DEVIATED NASAL SEPTUM

Singapore's humid climate can often aggravate nasal issues like allergies or sinusitis, making early recognition of a deviated septum crucial. While many people have some degree of deviation, a more pronounced curvature can cause breathing difficulties, snoring, sinus infections, or poor sleep. Being aware allows you to seek timely evaluation and treatment from a specialist.

What Is a Deviated Nasal Septum?

Picture a thin wall that divides your nasal passages, like a centre line running down a road; that is the nasal septum. Ideally, it evenly divides your nose into equal passages. However, if this line swerves to one side, making one passage narrower, you have a deviated septum.

What Are the Causes of Deviated Nasal Septum?

Understanding whether a deviated septum is congenital or acquired helps guide treatment, especially when symptoms such as breathing difficulty or nasal congestion persist.

A condition present from birth

Some people are born with a deviated nasal septum due to irregular development in the womb. The septum may shift during foetal growth or result from a challenging delivery, especially in cases involving prolonged labour or the use of delivery instruments. This type of deviation is typically noticed early in life and may worsen as the face matures.

Acquired Conditions

 Trauma to the face is a common cause of septal displacement. Whether from falls, contact sports, accidents, or physical altercations, even minor impacts can lead to misalignment, particularly in children with their more delicate nasal structures. Additionally, age-related changes in cartilage and bone may subtly shift the septum over time, even without obvious injury. This gradual drift can slowly impair nasal airflow.

Signs & Symptoms of a Deviated Nasal Septum

A deviated nasal septum often goes undetected. A majority of people with this condition do not experience any noticeable symptoms. However, if your deviated nasal septum is more pronounced, you might observe:

• Difficulty Breathing – like trying to inhale through a straw due to blocked nostrils. This is especially noticeable when a cold or allergies cause your nasal passages to swell.

• Frequent Nosebleeds – provoked by the drying out of the skin over the nasal septum.

• Noisy Breathing While Sleeping – because of the turbulent airflow through the nose in the presence of a deviated septum

• A Particular Sleeping Preference – favouring one side to breathe more comfortably, given the narrowing of one nasal passage

• Facial Pain – can cause uneven airflow through the nasal passages, leading to pressure build-up in one or both sides of the face.

How Is a Deviated Nasal Septum Diagnosed?

Diagnosis typically begins with a thorough consultation and physical examination. Using a nasal speculum, your doctor will first check for visible signs of septal deviation and assess the condition of your nasal passages.

To get a more detailed view, especially if symptoms are significant or the deviation isn't clearly seen during the initial exam, a nasal endoscopy may be performed. This involves inserting a thin, flexible tube with a light and camera (endoscope) into your nose. It allows your ENT specialist to examine deeper areas of the nasal cavity and better evaluate the extent of deviation, any associated swelling, or other existing conditions like polyps or sinus drainage issues.

This in-clinic procedure is quick, well-tolerated, and provides valuable insight to guide treatment decisions.

What Are the Treatment Options for Deviated Nasal Septum?

We may first prescribe medications for symptom relief:

• Decongestants to reduce swelling in your nasal tissue

• Antihistamines to prevent allergy symptoms

• Nasal steroid sprays reduce swelling in your nasal passage and help with drainage

Please note, these won't correct a deviated nasal septum but may reduce the symptoms. If medications do not help, you might need surgery.

• Septoplasty - When medical management isn't enough to alleviate your nasal symptoms, you might consider a surgical procedure known as Septoplasty. This procedure involves the meticulous straightening and repositioning of your nasal septum. The level of improvement you can expect is directly related to the severity of your septum deviation. Complete relief from symptoms like nasal obstruction is possible. However, it's important to note that Septoplasty alone cannot cure other nasal or sinus conditions affecting your nose, such as allergies.

• Septorhinoplasty - When your external nasal structure contributes to nasal obstruction and septum deviation, a different surgical procedure, known as septorhinoplasty, might be recommended. This involves modifying your nose's external bones and cartilage to change its shape or size.

What Are the Complications of a Deviated Nasal Septum?

A mildly deviated septum may not cause any problems. But when the deviation is more severe, it can lead to several complications, including:

• Dry mouth

• Snoring and noisy breathing during sleep

• Magnified sleep apnoea symptoms

• Frequent nosebleeds

• Reduced sense of smell

Can You Prevent a Deviated Nasal Septum?

Not all cases of a deviated septum can be prevented, as some are present from birth or develop during early facial growth. However, the risk of acquiring a deviated septum due to trauma can be reduced by taking appropriate safety precautions. These include wearing protective equipment—such as facial guards or helmets—during contact sports and always using a seatbelt while in a vehicle.

Dr Valerie Tay
Senior Consultant ENT Surgeon
MBBS (S’pore), MRCS (Edin), MMed (ORL), FAMS

Dr Valerie Tay is a Senior Consultant ENT Surgeon in Singapore with a strong focus on nasal conditions such as deviated nasal septum, allergic rhinitis and sinus conditions. She frequently manages complex nasal obstruction that stems from nasal septal deviation. Beyond clinical work, Dr Tay has played a significant role in shaping ENT training as a former President of the ENT Society and core faculty member of the National Health Group (NHG) residency programme. She continues to share her expertise through workshops and conferences to advance patient care in the field.