cause the nose to have a C-shaped or reverse C-shaped deviation

• Concave/convex dorsal deformities: cause the nose to have an S-shaped deviation

Plastic surgeons typically use a more complex classification system, organizing deviated septum into five different types. They are similar to the three types above, but they are partly based on whether deviations are in the bony part of the septum, the cartilage part, or both. These nuances are harder for non-specialists to see, but they are vital to plastic surgeons in restoring a more natural appearance to the nose. 

When to see a doctor for deviated septum symptoms

Seeing a healthcare provider for a deviated nasal septum is usually a personal decision based on personal appearance or symptom intolerance. Most people don’t seek treatment. By some estimates, septal deviation can be found in over 80% of the population. Most don’t know it. The most common symptoms are minor or nonexistent, and the appearance of the nose is not affected. 

If symptoms are bad, including breathing problems, headaches, pain, or repeated and frequent sinus infections, see a healthcare provider. These symptoms will probably require surgery to correct them.

Because septal deviations are widespread, an initial diagnosis aims to determine the severity of the deviation. An initial evaluation will consist of a medical history and physical exam by a healthcare provider. Since a deviated septum is an anatomical irregularity in the nose, healthcare professionals typically diagnose the condition by examining both the outside and inside of the nose. They will examine the inside of the nose with an otoscope, a nasal endoscope, or a fiber optic tube attached to a monitor or camera. When examining the nasal passages, the clinician may use a nasal speculum that widens the nasal opening. A medical history will help determine the symptoms and any possible causes, such as a past injury. 

If the deviation is severe, the symptoms are bad, or the patient desires surgical correction, the healthcare provider will refer the person to a plastic surgeon, an ear, nose, and throat (ENT) specialist, or an otolaryngologist. Before surgery, the goal of the diagnosis is to determine the exact nature of the deviation. These specialists typically use fiber-optic endoscopy and CT scans to get the most accurate picture of the deviation and any possible damage to the face, bones, and cartilage.

RELATED: Sinus infection symptoms: what are the early signs of sinus infection?

Complications of a deviated septum

Possible complications of an uncorrected deviated septum include:

• Difficulty breathing

• Worsening of obstructive sleep apnea

• Sleep disruptions

• Dry mouth (from breathing through the mouth)

• Poor sinus drainage

• Recurring sinus infections

• Headaches

• Sinus and nasal congestion

Bony spurs are a possible complication of a deviated septum and can cause their own set of complications, including:

• Nosebleeds

• Headaches

• Facial pain

Additionally, one study found an increased rate of psychiatric problems in people with symptomatic septal deviation, including depression, anxiety, and migraines .

How to treat deviated septum symptoms

The standard treatment for a deviated septum is surgical correction. However, the symptoms of a deviated septum, such as congestion, can be treated with over-the-counter and prescription medications. 

Symptom relief treatment typically consists of oral antihistamines, nasal spray antihistamines, decongestants, corticosteroid nasal sprays, or allergen immunotherapy injections (“allergy shots”). These drugs can help reduce swelling in the nasal passages to allow for easier breathing. They do not correct the septal deviation.

An ENT specialist or plastic surgeon can surgically correct the deviated septum using a procedure called septoplasty. It is one of the most common surgical procedures among ENT specialists and plastic surgeons. The surgery can be done through the nostrils, either with an endoscope or by cutting open the nose at the base. It can be done in the doctor’s office, an outpatient surgery center, or a hospital. People are usually sent home on the day of the surgery.

During a septoplasty, a plastic surgeon may also perform a rhinoplasty, a type of plastic surgery or reconstructive surgery that reshapes the nose. It is a much more complex and expensive operation. A rhinoplasty is mostly a cosmetic procedure, but it may improve nasal symptoms.

RELATED: The best medicine for congestion

Living with a deviated septum

If one chooses to not have surgery on a deviated septum, there are ways to manage the symptoms and keep the nasal passages clear:

• Use a warm saline rinse or Neti pot to help clear mucus and decongest the nose

• Find the best sleep position at night to keep the nasal passages open—this may be on the back with the head elevated or sleeping on the opposite side of the blocked nostril

• Use a humidifier to clear nasal passages, mainly when sleeping

• Use an air purifier to remove allergens and irritants from the air being breathed

• Use over-the-counter medications, such as decongestants, antihistamines, and nasal steroid sprays, to keep nasal passages open

RELATED: How to get rid of a stuffy nose

FAQs about deviated septum symptoms

What happens if you don't fix a deviated septum?

Many choose to not correct a deviated septum when there are no complications or problems. Mild deviations usually don’t cause problems, and many people are happy with the appearance of their noses. Severe deviations can cause issues, but none of them are necessarily health-threatening. 

How can I straighten a deviated septum without surgery?

A septal deviation can only be corrected with surgery.

What is the best position to sleep with a deviated septum?

The best position for sleeping with a deviated septum is on the back with the head elevated. This will promote drainage of the nostrils and sinuses. If this doesn’t work, try sleeping on the side opposite of the blocked nostril. Not every solution will work for everyone, so finding the best solution may take a while. 

What’s next? Additional resources for people with deviated septum symptoms

Test and diagnostics

• Classification of the deviated nose and its treatment, JAMA

• Deviated septum, NYU Langone Health

• Nasal endoscopy, Mount Sinai

Treatments

• Deviated septum, NYU Langone Health

• Deviated septum: diagnosis and treatment, Mayo Clinic

• Septoplasty, Cleveland Clinic

• Septoplasty, StatPearls

Scientific studies and clinical trials

• Association of nasal septal deviation with the incidence of anxiety, depression, and migraine: a national population-based study, PloS One

• Nasal septal deviation: a comprehensive narrative review, Cureus

More information on related health conditions

• Sinus infection treatments and medications, SingleCare

• Sleep apnea treatments and medications, SingleCare

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