Specialties · Rhinology
Deviated septum: when to operate
A deviated septum is a displacement of the wall that separates the two nostrils, and it can leave the nose persistently blocked on one side or both. Not every deviation needs surgery: the indication depends on the impact on breathing and on the response to medical treatment. Assessment includes consultation and, where needed, nasal endoscopy.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
What is a deviated nasal septum?
The nasal septum is the thin wall of cartilage and bone that divides the nose into two nostrils. When that wall is not straight, there is a septal deviation. It may be present from birth, develop as the face grows during adolescence, or follow an injury to the nose.
Having a deviation is the rule, not the exception. What determines whether it is a problem is not the image, but how much it interferes with breathing.
What are the signs that a deviation is causing trouble?
- A blocked nose that does not clear, on one side or alternating between sides.
- Difficulty breathing through the nose when lying down or during exercise.
- Dry mouth on waking, restless sleep and snoring.
- Recurrent sinusitis and a feeling of pressure in the face.
- Frequent nosebleeds, consistently from the same side.
How is the diagnosis made at Clínica Rhinus?
The consultation begins with the history — how long, what makes it worse, what has already been tried — and with examination of the nose. When the deeper structures need to be seen, we perform nasal endoscopy, a consulting-room procedure in which a thin camera passes through the inside of the nose. It takes about five minutes and is done without anaesthesia.
The examination shows the septum along its full length, the state of the turbinates, the presence of polyps and the adenoid region — information that inspection from the front of the nose cannot provide.
Medical or surgical treatment?
| Medical treatment | Septoplasty | |
|---|---|---|
| When it is usually first choice | Where rhinitis coexists, or obstruction is mild to moderate | Where obstruction persists despite well-conducted medical treatment |
| What it involves | Topical medication, nasal irrigation and control of allergic triggers | Surgery to reposition the septum |
| What it acts on | Inflammation of the lining | The structure of the septum |
| Time to judge the effect | Weeks | Assessment after healing |
A common error is to operate without first treating rhinitis. If the lining is inflamed, the sense of a blocked nose persists after surgery — and the mistaken conclusion is that “the operation did not work”.
What does septoplasty involve?
It is a procedure carried out through the nostrils, without an external incision. The surgeon repositions or removes the deviated portions of cartilage and bone of the septum. It is often combined with turbinate reduction, where the inferior turbinates are enlarged. Where there is also a wish to change the external shape of the nose, the path is rhinoplasty.
Recovery involves internal swelling and a blocked nose for some days, frequent nasal irrigation, relative rest and follow-up visits for cleaning. Breathing improves gradually as the swelling subsides.
What about a mouth-breathing child?
In childhood, a blocked nose is rarely explained by the septum alone. Assessment also considers allergic rhinitis and enlarged adenoids — the subject of the page on snoring and mouth breathing in children. Septal surgery in children who are still growing follows specific criteria and is indicated sparingly.
Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about rhinology
Does every deviated septum need surgery?
No. Most people have some degree of septal deviation and never need an operation. Surgery is considered when the deviation causes persistent nasal obstruction that interferes with sleep, exercise or daily life, and when medical treatment has not resolved it. The decision is individual and made in consultation.
What is the difference between a deviated septum and rhinitis?
A deviated septum is a change in the structure dividing the two nostrils — an anatomical problem. Rhinitis is inflammation of the lining of the nose, usually allergic. Both can coexist, and rhinitis commonly makes the sense of blockage far worse in someone who already has a deviation.
How does the ENT specialist confirm the diagnosis?
Assessment begins with the consultation and examination of the nose. When the internal structures need to be seen properly, Clínica Rhinus performs nasal endoscopy, a five-minute procedure done in the consulting room with a thin camera and without anaesthesia. In some cases imaging is also requested.
Does septoplasty change the shape of the nose?
Septoplasty works from the inside, on the septum, and has a functional purpose: to improve airflow. It is not performed to alter external appearance. When a patient also wishes to change the shape of the nose, the procedure is rhinoplasty, which has its own page on this site.
Can children have a deviated septum?
They can, but in childhood a blocked nose usually has more frequent causes, such as allergic rhinitis and enlarged adenoids. Assessment of a mouth-breathing child therefore looks at the whole picture rather than at the septum alone.