In a deviated nasal septum, the nasal septum deviates from its normal straight and central position and is crooked or curved. Septal deviation is very often congenital, but it can also be acquired through an injury, such as a blow to the nose.
What is a deviated septum?
Nasal septal deviation is a deviation (deviation) of the nasal septum and is referred to by medical term as septal deviation. The nasal septum consists of both cartilage and bone parts. It normally runs down the middle of the nose, separating it into two nasal cavities. However, since the human body is never completely symmetrical and textbook, it is completely natural and very common for the nasal septum to be slightly curved. In about 80% of people this is the case. As long as one’s breathing is not restricted, this small deviation can be considered normal. One speaks of a pathological (pathological) deviation of the nasal septum if it causes breathing difficulties or frequent inflammations, which possibly infect not only the nose, but additionally the sinuses and the throat and lead to chronic complaints.
Causes
Nasal septal deformity is either congenital or acquired. The congenital form is hereditary. The acquired nasal septum curvature can be caused by force on the nose. For example, after a blow to the nose, such as from a fall or during sports, the bone may break and then fail to grow back together evenly. In children who are still growing, the bony and cartilaginous parts of the nasal septum may grow at different rates, resulting in the formation of a curvature of the nasal septum. Also, if the growth of the midfacial bone is not uniform, a curvature may develop.
Symptoms, complaints and signs
The central characteristic of a curvature of the nasal septum is an impairment of normal breathing. Quickly, mucus-ridden noses result in complete obstruction of the airway. The crooked nasal septum alone is not responsible for the discomfort. The unusual airflow through the nasal passages also contributes to the symptoms. Thus, there are more frequent complaints of a blocked nose, even though it appears completely clear during an examination. In many cases, affected individuals do not experience any pain or otherwise stored symptoms. However, a subsequent displacement due to an accident or swelling of the mucous membranes then quickly leads to problems. Severe colds, but also an allergic rhinitis, then block the passage for the respiratory air. The permanent reduction in the size of the airways leads to an accelerated flow of air. As a result, the mucous membranes dry out quickly and become more susceptible to nosebleeds. If the deviated nasal septum affects the air circulation in the paranasal sinuses, recurrent inflammations can be observed in these areas. Bacterial infections even threaten to become permanently established under these conditions. If the curved nasal septum is in direct contact with the turbinate, it increases the tendency for spontaneous headaches to occur. Extensive secretion, on the other hand, is not one of the typical signs. On the other hand, the misalignment of the nasal septum occasionally causes a reduction in the sense of smell. The reduced size of the nostrils disturbs the sleep of those affected. Pronounced snoring and audible nasal whistling massively reduce the quality of sleep. As a result, patients suffer from a reduced ability to concentrate the following day.
Diagnosis and course
A milder deviated septum usually causes no symptoms. In the more severe form, breathing through the nose is often difficult because the airflow is obstructed by the crooked course of the septum. Affected individuals therefore breathe more through the mouth, which can lead to more frequent inflammation of the throat (pharyngitis) and snoring. The nose is no longer sufficiently ventilated and germs thus settle in the nasal cavities. This leads to rhinitis and swelling of the nasal mucous membranes. In the further course, inflammations develop that spread to the sinuses (sinusitis).Since the nose normally filters the air we breathe and clears it of germs, if we breathe only through the mouth, the germs can travel down the trachea into the lungs and cause acute bronchitis. The doctor can examine the inside of the nasal cavity with a rhinoscopy and determine whether there is a deviated nasal septum. To do this, a nasal endoscope (tiny camera) is inserted after a surface anesthesia (numbing) of the nasal mucosa. This allows the doctor to see the exact location, texture and course of the nasal septum and make a definite diagnosis.
Complications
A crooked nasal septum, if left untreated, can bring complications that limit the quality of life of those affected. Complications can also occur in the course of treatment, such as nasal septum surgery (septoplasty). Since a curved nasal septum makes nasal breathing difficult, affected individuals breathe unconsciously through the mouth. Such breathing problems often result in throat infections and restless sleep. In addition, the risk of viral infections increases, which can trigger protracted sinusitis. If those affected suffer from these complaints in the long term, surgery should be performed on the crooked nasal septum. Since during this operation superfluous cartilage and bone pieces are removed, the overlying sensitive mucous membranes must be removed first. If the surgeon unintentionally injures the mucosa during this process, this can lead to the formation of a hole in the nasal septum. This would have to be removed with the help of another surgical procedure. Following the operation, there may be bleeding under the mucosa. These can lead to the formation of a hematoma (septal hematoma). A septal hematoma must be drained during surgery. Surgery of the nasal septum can impair the sense of smell as well as lead to an altered shape of the nose. Furthermore, permanent numbness of the nose may result. The operation is performed under general anesthesia. Accordingly, the typical side effects of anesthesia may occur. Therefore, for example, nausea, difficulty swallowing or hoarseness may occur.
When should you go to the doctor?
If changes in the shape of the nose occur as a result of an accident, blow or fall, a doctor should be consulted. If there is pain, discomfort, as well as impaired breathing, a doctor is needed. A deviated septum may develop as a result of a sudden event or during the natural process of growth and development. A visit to the doctor is necessary as soon as there is any disturbance or discomfort and the affected person feels the need for relief. If there is a feeling of tightness in the nose, a conspicuousness of speech and swelling of the mucous membranes, a clarification of the complaints by a doctor is recommended. If a fear of choking sets in or a feeling of oxygen deprivation develops, a physician is needed. Nosebleeds, infections and persistent rhinitis are signs of health impairment. If the symptoms persist over a longer period of time or increase in intensity, a visit to the doctor is advisable. In case of sleep disturbances, rapid fatigue and exhaustion, a check-up visit to a doctor should be initiated. A feeling of illness, mental abnormalities and peculiarities of behavior are further indications of a health problem that should be investigated and treated. If feelings of shame occur or the affected person withdraws from his or her social environment, there is usually a condition that should be discussed with a physician.
Treatment and therapy
If the deviated septum is severe enough to cause discomfort, it must be treated surgically. A septoplasty is performed; a restoration of the straight nasal septum and/or a septal resection, a removal of parts of the nasal septum to return it to a straight position. Children should be operated on after they have completed their growth phase, if possible, otherwise there is a risk that the septum will shift again. The operation usually takes place under general anesthesia and is performed through the nostrils. The doctor separates the nasal cartilage from the bone, removes or straightens the curved parts of the septum, and puts the septum straight back together. The procedure takes between 30 and 60 minutes, depending on the severity.In the end, special tamponades with air tubes inside them are inserted into the nose for 1-2 days. They allow breathing through the nose already immediately after the operation.
Outlook and prognosis
A deviated septum offers a good prognosis. The curvature can be treated effectively nowadays. Surgical straightening of the nasal septum is usually successful. The surgery facilitates breathing through the nasal cavity. However, there is a risk of complications, such as inflammatory diseases. In addition, the nasal septum may deviate again. If the curvature of the nasal septum is not treated surgically, there is a risk of recurrent inflammation in the ENT area. Affected persons suffer from difficult breathing and other complaints. The well-being is considerably limited by these accompanying symptoms. Life expectancy is not reduced by a deviated septum. However, the quality of life decreases and in the long term, health problems can occur due to the lack of oxygen. People suffering from a deviated septum should consult an ENT physician. The medical professional will make a prognosis with regard to the severity of the curvature. In addition, the prognosis is improved by a good control of the nasal septum. If there is a suspicion that a deviation will occur again, this can be prevented by early surgery. In conclusion, therefore, a curvature of the nasal septum offers a very good prognosis, provided that it is detected and treated early.
Prevention
A deviated septum cannot be prevented, as it is either congenital or caused by injury. However, it is recommended to have the deformity treated by a doctor as soon as possible, so that further discomfort and damage to the respiratory tract do not occur as a result of the deviated septum. However, one should refrain from martial arts, such as boxing, since here the risk of getting a deviated septum due to a blow to the nose can be significantly high.
Follow-up
In most cases, the measures and options for aftercare for a deviated septum are significantly limited and reduced. Therefore, affected individuals should ideally see a doctor early to avoid further complications or discomfort. The sooner a doctor is consulted, the better the further course of the disease usually is. Therefore, affected persons should already initiate an examination at the first signs and complaints. In most cases, the treatment of deviated septum is a surgical procedure. Afterwards, affected persons should rest and also take care of their body. Efforts or other stressful and physical activities should be refrained from in order not to put unnecessary strain on the body. Likewise, bed rest should be observed so that a complete recovery can occur. As a rule, this condition does not reduce the patient’s life expectancy. After a successful operation, regular checks and examinations continue to be very useful in order to detect other complaints at an early stage. However, further measures of an aftercare are not available to the affected person and are not necessary in this case.
What you can do yourself
Patients with a deviated septum are subject to an increased susceptibility to infections of the respiratory tract. Affected persons should therefore always make sure that they do not expose themselves to unnecessary stress and avoid places where a strong transmissibility of existing pathogens is to be expected. The immune system can be strengthened with a healthy and balanced diet. In the fight against viruses, bacteria as well as other germs, defenses can be mobilized more quickly. A diet rich in vitamins and the avoidance of harmful substances such as alcohol and nicotine are advisable. Physical exertion should also be avoided. Due to the limited breathing capacity, this will cause discomfort. Nevertheless, sufficient mobility is important for maintaining health. If stressful situations occur, regular breaks should be taken. Calmness must be maintained so that the situation is not aggravated by hectic activity. Meditative exercises or the practice of yoga are helpful for this. This stabilizes the inner balance and at the same time supports necessary physical exercise. Rooms should always be checked for good oxygen levels.Regular ventilation and walks promote the absorption of oxygen and relieve the heart activity. In addition to the restrictions and stresses of everyday life, surgical intervention should be considered. This can provide permanent relief, which may not be achieved in self-help, despite the attention to all indications.
