Do I need surgery for a deviated septum?

Most people do not. Surgery is considered only when the deviation causes persistent symptoms such as blocked breathing, repeated sinus infections, or sleep problems that have not improved with sprays and allergy management. If you breathe comfortably, a deviated septum found incidentally needs no treatment at all.

What does septoplasty involve and what is recovery like?

Septoplasty is usually done under general anaesthetic through the nostrils, so there are no external cuts or visible scarring. The surgeon trims and repositions the bent cartilage and bone. Most people go home the same day, feel congested for one to two weeks while swelling settles, and are back at work within a week or so, with strenuous activity avoided for a few weeks.

Can a deviated septum cause sleep apnoea?

A deviated septum on its own rarely causes true obstructive sleep apnoea, which involves the throat collapsing during sleep. However, nasal blockage worsens snoring, makes CPAP therapy harder to tolerate, and can add to breathing disruption. Correcting the septum sometimes improves sleep quality and CPAP comfort, even if it does not cure apnoea.

RespiratoryICD-10: J34.2Very common; a large proportion of adults have some degree of septal deviation, most without symptoms

Deviated Septum

Also known as: Nasal septal deviation, Crooked septum

The nasal septum is the thin wall of cartilage and bone that divides the inside of your nose into two passages. In a deviated septum, this wall is off-centre or bent, making one nasal passage narrower than the other. A mild deviation is extremely common and causes no trouble at all; many people have one without knowing. When the bend is more pronounced, it can block airflow, dry out the lining of the nose, cause nosebleeds, and contribute to snoring, sinus infections, and mouth breathing. Some people are born with a deviated septum, while others develop one after a blow to the nose. Treatment ranges from simple measures and nasal sprays to a surgical straightening procedure called septoplasty.

At a Glance

Common symptoms: Blockage of one or both nostrils, often worse on one side, Difficulty breathing through the nose, especially during colds or allergies, Frequent nosebleeds from drying of the nasal lining
Main treatments: Steroid nasal sprays to reduce swelling of the nasal lining and improve airflow, Antihistamines or allergy treatment if allergies add to the congestion, Short courses of decongestant sprays for temporary relief (no more than a few days, to avoid rebound congestion)
Category: Respiratory · Very common; a large proportion of adults have some degree of septal deviation, most without symptoms
See a doctor if: Nasal blockage that affects your sleep, exercise, or daily comfort

Symptoms

Blockage of one or both nostrils, often worse on one side

Difficulty breathing through the nose, especially during colds or allergies

Frequent nosebleeds from drying of the nasal lining

Recurrent or lingering sinus infections

Noisy breathing during sleep, snoring, or sleeping on one particular side to breathe better

Facial pressure or headaches

Awareness of the 'nasal cycle', the normal alternation of congestion between sides

Causes

Being born with a deviated septum, sometimes from pressure during birth
Injury to the nose from sports, falls, car accidents, or fights
Uneven growth of the septum and surrounding bones during childhood and adolescence
Normal ageing, which can worsen an existing deviation as cartilage changes
Swelling of the nasal lining from allergies or infections that makes a mild deviation more obvious

Risk Factors

Contact sports or activities with a risk of facial injury
Previous nasal fracture or nose surgery
Not wearing seat belts or protective headgear
Allergic rhinitis, which amplifies the effect of a narrowed passage
Family history of septal deviation

Diagnosis

Examination of the inside of the nose with a bright light and nasal speculum
Nasal endoscopy with a thin camera to view the whole septum and sinuses
Assessment before and after a decongestant spray to see how much of the blockage is from swelling versus structure
CT scan if sinus disease or surgery is being considered

Treatment

Steroid nasal sprays to reduce swelling of the nasal lining and improve airflow
Antihistamines or allergy treatment if allergies add to the congestion
Short courses of decongestant sprays for temporary relief (no more than a few days, to avoid rebound congestion)
Septoplasty: surgery to straighten and reposition the septum, usually as a day procedure
Rhinoplasty combined with septoplasty (septorhinoplasty) if the outer shape of the nose also needs correction
Supportive: saline rinses to keep the nasal lining moist, nasal strips to open the nostrils during sleep, and a humidifier in dry rooms

Prevention

Wear a helmet or face guard for contact sports and cycling
Always wear a seat belt in vehicles
Treat nasal allergies to keep swelling down
Avoid overusing decongestant sprays, which can worsen congestion over time
Seek assessment promptly after a nose injury, when a displaced fracture can sometimes be reset

When to See a Doctor

Nasal blockage that affects your sleep, exercise, or daily comfort
Frequent nosebleeds or recurrent sinus infections
Loud snoring or pauses in breathing during sleep
Breathing difficulty after a nose injury, or a nose that looks crooked after injury
Symptoms that don't respond to nasal sprays and allergy treatment

Frequently Asked Questions

Related Conditions

Nasal Polyps

Respiratory

Sinusitis

Respiratory

Snoring

Respiratory

Sleep Apnea

Respiratory

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