A deviated septum is a common structural condition where the thin wall of bone and cartilage separating the nasal passages is misaligned. This crooked structure, which can occur from birth or an injury, often leads to one nasal airway being narrower than the other. While the structural misalignment cannot be physically corrected without a surgical procedure, the uncomfortable symptoms it causes, such as chronic congestion and difficulty breathing, can frequently be managed and relieved through non-surgical methods. These conservative treatments aim to reduce the soft tissue swelling in the nasal passages, thereby widening the available breathing space.
What a Deviated Septum Is
The nasal septum is the dividing wall inside the nose, composed of a combination of bone and cartilage, extending from the nostrils to the back of the throat. Ideally, this wall sits centrally, creating two symmetrical nasal cavities for airflow. A deviated septum occurs when this partition is substantially pushed away from the midline, causing an obstruction in one or both passages. This physical obstruction restricts the flow of air, leading to several bothersome symptoms. Common complaints include persistent difficulty breathing through the nose, chronic nasal congestion, facial pressure, and frequent nosebleeds. The deviation can also contribute to noisy breathing during sleep, snoring, or sleep apnea.
Managing Symptoms Without Operation
For many people, the symptoms of a deviated septum are mild enough to be effectively managed using targeted medical therapies and simple aids. These treatments focus on reducing inflammation and clearing the nasal passages to maximize the space around the physical obstruction.
Nasal Sprays and Medications
Nasal corticosteroid sprays are frequently the first line of treatment, working directly on the nasal lining to reduce swelling and inflammation. These medications contain corticosteroids that inhibit the release of inflammatory substances, which helps to shrink the soft tissue surrounding the septum. Consistent daily use is necessary, as it can take two weeks or more for the full anti-inflammatory effect to be achieved.
Decongestant medications, available as oral pills or nasal sprays, offer quick relief by constricting the blood vessels in the nasal lining. This vasoconstriction rapidly shrinks the swollen tissues, temporarily opening the nasal passages and improving airflow. It is important to limit the use of topical decongestant sprays to no more than three to five days. Prolonged use can lead to rhinitis medicamentosa, or rebound congestion, which causes worse swelling when the medication is stopped.
Saline Rinses and External Aids
Saline nasal sprays and irrigation methods, such as using a Neti pot, are simple but effective physical treatments. Rinsing the nasal passages with a sterile saline solution helps to flush out thick mucus, allergens, and irritants. This process improves the function of the cilia, helping to clear the airway and reduce irritation.
External nasal aids provide mechanical relief without medicine by physically altering the shape of the external nose. External nasal dilator strips adhere to the bridge of the nose and use spring-like tension to gently pull the nostrils open. This action widens the nasal valve area, mechanically improving the airway opening and making it easier to breathe, particularly during sleep or exercise.
Why Non-Surgical Methods Do Not Correct Deviation
While non-surgical methods successfully provide symptom relief, they are fundamentally limited because they address only the soft tissue component of the nasal obstruction. The septum itself is a fixed structure made of bone and cartilage that cannot be physically reshaped or moved by any medication. Medications like corticosteroid sprays only target the inflamed nasal mucosa, which is the soft, moist lining that covers the nasal septum and turbinates. By reducing this inflammation, they decrease the soft tissue swelling that contributes to the blockage, but the underlying skeletal framework remains crooked. The deviation is a structural problem, and no amount of anti-inflammatory drug or decongestant can dissolve or remodel the bone and cartilage structure. The only exception to this rule is in the case of a very recent injury, where a healthcare provider might be able to manually reposition the septum immediately after the trauma; otherwise, the structural defect is permanent without surgical intervention.
When Septoplasty Is Recommended
The decision to move from symptom management to surgical correction is reserved for cases where non-surgical methods fail to provide adequate relief. Septoplasty, the procedure used to correct a deviated septum, is recommended when the structural issue severely impairs a person’s quality of life. Primary indications include persistent nasal obstruction that is refractory to medical therapy, meaning congestion continues despite consistent use of sprays and aids. Surgery is also considered when the deviation leads to recurring complications, such as frequent nosebleeds, recurrent sinus infections, or significant sleep disturbances like snoring or obstructive sleep apnea. Septoplasty involves surgically repositioning or removing the bent portions of the septum to straighten the wall, restoring symmetry and permanently correcting the underlying structural defect. This procedure is the only way to permanently correct the underlying structural defect and improve airflow within the nose.