The nasal septum is the wall between the left and right sides of the nose. It is firm, but bendable, and it is covered by skin that has a rich supply of blood vessels. Ideally, the nasal septum should lie exactly in the center, so that the left and right sides of the nose are of equal size. In about 80% of us, however, the nasal septum is a little off-center, although most of us never notice. Less often, the septum is more dramatically off-center. This is called a deviated septum.

In people who have a deviated septum, one side of the nose is wider than normal and one is narrower. This alters the pattern of airflow in the nose and sometimes blocks the narrowed side. In some cases, sinus openings can be blocked, triggering a sinus infection (sinusitis) that lasts a long time or keeps returning. The altered airflow pattern within the nose can cause the skin of the nasal septum to become dry and cracked, which can cause frequent nosebleeds.

Some people are born with a deviated septum because the nose developed that way before birth. More often, however, a deviated septum is caused by injury to the nose during birth. Later in life, a deviated septum can be caused by trauma, although adults and teenagers often cannot remember the injury that caused the problem. In most cases, however, it was probably a blow to one side of the nose � often during contact sports, playground games, or a traffic accident � that knocked the nasal septum out of position.

Symptoms of a deviated septum can include:

• Blockage of one or both nostrils
• Nasal congestion, sometimes on one side
• Frequent nosebleeds
• Frequent sinus infections
• Facial pain, headaches, postnasal drip
• Noisy breathing during sleep in infants and young children

In some cases, a person with a mildly deviated septum has symptoms only when they also have a cold or other upper respiratory tract infection. In these people, the respiratory infection causes nose tissues to swell, which can make airflow problems worse. Once the cold goes away, the symptoms of a deviated septum often go away, too.

After reviewing your symptoms, the doctor will ask you whether you have ever broken or severely injured your nose and whether you have ever had nasal surgery. Your doctor will look at your nose and the position of your nasal septum. Your doctor will use a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril. The lining tissues of the nose may be temporarily shrunken by use of Afrin or Neosynephrine nasal spray to get a better look at the entire septum. Sometimes a fiberoptic scope will be inserted in the nose to look at the posterior septum directly. In most cases, you will not need any special tests.

If your deviated septum is causing troublesome nosebleeds, repeated sinus infections or other significant problems, then your primary care doctor will refer you to an otolaryngologist (ear, nose and throat specialist) or plastic surgeon for treatment.

A person with a mildly deviated septum may have symptoms only during an upper respiratory tract infection. Someone with a more severe deviation may develop chronic sinusitis or recurring nosebleeds that will last until the problem is corrected surgically.

You can help to prevent a deviated septum by avoiding injury to your nose. To do this, wear seat belts and shoulder harnesses whenever you ride in a car and wear well-fitting headgear to protect your face during contact sports, such as football or karate.

If you have a deviated septum, you will need a type of surgery called septoplasty. In this procedure, the surgeon will move your septum to a normal position. In some cases, the surgeon also will reshape the external appearance of your nose in a procedure called rhinoplasty. When the two procedures are done at the same time, the surgery is called a septorhinoplasty.

If your child has a deviated septum, the doctor may wait until your child's nose has finished growing before doing surgery. In most cases, this is not until age 15 or 16. Boys usually need to wait a little longer than girls because they finish growing a little later.

Make an appointment to see your doctor if you keep having nosebleeds or if you have a blocked nostril or a sinus infection that does not respond to treatment after two to three weeks.

Call your doctor immediately if your nose is injured and you think your septum may have been knocked out of position.

In the most cases, surgery is successful. However, a small percentage of patients choose to have a second surgery for cosmetic reasons or to improve airflow.

National Institute of Allergy and Infectious Diseases (NIAID)
Office of Communications & Public Liaison
6610 Rockledge Drive, MSC6612
Bethesda, MD 20892-6612
Phone: 301-496-5717
http://www.niaid.nih.gov/

American Academy of Otolaryngology � Head and Neck Surgery
One Prince St.
Alexandria, VA 22314-3357
Phone: 703-836-4444
Email: info@entnet.org
http://www.entnet.org/

American Academy of Oral and Maxillofacial Radiology
P.O. Box 1010
Evans, GA 30809-1010
Phone: 706-721-2607
http://www.aaomr.org/

American Society of Plastic Surgeons
444 E. Algonquin Road
Arlington Heights, IL 60005
Toll-Free: 1-888-475-2784
http://www.plasticsurgery.org/

American Rhinologic Society
C/O Marvin P. Fried, M.D.
Montefiore Medical Center
Department of Otolaryngology
3400 Bainbridge Ave.
MAP 3rd Floor
Bronx, NY 10467
Email: info@american-rhinologic.org
http://www.american-rhinologic.org/