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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Recognizing the need for medical intervention usually begins with identifying persistent and bothersome symptoms. A deviated septum or structural blockage in the nose does not always present itself with sudden pain. Instead, it often manifests as a chronic, low-grade annoyance that slowly degrades a person’s quality of life. Patients often adapt to their limited breathing over years, not realizing how much better they could feel. The symptoms can range from simple stuffiness to complex sleep issues and frequent illnesses.
Understanding the causes is equally important. Knowing why the nasal passage is blocked helps patients understand that it is a physical, structural issue rather than a temporary illness like a cold or flu. Structural problems generally do not resolve on their own with time or medication. They require a physical correction. This section explores the common signs that indicate a need for SMR and explains the underlying reasons why the nasal septum might become deviated or damaged in the first place.
The most common complaint from patients requiring SMR is a feeling of constant blockage. This is not the same as the congestion you experience from a cold, which goes away after a week. This blockage is persistent and lasts for months or years. Patients often describe it as trying to breathe through a narrow straw. It requires more effort to pull air in, which can be exhausting. This obstruction can affect one side of the nose or both sides, depending on how the septum is bent.
Occasionally the blockage switches sides. This is known as the nasal cycle. It is normal for the nose to alternate congestion between sides throughout the day, but for someone with a deviated septum, the cycle feels much more extreme. When the nasal cycle shifts to the narrow side, the blockage can feel complete and overwhelming. This makes the person breathe through their mouth, which is not the best way to breathe. Mouth breathing can lead to other issues, such as dry mouth and dental problems.
In many cases of a deviated septum, the wall is pushed significantly to one side. This creates a large, open passage on one side and a very tight, narrow passage on the other. The patient will often notice that one nostril always feels free, while the other is useless for breathing. They may sleep only on one side to try and open the airway, or they may constantly pull on their cheeks to manually open the nose’s valve. This unilateral, or one-sided, blockage is a classic sign of a structural deviation.
Some patients feel congested on the side that appears wide open. This happens because the turbinates, which are structures on the side walls of the nose, swell up to fill the extra space created by the deviation. This procedure is the body’s attempt to normalize airflow, but it often backfires, causing blockage on the wide side as well. This phenomenon can be confusing for patients who feel blocked on both sides, even if the septum is only bent to one side.
Breathing difficulties often become much worse at night. When you lie down, gravity causes the blood vessels inside the nose to swell slightly, increasing congestion. For someone with a deviated septum, this extra swelling can make nasal breathing impossible. As a result, the person is forced to breathe through their mouth while sleeping. This leads to loud, noisy breathing and snoring. Snoring caused by a deviated septum is the sound of air struggling to pass through a restricted airway.
While a deviated septum alone is not always the sole cause of sleep apnea, it can certainly contribute to it. Sleep apnea is a serious condition where breathing stops and starts during sleep. A blocked nose adds resistance to the airway, making the lungs work harder. Treating the septum with SMR can improve the effectiveness of other sleep apnea treatments, such as CPAP machines, by allowing the pressurized air to enter the nose more easily. Better nasal breathing generally leads to deeper, more restful sleep.
People with untreated septal deviations often wake up feeling unrefreshed. Because they have been mouth-breathing all night, they may wake up with a severe dry mouth, a sore throat, or chapped lips. They may also have a headache immediately upon waking. This is due to the strain of struggling to breathe and poor oxygenation during the night. Starting the day feeling worn out and dehydrated is a common frustration for these patients.
The symptoms of a deviated septum affect not just the patient but also their sleeping partner. Loud snoring and restless tossing and turning can disrupt the sleep of others in the household. Correcting the nasal obstruction often brings relief to the entire family, restoring quiet and peace to the bedroom environment.
The sinuses are air-filled pockets located in the forehead, cheeks, and behind the eyes. They are lined with the same mucous membrane as the nose. Normally, mucus drains from the sinuses into the nose and is swallowed. However, a deviated septum can physically block the drainage pathways of the sinuses. When the drainage path is blocked, mucus becomes trapped inside the sinus cavities.
Stagnant mucus is a breeding ground for bacteria. This leads to sinus infections, also known as sinusitis. Patients with a deviated septum may suffer from frequent infections that take a long time to heal. They may experience facial pain, pressure around the eyes, and thick yellow or green discharge. If a person gets sinus infections three or four times a year or has a chronic low-grade infection that never seems to go away, a structural blockage like a deviated septum is often the culprit.
A deviated septum can alter the way air moves through the nose. Instead of flowing smoothly, the air may become turbulent, swirling around the bent cartilage. This concentrated airflow can dry out a specific spot on the nasal lining. The mucous membrane needs moisture to stay healthy. When it becomes overly dry, it becomes crusty and fragile.
This fragility often leads to nosebleeds. The skin over the most bent part of the septum becomes thin and cracks easily. Minor bumps, sneezing, or even just blowing the nose can cause the vessel to burst and bleed. Frequent, unexplained nosebleeds are a common symptom that brings patients to the doctor. In addition to bleeding, the sensation of constant dryness and crusting inside the nose can be very uncomfortable and irritating.
When the inside of the nose is crowded, structures can press against each other. The deviated septum may press into the side wall of the nose or the turbinates. These areas are rich in nerves. This constant physical contact, known as contact points, can trigger pain signals. Patients may feel a dull ache across the bridge of the nose, in the cheeks, or even in the forehead.
This type of facial pain is often mistaken for a tension headache or a sinus headache. The pain might become worse when the nose is congested due to allergies or a cold, as the swelling increases the pressure at these contact points. SMR surgery can relieve this pain by creating space between the structures, eliminating the pressure that triggers the nerves.
Understanding why the septum is deviated helps patients realize it is not their fault. There are two main categories of causes: congenital and traumatic. Congenital causes mean that the person was born with the deviation or it developed naturally as they grew. As the face develops from childhood to adulthood, the nasal septum grows. Occasionally, the septum grows faster than the facial bones around it. With nowhere to go, the cartilage buckles and bends, creating a deviation.
Traumatic causes involve injury. A broken nose is a very common cause of a deviated septum. This condition could happen from a sports injury, a car accident, a fall, or even a bump to the nose during childhood that was forgotten. The force of the impact can fracture the cartilage or bone and shift it out of position. Once it heals in that crooked position, it stays that way permanently until corrected by surgery.
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No, allergies cannot cause the bone or cartilage to bend. However, allergies cause swelling that makes the symptoms of a deviated septum feel much worse.
It can be. The way your face and nose grow is determined by your genetics, so it is possible to inherit the tendency for a crooked septum from your parents.
The bone structure typically does not change much after adulthood. However, the symptoms can get worse as tissues age and become less elastic, or if allergies worsen.
Not always. A minor bump might cause swelling that goes away. However, a strong impact that breaks the nose often shifts the septum out of place.
Lying down increases blood flow to the head, causing normal swelling in the nose. If your passages are already narrow from a deviation, this small amount of swelling blocks them completely.
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