Deviated Septum: Symptoms, Types, Causes and Treatment

A deviated septum is a condition where the thin wall (nasal septum) between your nasal passages is displaced to one side. While a perfectly straight septum is rare, significant deviation can cause a cascade of symptoms, affect quality of life, and may require medical or surgical intervention. In this article, we’ll explore what it means to have a deviated septum, how it manifests, its types and causes, and the evidence-based approaches to treatment.

Symptoms of Deviated Septum

A deviated septum often goes unnoticed in mild cases. However, when the deviation is more pronounced, it can lead to symptoms that significantly impact daily life. Recognizing these symptoms is the first step towards diagnosis and management.

Symptom	Description	Frequency/Prevalence	Sources
Nasal Obstruction	Difficulty breathing through one/both nostrils	Most common symptom (up to 94%)	2 3 4
Nasal Discharge	Mucus drip or watery nasal secretions	Frequently reported	2 4
Sinusitis	Chronic or recurrent sinus infections	Common, especially with severe deviation	1 4 11
Snoring	Noisy breathing during sleep	Often associated	2 4
Headache/Facial Pain	Pressure or pain in the face/head	Sometimes present	4 11
Hyposmia	Reduced sense of smell	Occasional	1 6
Cosmetic Changes	Visible nasal asymmetry or deformity	In some cases	2 4 11

Table 1: Key Symptoms of Deviated Septum

Understanding the Symptoms

Nasal Obstruction

Nasal obstruction is the hallmark symptom of a deviated septum. Most patients experience difficulty breathing through one or both nostrils, which can worsen during a cold or allergy flare-up. Studies have shown that up to 94% of patients with symptomatic deviated septum report nasal obstruction as their chief complaint 2 3 4.

Nasal Discharge and Postnasal Drip

Many patients experience chronic nasal discharge or postnasal drip. This can be due to altered airflow patterns and impaired drainage of mucus, making the nose feel persistently “blocked” or “runny” 2 4.

Sinusitis

A deviated septum can predispose to chronic or recurrent sinus infections, especially when the deviation blocks sinus drainage pathways. Studies have found a strong association between deviated septum and chronic sinusitis, particularly in more severe or S-shaped deviations 1 4 11.

Snoring and Sleep Disturbance

Snoring is a common complaint among those with a deviated septum, mainly because blocked airflow forces breathing through the mouth, leading to noisy sleep and sometimes obstructive sleep apnea 2 4.

Headache, Facial Pain, and Smell Disorders

Some individuals report facial pain, pressure, or headaches—usually linked to sinus blockages. Others may notice a reduced sense of smell (hyposmia), particularly if airflow to olfactory regions is disrupted 1 4 6.

Cosmetic Concerns

In certain cases, especially with severe deviation or associated trauma, visible changes in the shape or alignment of the nose can occur, affecting self-image 2 4 11.

Types of Deviated Septum

Not all septal deviations are alike. Understanding the types helps guide both diagnosis and treatment.

Type	Description	Prevalence/Notes	Sources
C-shaped	Single curve, either left or right	Most common	1 2 3 5
S-shaped	Double curvature, looks like an “S”	Less common, more severe	1 3 5 8
Septal Tilt	Slanted or tilted septum without curvature	Frequent in some studies	5 8
Spurs	Localized bony/cartilaginous protrusions	Can cause significant block	5
Mladina Types 1–7	Classification based on location/shape	Types 2, 3, 5, 7 frequent	4 6 7

Table 2: Types of Deviated Septum

A Closer Look at Septal Deviation Types

C-shaped and S-shaped Deviations

• C-shaped: The septum curves to one side, causing asymmetry and often leading to obstruction on that side. It’s the most frequently reported type in clinical studies 1 2 3 5.
• S-shaped: The septum bends in one direction and then the other, forming an “S”. This type is generally linked to more severe symptoms and a higher risk of sinus disease or other ENT complications 1 3 5 8.

Septal Tilt

Instead of a curve, the septum is slanted or tilted off the midline. This can still cause substantial blockage, especially if the deviation impinges on narrow areas of the nasal cavity 5 8.

Spurs

These are focal points of bone or cartilage that protrude into the airway, sometimes causing localized nasal obstruction or even pressure against the nasal wall 5.

Mladina Classification (Types 1–7)

A more nuanced classification based on CT or endoscopic findings identifies seven types, varying by location (anterior vs. posterior, superior vs. inferior) and pattern (e.g., horizontal, vertical, complex). Types 2, 3, 5, and 7 are reported as most frequent in population studies 4 6 7.

Clinical Relevance

The type and location of deviation can influence:

• Symptom severity (but not always directly correlated) 7
• Surgical planning and technique selection 5 8
• Risk of associated sinus disease, especially with S-shaped or complex deviations 1 3 8

Causes of Deviated Septum

The origins of a deviated septum are varied—sometimes it’s something you’re born with, other times it’s the result of trauma.

Cause	Description	Commonality/Notes	Sources
Congenital	Present at birth or develops during growth	Very common	10 11
Trauma (Birth/Childhood/Adult)	Injury to nose causing displacement	Major cause, often unrecognized	10 11
Developmental	Uneven growth of facial bones during adolescence	Can cause deviation	10
Other Factors	Infections, inflammation, genetic predisposition	Less frequent	10 11

Table 3: Causes of Deviated Septum

Unpacking the Causes

Congenital and Developmental Factors

A deviated septum can be present at birth due to normal variations or subtle trauma during delivery (as the head passes through the birth canal). As a person grows, asymmetrical growth of the septal cartilage and surrounding bones can accentuate the deviation 10 11.

Trauma: Birth, Childhood, and Beyond

Trauma—whether from birth, sports, falls, or accidents—is the leading cause of septal deviation. Childhood injuries are especially important, as they may go unnoticed but result in later deformity as the nose grows 10 11. Even minor bumps can have lasting effects if they disrupt the cartilage or bone structure.

Infections, Inflammation, and Other Factors

Occasionally, infections that lead to septal hematoma or abscess can damage cartilage, causing deviation. Some genetic or racial differences in facial bone structure may also play a minor role 10 11.

Why Causes Matter

• Identifying the cause can guide prevention (e.g., protective gear in sports).
• Early recognition in children may prevent long-term complications.
• Understanding the cause (trauma vs. congenital) can influence surgical planning.

Treatment of Deviated Septum

Managing a deviated septum ranges from conservative measures to surgery, depending on symptom severity and impact on quality of life.

Treatment Type	Approach/Description	Effectiveness/Notes	Sources
Medical Management	Nasal steroids, decongestants, saline sprays	Symptom relief, not corrective	12 13
Septoplasty	Surgical correction of septal deviation	Mainstay for severe symptoms; effective	12 13 15
Turbinate Surgery	Reduction of nasal turbinates, sometimes with septoplasty	May be combined, no consistent extra benefit	12
Endoscopic Septoplasty	Minimally invasive surgical technique	Effective, less invasive	15
Revision Surgery	Correction of persistent/recurrent deviation	Necessary in some cases	9 14 15

Table 4: Treatment Approaches

Treatment Pathways

Medical (Non-surgical) Management

For mild cases, or while awaiting surgery, options include:

• Nasal saline irrigation: Helps clear mucus and reduce blockages.
• Topical nasal steroids: Reduce inflammation and swelling.
• Decongestants/antihistamines: Temporary relief, especially if allergies contribute to symptoms.

These therapies do not correct the deviation but can improve comfort 12 13.

Septoplasty: The Gold Standard

Septoplasty is the definitive treatment for symptomatic deviated septum. Performed under local or general anesthesia, it involves straightening the septum by removing or reshaping cartilage and bone 12 13 15. Modern techniques focus on preserving as much tissue as possible, minimizing complications and maintaining nasal function 8 15.

Evidence from randomized controlled trials shows that septoplasty is more effective than medical management alone for improving quality of life and relieving nasal obstruction, with benefits sustained for at least two years 13.

Turbinate Surgery: When and Why?

Sometimes, enlarged turbinates (structures on the side wall of the nose) contribute to blockage. While reduction of these structures can be performed alongside septoplasty, studies show no consistent additional benefit over septoplasty alone 12.

Endoscopic and Specialized Surgical Techniques

Endoscopic septoplasty and preservation rhinoplasty (PR) approaches are increasingly popular, offering less invasive correction with similar outcomes and faster recovery 8 15.

Revision Septoplasty

Some patients require revision surgery due to persistent or recurrent deviation, often involving the middle or caudal (front) part of the septum. Techniques such as chondrotomy (cutting cartilage) and grafting are used in these cases 9 14 15.

Risks and Complications

Complications are rare but can include septal perforation, bleeding, infection, or changes in nose shape. Proper surgical technique and aftercare minimize these risks 15.

When to Seek Treatment?

• Persistent nasal obstruction impacting daily life.
• Recurrent sinus infections unresponsive to medical therapy.
• Significant snoring or sleep disturbance due to nasal blockage.
• Cosmetic concerns or visible deformity.

Conclusion

A deviated septum is a common anatomical variation, but when severe, it can profoundly impact health and quality of life. Understanding its symptoms, types, causes, and treatment options is key to effective management.

Key Takeaways:

• Symptoms: Nasal obstruction is the most common, but sinusitis, snoring, facial pain, and reduced sense of smell are also frequent.
• Types: Septal deviation varies in shape and location; C-shaped, S-shaped, septal tilt, and spurs are the most clinically relevant.
• Causes: Most often due to trauma (birth, childhood, adult), but congenital and developmental factors are also important.
• Treatment: Mild cases may be managed conservatively, but septoplasty is the gold standard for persistent, bothersome symptoms. Surgical approaches are tailored to the type and location of deviation.

By recognizing the signs and seeking timely evaluation, individuals with a deviated septum can achieve significant improvements in breathing, sleep, and overall quality of life.