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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Before any surgery is scheduled, a thorough diagnosis is essential. Doctors do not recommend SMR based on a patient’s description of symptoms alone. They must see the physical blockage to confirm that the septum is indeed the cause of the problem. The diagnostic process is straightforward and typically painless. It involves a visit to an Ear, Nose, and Throat (ENT) specialist, who has the tools and expertise to look deep inside the nasal passages.
The goal of the diagnosis is to map out the anatomy of the nose. The doctor needs to see exactly where the bend is, how severe it is, and if there are other contributing factors like swollen turbinates or polyps. This assessment ensures that the surgery is planned correctly to address the specific issues of the individual patient. It also serves as a time for the patient to ask questions and understand their condition better. The following sections outline the specific tools and tests used during this evaluation.
The initial physical examination is the first step in diagnosing a deviated septum. After discussing your medical history and symptoms, the doctor will ask you to sit in an examination chair. They will start by looking at the outside of your nose. They examine for any external twists or deformities that might suggest an internal problem. They may also press gently on your cheeks and forehead to examine for tenderness that could indicate a sinus infection.
Next, the doctor will look inside your nostrils. To achieve this, they use a bright light, often worn on their head, and a small handheld instrument called a nasal speculum. The speculum gently widens the nostril opening, allowing the light to shine into the front part of the nasal cavity. This process provides a clear view of the anterior, or front, part of the septum. Even with this simple examination, a severe deviation is often immediately visible.
The headlight used by ENT specialists is very bright and focused. It allows the doctor to have both hands free while directing light exactly where they are looking. This aspect is crucial because the inside of the nose is a dark, cavernous tunnel. Without proper illumination, it is impossible to see the structures clearly. The doctor will ask you to tilt your head back slightly so the light can reach deeper into the passage.
The nasal speculum might look somewhat intimidating, but it is not sharp. It is usually made of metal or plastic and functions like a small pair of reverse tongs. When the doctor squeezes the handle, the tips open up. This device gently spreads the nostril rim. It does not hurt, though it might feel a bit strange. This tool is essential for bypassing the small hairs at the entrance of the nose to obtain a detailed look at the mucous membrane and the position of the septum.
Occasionally, the deviation occurs further back in the nose, an area that the standard light and speculum cannot reach. In these cases, the doctor will perform a nasal endoscopy. An endoscope is a thin, rigid, or flexible tube with a tiny camera and light at the tip. This instrument allows the doctor to take a guided tour of the entire nasal cavity, all the way to the back of the throat.
Before inserting the endoscope, the doctor may spray a decongestant and a mild numbing medication into your nose. This makes the procedure comfortable. The scope is then gently inserted. The images from the camera may be projected onto a screen, allowing you to see what the doctor sees. This type of test is the gold standard for diagnosis because it reveals blockages, polyps, or drainage issues that would otherwise be invisible.
The camera provides a magnified view of the internal structures. The doctor can see if the septum is touching the side wall (contact point). They can examine the openings of the sinuses to see if they are blocked by swollen tissue or the deviated septum itself. They can also assess the health of the mucous membrane, looking for signs of chronic inflammation, infection, or allergy.
For the patient, endoscopy is quick, usually taking only a minute or two. While there might be a sensation of pressure or a tickle as the scope moves, it is generally not painful. The numbing spray helps significantly. Afterward, the numbness wears off in about 20 to 30 minutes. This test provides definitive proof of the structural problems and helps the surgeon plan exactly what needs to be corrected.
In straightforward cases of a deviated septum, a physical exam and endoscopy are sufficient. However, if the patient has a history of chronic sinus infections or if the doctor suspects other issues, a CT scan (computed tomography) may be ordered. A CT scan is a specialized X-ray that creates detailed cross-sectional images of the head. It provides a roadmap of the sinuses and the bony structures of the face.
The CT scan is excellent for seeing the bones. It shows the doctor the exact shape of the septum, including the bony parts deep in the skull that are difficult to see with a camera. It also shows if the sinuses are filled with fluid or thickened lining, which confirms chronic sinusitis. This scan is painless and usually takes less than 15 minutes. It is a crucial tool for planning surgery if sinus work is being done at the same time as the SMR.
Subjective feelings of blockage are important, but sometimes doctors want to measure the airflow objectively. While less common than endoscopy, specific tests can measure the resistance of the nasal airway. One such test involves breathing into a mask or a small tube that measures the pressure and flow of air through each nostril.
These tests can help quantify how severe the blockage is. For example, it can show that the left nostril has 80% less airflow than the right. This data can be useful for insurance purposes or to track improvements after surgery. However, in most clinical settings, the visual confirmation of a bent septum and the patient’s report of symptoms are enough to proceed.
A vital part of the diagnosis is the conversation about your general health. The doctor needs to know about any past injuries to the nose, even if they happened years ago. They will ask about your history of allergies, as untreated allergies can mimic or worsen the symptoms of a deviated septum. They will also inquire about medications you are currently taking, especially blood thinners, as these affect surgical planning.
Understanding your lifestyle is also relevant. Do you smoke? Smoking irritates the nasal lining and slows down healing. Do you play contact sports? These activities might influence the timing of the surgery. This holistic review ensures that SMR is the right choice for you and that you are healthy enough to undergo the procedure safely.
Making the most of your diagnostic appointment requires preparation. Write down your symptoms before you go, noting when they are worst and what makes them better or worse. If you have tried nasal sprays or allergy pills, make a list of them so the doctor knows what has failed in the past. Being clear about your goals—whether it is simply breathing better, sleeping better, or having fewer infections—helps the doctor tailor the treatment plan to your needs.
Send us all your questions or requests, and our expert team will assist you.
Most patients feel pressure or a weird sensation, but it is rarely painful. The numbing spray used beforehand is very effective at preventing pain.
A CT scan is needed if the doctor suspects sinus infections deep in the cavities that cannot be seen with the naked eye or the camera.
A general doctor can suspect it using a basic light, but an ENT specialist is needed to fully confirm the diagnosis and inspect the deep internal structure.
The physical exam can show signs of allergies, like pale or blue-tinted lining, but specific allergy testing (skin prick or blood test) is needed to confirm what you are allergic to.
The entire visit, including the exam, endoscopy, and discussion, usually takes about 20 to 30 minutes.
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