All You Need to Know About a Deviated Septum

Your nose looks simple from the outside. But inside there are many specialized cells and structures. They help your nose identify smells and trap foreign particles. They also help warm and humidify the air that goes to your lungs. 

When you have a cold or allergies, you may notice temporary nasal symptoms. These are things like stuffiness, dripping, and draining. But if you have a deviated nasal septum, it can feel like your nose is blocked almost all the time. And a deviated nasal septum can lead to more than nasal congestion.

What is a deviated septum?

The nasal septum divides your nasal cavity into two sections. It’s made of a thin piece of bone and cartilage. Cartilage is the same type of tissue that makes your ears firm, but flexible. 

If you have an angled or crooked septum, that means you have a “septal deviation.” It’s the most common structural abnormality of the nose. It affects up to 80% of people.

There are different types of deviated septums. Some are curved like a “C” or an “S.” Others may just tilt slightly to one side. You may have partial blockage of one nostril — while someone else can’t even breathe out of one nostril. Some deviations even curve so much that parts of the septum enter both nasal passageways.

Causes of a deviated septum

Some people are born with a deviated septum. That can happen when the septum doesn’t develop properly during pregnancy or gets damaged during birth. Other people with septal deviation develop it during their lifetime. Any injury to the face — such as during contact sports or a car accident — can cause this. Even mild injuries can cause problems. In fact, many people don’t know how or when they damaged their nasal septum.  

How can I tell if I have a deviated septum?

Without being able to see inside your nose, it’s difficult to know exactly how your septum is set. But there are some clues that you might have a deviated septum:

• Your nose looks crooked when you look in the mirror.

• When you tilt your head back and look up your nostrils, one side seems narrowed.

• You can't breathe easily through either nostril.

Your primary care provider or otolaryngologist (ears, nose, and throat specialist) can look deeper into your nose. They will do this with special lights and cameras (a nasendoscopy) to find out for sure. A CT scan is often helpful.  

Symptoms of a deviated septum

To understand the symptoms of a deviated septum, it helps to visualize what’s going on inside the nose. With a deviated septum, your nasal passages narrow, which makes normal congestion even worse. So it’s no wonder your nasal passages will feel blocked.

And this change in airflow leads to long-term swelling and inflammation. Over time, congestion builds and blocks your nasal passages even more. 

So it probably doesn’t come as a surprise that a deviated septum can affect your smell and taste. But that isn’t always the case. If you have a deviated septum from an injury, it’ll likely hurt. But if you haven’t had a recent blow to the nose, there are other symptoms that may suggest a deviated septum. These symptoms are usually related to congestion and include: 

• Difficulty breathing through one or both sides of the nose for long periods of time

• Nasal stuffiness, congestion, or plugging

• Runny nose

• Post-nasal drainage

• Frequent pain/pressure in the sinuses or ears

• Snoring

• Trouble smelling or tasting

Other issues of a deviated septum

As if the symptoms related to congestion weren’t bothersome enough, a deviated septum can also lead to other issues like: 

• Sinus infections

• Enlarged turbinates: Turbinates are structures in your nose. They help humidify and warm the air that you breathe. They can become swollen when you have a deviated septum.

• Nose bleeds

• Trouble sleeping: This can happen with or without sleep apnea. Sleep apnea is a condition where your breathing is shallow or you stop breathing while you sleep.

• Headaches

Can a deviated septum cause ear problems?

Yes. And it has to do with your eustachian tube. This structure connects your middle ear to the spot where the back of your nose meets your throat. It helps equalize pressure in your middle ear, which is why you may feel your ears “pop” when you fly in an airplane. It also drains your ears and sinuses.

The swelling from a deviated septum can prevent normal drainage of the eustachian tubes and sinuses. If this happens, you may feel ear pain and pressure or get infections in your ears and sinuses.

Treatments for a deviated septum

Treating a deviated septum usually requires a few steps. First your healthcare provider will recommend treatments for your symptoms. You may just need help reducing nasal congestion, which include the following measures:

• Nasal strips: to open nasal valves

• Nasal steroid medications: to treat inflammation, like Flonase (fluticasone) or Nasacort (triamcinolone)

• Antihistamine medications: to treat allergies, like azelastine or fexofenadine 

• Nasal washing or sinus rinses: to clear mucus, particles, and allergens

Your provider may also recommend treatment for other issues a deviated septum causes. One example is pain medication for headaches or ear pain. 

But what if these treatments don’t help? And what if you frequently experience issues like nosebleeds or sinus infections? That’s when surgery may be the next step.

What is a septoplasty?

A septoplasty is a surgical procedure that straightens a deviated septum. It involves reshaping or removing part of the nasal septum to open the nasal passages.

An ear, nose, and throat (ENT) specialist will perform different techniques for each individual. This is because the shape and severity of the septal deviation is also different in each person. 

But a successful septoplasty may not always resolve your symptoms. This is why healthcare teams sometimes combine septoplasty with other surgeries, like:

• Cartilage grafting: You may need extra cartilage to repair your nasal septum. Your surgeon may take a piece of cartilage from your ear or ribs to transfer to your nose.

• Turbinoplasty: This procedure makes enlarged turbinates smaller.

• Rhinoplasty: This cosmetic procedure is also known as a “nose job,” and it changes how your nose looks. Misshapen bones of the nose can cause a deviated septum. So they may need to be reshaped to also fix the deviated septum.

What happens if I don’t treat my deviated septum?

About 80% of people have a deviated septum. But most of them don’t have long-term nasal blockage symptoms. So you may not need other treatment. Or you may only need medications, rinses, or nasal strips to treat your nasal congestion.

But your symptoms may be very bothersome. For example, you may get frequent sinus infections. If this is the case, talk with your primary care provider or your specialist. They will help you pick a treatment that's right for you.

Can I snap my deviated septum into place myself?

If you’re tempted to try to fix your nasal septum by yourself — do not do it. Your nasal septum is so thin that you are likely to put a hole in it or make the deviation worse. It’s connected to other bones in your skull, so it isn’t an easy fix. Plus it can be dangerous.

There are some situations where you should seek treatment right away — like if you have a badly broken nose or a newly deviated septum. This can happen from situations like a sports injury or a car accident. A specialist may be able to realign your nose and nasal septum without making any surgical incisions. This procedure is called a “closed reduction.”

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Written by:

Shane McCarthy, DO

Shane McCarthy, DO, practices full-spectrum family medicine and is board certified through the American Board of Family Medicine. She has over 20 years of experience.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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