Otorhinolaryngology focuses on the ear, nose, and throat. Learn about the diagnosis and treatment of hearing loss, sinusitis, tonsillitis, and voice disorders.
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Once a deviated septum is confirmed as the source of your breathing troubles, the conversation shifts to treatment. There is no universal approach to treating a deviated septum. It ranges from conservative management with medications to surgical intervention. The decision depends on the severity of your symptoms and how much the condition affects your daily life.
This section details the various paths you can take. We will start with non-surgical options that can help manage mild symptoms. Then, we will provide an in-depth look at the surgical procedure (SRP) itself, explaining what happens in the operating room. We will also discuss common additional procedures often done at the same time, like turbinate reduction. Understanding the risks, benefits, and the role of medication helps you and your doctor choose the right strategy for your health.
For some patients, surgery is not immediately necessary. If the deviation is mild, or if the symptoms are only bothersome during allergy season, non-surgical management is the first line of defense. The goal here is not to correct the crooked bone but to reduce the swelling of the tissues lining the nose. When the lining is less swollen, the airway opens up, even if the septum is still crooked.
Steroid nasal sprays are commonly prescribed to reduce inflammation. Antihistamines and decongestants can also help manage symptoms caused by allergies. Saline rinses or irrigation bottles are excellent for keeping the nose clean and reducing congestion. While these treatments cannot straighten the septum, they can sometimes provide enough relief that surgery can be delayed or avoided. However, for patients with a severe mechanical blockage, these measures often provide only temporary or partial relief.
If medical management fails, the Septal Reconstruction Procedure (septoplasty) is the definitive treatment. This surgery is typically performed on an outpatient basis, meaning you go home the same day. It is usually done under general anesthesia. The surgeon makes a small incision inside the nostril to lift the mucous membrane covering the septum.
Once the cartilage and bone are exposed, the surgeon carefully removes the parts that are bent or deviated. In some cases, they may reshape the cartilage and place it back into the nose to provide support.
After the septum is straightened, the mucous membrane is laid back down. The surgeon uses dissolvable stitches to close the incision. Sometimes, soft silicone splints are placed inside the nose to hold the septum straight while it heals. These splints are temporary and are usually removed within a week.
It is very common for a septoplasty to be combined with a turbinate reduction. The turbinates are structures on the side walls of the inside of the nose. When the septum is deviated to one side, the turbinate on the opposite (open) side often grows larger to fill the space. This type of growth is called compensatory hypertrophy. If the surgeon only fixes the septum, this enlarged turbinate might still block the airway.
Turbinates are made of bone and soft tissue. Their job is to warm and humidify air. However, when they become chronically swollen, they obstruct breathing.
During the surgery, the surgeon can shrink the size of these turbinates. This can be done by removing a small amount of bone or by using radiofrequency energy to shrink the tissue. Combining this with septal correction maximizes the airway space on both sides of the nose.
Septoplasty is a routine and safe procedure, but like all surgeries, it carries some risks. Bleeding is the most common risk, though severe bleeding is rare. Infection is also a possibility, but antibiotics are often given to prevent this. Some patients may experience a temporary numbness in the upper teeth or lip, as the nerves in the nose are connected to these areas.
A septal perforation, which is a small hole in the septum, is a rare but specific risk. This can happen if the membrane is torn on both sides during surgery. Small perforations usually cause no symptoms, but larger ones might cause crusting or a whistling sound when breathing. Revision surgery is occasionally needed if the deviation persists or returns, though satisfaction rates for the primary surgery are very high. Discussing these risks with your surgeon ensures you are fully informed.
Medications play a crucial role both before and after the treatment. Before surgery, your doctor may ask you to stop taking blood-thinning medications, such as aspirin or ibuprofen, to reduce the risk of bleeding. You might also be prescribed a course of antibiotics or steroids to reduce infection and inflammation before the operation begins.
After surgery, pain management is key. Most patients are prescribed mild pain relievers for the first few days. Antibiotic ointment is often applied inside the nose to prevent infection and keep the area moist. Saline sprays are universally recommended to wash away crusts and blood clots, which speeds up healing. Following the medication schedule strictly is a major part of a smooth recovery.
Deciding between continued medical management and surgery is a personal choice. If your symptoms are mild and manageable with a daily spray, surgery might not be worth the downtime. However, if your breathing issues are affecting your sleep or your ability to exercise, or are causing frequent sinus infections, surgery is often the best path to long-term health.
Your doctor will help guide this decision by reviewing your CT scans and airflow tests. They will weigh the severity of the structural problem against your lifestyle and general health. The goal is to choose the option that provides the most relief with the least risk. Remember, the “right” time for surgery is when the symptoms significantly interfere with your quality of life.
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Usually, no. Since septoplasty is done internally and does not break the nasal bones, black eyes are rare unless rhinoplasty is also performed.
If splints are used, they are typically removed by the doctor at your first follow-up appointment, usually five to seven days after surgery.
No, because you will be under general anesthesia, you must have a friend or family member drive you home and stay with you for the first night.
You will likely need saline sprays immediately after surgery. You should ask your doctor when to stop or restart other medicated sprays.
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