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Doctor, my nose seems blocked & bent out of shape, is that bad?

Good morning everyone and TGIF!


Welcome to another Dr Euan's ENT Blogpost!


Today's topic is on nasal septal deviation.


If you're curious to find out more please continue reading below.


Q: What is a deviated nasal septum?

A deviated septum occurs when the thin wall (nasal septum) between your nasal passages is displaced to either one side, left or right. In many normal people, the nasal septum is off-center — or deviated — making one nasal passage smaller, but some people may feel a sense of blockage.


When a deviated septum is severe, it can block one side of the nose and reduce airflow, causing difficulty breathing. The exposure of a deviated septum to the drying effect of airflow through the nose and mucosa may sometimes contribute to crusting or bleeding in certain people.

It is actually common for most people to have a deviated nasal septum to some degree


Q: Why is my nasal septum deviated / not straight?

A deviated septum occurs when your nasal septum — the thin wall that separates your right and left nasal passages — is displaced to one side, either left or right.


A deviated septum can be caused by:

  • A condition present at birth. In some cases, a deviated septum occurs when the fetus develops in the womb and is apparent at birth.

  • Injury to the nose. A deviated septum can also be the result of an injury that causes the nasal septum to be moved out of position. In infants, such an injury may occur during childbirth as the head is squashed as the baby moves through the birth canal. In children and adults, a wide array of accidents may lead to a nose injury and deviated septum. Trauma to the nose most commonly occurs during contact sports such as rugby, boxing, rough play such as wrestling, or automobile accidents.

  • The ageing process may affect nasal structures, worsening a deviated septum over time.

  • Swelling and irritation of the nasal cavities or sinus cavities due to an infection can further narrow the nasal passage and result in more nasal obstruction.

Q: Does a deviated nasal septum have to be corrected?

Most septal displacements result in no symptoms, and most people may not even know that they have a deviated septum. So in most cases, a deviated nasal septum can be left alone. However, if the degree of deviation is severe, you may begin to experience some symptoms of nasal blockage.


Q: What effects can deviated nasal septum have?

Some septal deformities may cause the following signs and symptoms:

  • Obstruction of one or both nostrils. This blockage can make it difficult to breathe through the nostril or nostrils. You may notice this more when you have a cold or allergies that can cause your nasal mucosa to swell and narrow the air passage in your nose.

  • Nosebleeds. The mucosal surface of your nasal septum may become dry, increasing your risk of nosebleeds. You can read about Dr Euan's advice on nosebleeds here.

  • Facial pain. There is still debate about the possible nasal causes of facial pain. A possible cause of one-sided facial pain could be a severe deviated septum in which surfaces within the nose touch and cause pressure. This is called "Sluder's Neuralgia".

  • Noisy breathing during sleep. A deviated septum or swelling of the tissues in your nose can be one of the many reasons for noisy breathing / snoring during sleep. If you would like to know more about how airway blockages can affect sleep and cause snoring, you can read Dr Euan's advice on Obstructive Sleep Apnoea (OSA).

  • Awareness of the nasal cycle. The nose alternates between being obstructed on one side, and then changes to being obstructed on the opposite side throughout the day and night. This is called the "Nasal Cycle". Being aware of the nasal cycle is not common and may indicate nasal obstruction.

  • Preference for sleeping on a particular side. Some people may prefer to sleep on a particular side to optimise breathing through the nose at night if one side is narrowed.

Complications of Nasal Septal Deviation

A severely deviated septum causing nasal blockage can lead to:

  • Dry mouth & throat, due to chronic mouth breathing

  • A feeling of pressure or congestion in your nasal passages

  • Disturbed sleep, due to the discomfort of not being able to breathe comfortably through your nose at night

There were previous studies on nasal airway blockage using Rhinomanometry, a machine with a probe fitted to your nose to measure airflow. Acoustic rhinometry and rhinomanometry can be used to assess nasal airway patency objectively.


For example, a study compared nasal obstruction symptoms before and after decongestion with several parameters of these objective tests. The patients assessed their nasal obstruction using a visual analogue scale (VAS).


The study results seem to show NO co-relation between a patient's sense of nasal blockage (VAS score) and the Rhinomanometry findings. In other words, the sensation of nasal blockage can be very subjective.


Nasal congestion can be caused by a mix of several nasal issues, which includes a deviated nasal septum. If you would like to know more about potential causes for a stuffy or running nose, you can read Dr Euan's advice on Sinusitis, Nasal Sprays, Dustmite Allergies, and Nasal Turbinates.


Possible treatment options for structural nasal blockage

Doctors may perform a Nasoendoscopy to inspect the nasal cavity for septal deviation


Q: What is septoplasty?

A crooked septum is common. But when it's severe, a deviated septum can block one side of your nose and reduce airflow, causing difficulty breathing through one or both sides of your nose.


Septoplasty straightens the nasal septum by trimming, repositioning and replacing cartilage, bone or both in the nose.


If you experience symptoms — such as difficulty breathing through your nose — that affect your quality of life, you may consider surgery to fix a deviated septum.


What are the risks?


As with any major surgery, septoplasty carries risks, such as bleeding, infection and an adverse reaction to the anaesthetic.


Other possible risks specific to septoplasty include:

  • Continued symptoms, such as nasal obstruction

  • Excessive bleeding

  • A change in the shape of your nose

  • A hole in the septum

  • Decreased sense of smell

  • Clotted blood in the nasal space that has to be drained

  • Temporary numbness in the upper gum, teeth or nose

You may need additional surgery to treat some of these complications. You may also need additional surgery if the outcome of septoplasty doesn't match your expectations.


What you can expect:


Septoplasty straightens the nasal septum by trimming, repositioning and replacing cartilage or bone. The surgeon works through incisions inside the nose. Occasionally it is necessary to make a small incision between the nostrils.


If the nasal bones are crooked and pushing the septum off to one side, it may be necessary to make cuts in the bones of the nose to reposition them. Spreader grafts are small, reinforcing strips of cartilage that can be used to help correct a deviated septum when the problem is along the bridge of the nose. Sometimes these are necessary to effectively straighten the septum.


After the procedure


To decrease the chances of bleeding and swelling, you should follow these precautions for several weeks after surgery. Depending on the extent of your surgery, you may do some or all of these:

  • Elevate your head when you're sleeping.

  • Don't blow your nose for several weeks.

  • Wear clothes that fasten in the front; don't pull clothing, such as shirts or sweaters, over your head.

  • Avoid strenuous activities, such as aerobics and jogging, for up to five weeks to avoid potentially causing a nosebleed.

Results of Septoplasty:


By three to six months after surgery, your nasal tissues will be relatively stable but it is still possible that cartilage and tissue may gradually move or reshape over time. Some changes can still occur for up to a year or more after surgery.


Most people find that septoplasty improves their symptoms, such as difficulty breathing, that were caused by a deviated septum. The level of improvement you can expect with septoplasty varies by person.


Some people find that their symptoms continue even after surgery and opt to undergo a second septoplasty to further refine the nose and septum.



Thank you for reading! I hope you found it interesting.


The blog will be taking a break for the December holidays, and will resume again in January.


Have a good Holiday!


Thanks

Dr Euan


If you would like to assess for a deviated nasal septum, or seek consultation for any other ENT issues, please feel free to contact us at Euan's ENT Surgery & Clinic to book an appointment.


References:

10. Stewart MG Witsell DL Smith TL Weaver EM Yueh B Hannley MT

Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004; 130: 157-163


11. van Zijl FVWJ Timman R Datema FR

Adaptation and validation of the Dutch version of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Eur Arch Otorhinolaryngol. 2017; 274: 2469-2476


12. Lodder WL Leong SC

What are the clinically important outcome measures in the surgical management of nasal obstruction?. Clin Otolaryngol. 2018; 43: 567-571



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