Nasal Septum Deviation

Diagnosis
During your visit, your doctor will first ask about any symptoms you may have.

To examine the inside of your nose, the doctor will use a bright light and sometimes an instrument (nasal speculum) designed to spread open your nostrils. Sometimes the doctor will check farther back in your nose with a long tube-shaped scope with a bright light at the tip. The doctor may also look at your nasal tissues before and after applying a decongestant spray.

Based on this exam, he or she can diagnose a deviated septum and determine the seriousness of your condition.

If your doctor is not an otolaryngologist (ear, nose and throat specialist) and treatment is deemed necessary, you may be referred to a specialist for further consultation and treatment.

Treatment
Managing symptoms
Initial treatment of a deviated septum may be directed at managing the symptoms of the tissues lining the nose, which may then contribute to symptoms of nasal obstruction and drainage. Your doctor may prescribe:

Decongestants. Decongestants are medications that reduce nasal tissue swelling, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray. Use nasal sprays with caution, however. Frequent and continued use can create dependency and cause symptoms to be worse (rebound) after you stop using them. Decongestants have a stimulant effect and may cause you to be jittery as well as elevate your blood pressure and heart rate.
Antihistamines. Antihistamines are medications that help prevent allergy symptoms, including obstruction and runny nose. They can also sometimes help nonallergic conditions such as those occurring with a cold. Some antihistamines cause drowsiness and can affect your ability to perform tasks that require physical coordination, such as driving.
Nasal steroid sprays. Prescription nasal corticosteroid sprays can reduce inflammation in your nasal passage and help with obstruction or drainage. It usually takes from one to three weeks for steroid sprays to reach their maximal effect, so it is important to follow your doctor's directions in using them.
Medications only treat the swollen mucus membranes and won't correct a deviated septum.

Surgical repair (septoplasty)
If you still experience symptoms despite medical therapy, you may consider surgery to correct your deviated septum (septoplasty).

Septoplasty is the usual way to repair a deviated septum. During septoplasty, your nasal septum is straightened and repositioned in the center of your nose. This may require your surgeon to cut and remove parts of your septum before reinserting them in the proper position.

The level of improvement you can expect with surgery depends on the severity of your deviation. Symptoms due to the deviated septum — particularly nasal obstruction — often completely resolve. However, any accompanying nasal or sinus conditions affecting the tissues lining your nose — such as allergies — can't be cured with only surgery.

Reshaping your nose
In some cases, surgery to reshape the nose (rhinoplasty) is performed at the same time as septoplasty. Rhinoplasty involves modifying the bone and cartilage of your nose to change its shape or size or both.

Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred directly to an ear, nose and throat specialist.

Your time with your doctor is limited, so preparing for the doctor's questions to you as well as for your questions to the doctor can help you make the most of your time together. For a deviated septum and its complications, some questions your doctor may ask you include:

How long has your nasal obstruction been present?
How much of the time are you aware of the nasal obstruction?
Is one side of your nose worse than the other?
Is the obstruction mild, moderate or severe?
Have you had any trauma to your nose?
Do you have allergies affecting your nose?
Do you have a decreased sense of smell?
Do you have problems with sinusitis?
Do you have nosebleeds?
Is there anything else that makes the obstruction worse?
Is there anything you do that relieves the symptoms?
What medications have you used previously for this?
What medications are you currently taking for this?
Does decongestant spray help?
Are you currently using decongestant spray every day?
Does placing a nasal adhesive strip help?
Is your nasal obstruction worse when you are lying down?
Have you had any nasal surgery?
Some basic questions you might ask your doctor include:

What is likely causing my symptoms or condition?
What is the best course of action?
What are the alternatives to the primary approach that you're suggesting?
I have these other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a specialist?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask further questions during your appointment.