What Happens If You Don’t Fix a Deviated Septum?

Dr. Reddy:

Hello, everyone. This is Dr. Reddy. I’m from NJ ENT, and we’re on another episode of We Noses Noses. So today, we will be discussing a topic that we frequently get asked by patients. And this question is: What happens if we don’t fix my deviated septum?

So this is a really common question because a lot of patients actually have a deviated septum. And it’s very common that, even if you don’t have any symptoms, if we were to take a look in your nose, you can have a crooked septum.

So, for a lot of people, if you don’t fix the deviated septum, what happens? Well, oftentimes, nothing happens. It’s only if the deviated septum is causing a problem that it’s worthwhile to actually go and try to fix it. However, if the crooked septum is not causing any issues, then if you don’t get it fixed, you probably won’t have any issues in the future.

Now, down the line, if your deviated septum causes issues, it’s a separate story, and it can be corrected then. But most people, if they’re not having any symptoms, then it’s likely not worthwhile to get it corrected. Now, there are some exceptions to that, but that’s the general rule.

Now, what is a deviated septum? The septum, first of all, is the thing that divides your nose in the middle, right between the left side and the right side. And it’s largely comprised of mostly cartilage in the front and the top of the septum. And the bottom part of the septum and the back of the septum are comprised of bone. Both components can be crooked, or one component can be crooked.

And the time that you consider correcting a deviated septum with a procedure, a septoplasty, is if you’re having trouble breathing through your nose. So typically, if the septum is crooked in one direction, then the side that it’s deviated toward is usually the side that’s going to be more narrowed, and there will be a decrease in airflow through the nose.

And it can be one of the contributing factors for trouble breathing through your nose. It can be one of the contributing factors to nasal congestion. And it can also cause other issues. Sometimes, a deviated septum can even potentially cause a little bit of sinus issues if the septum is crooked enough to actually cause blockage of some of your sinus outflow tracts into your nose.

So the decision on whether or not you decide to get your septum corrected with surgery really depends on two broad factors. One, do you have a crooked septum or a deviated septum? And if yes, then the second question is: Is the deviated septum causing problems, and is it affecting your quality of life?

So some of the common complaints that I might get are complaints of trouble breathing through your nose, especially when you’re doing strenuous types of activities, such as working out or sports, and you notice that you’re mouth breathing and having trouble breathing through your nose at those times.

Another common complaint that I might get is trouble sleeping at night because you’re having more difficulty breathing through your nose when you’re laying flat, and sleep quality issues.

Another very common complaint that we get is if you have sleep apnea and you’re using a CPAP device, especially a nasal pillow that actually blows air into your nose to help with the sleep apnea. And if you have a narrowed nose due to a deviated septum, it can really affect the comfort levels of being able to even use those CPAP devices or even an oral appliance therapy.

And so, you know, those therapies, while they may be effective for the sleep apnea, can be very uncomfortable to use, especially if you’re having obstruction in the nose. And so, a lot of our patients end up having deviated septum surgery, or septoplasty, just to help with their compliance with a CPAP device or oral appliance therapy, even though they know full well that it likely will not improve their underlying sleep apnea.

So those are some of the common, you know, that’s generally, in a nutshell, the answer for: Should you get your septum corrected? And I’m going to go over some rapid-fire questions that a lot of patients have that are related to this.

The first question that I have is: Can you live your entire life with a deviated septum? So the answer to that is absolutely. If you have a deviated septum and it’s not causing any symptoms, you can certainly live your entire life without getting surgery for it. And in fact, if you hadn’t gone to the doctor, you may never have even known that you had the issue.

And another question that we get is: Can nasal sprays help straighten a deviated septum? And the answer to that is no. So over-the-counter nasal sprays like Afrin or Flonase, or antihistamine sprays, while they may improve some of the swelling in your nose, may improve congestion, and may improve breathing through your nose kind of indirectly by decreasing inflammation, they’re not going to change the structure of your nose. And so, the deviated septum still remains the same regardless of sprays.

Can deviated septums cause headaches? Generally speaking, my answer to that is no. However, there are some controversial diagnoses out there, something called contact point headache, where there are described cases in the literature where we think that a deviated septum that contacts certain points of the side parts of your nose may be contributing to headaches, maybe because of underlying nerve irritation.

And so, sometimes we do surgeries for helping with headaches for this on the septum, but it’s never a primary indication. And it’s certainly not a guarantee that it’s going to help with headaches.

The other question that I frequently get is: Can my deviated septum be causing sinus infections? And the answer to that can certainly be yes. If the septum is specifically crooked in the area called the ostiomeatal complex, one particular aspect of the nose where a lot of your sinus passages drain, if the septum is crooked in that area and is causing a narrowing of your sinus passages, then it can certainly be a contributor to sinus infections.

Will septoplasty cure sleep apnea? Generally speaking, no. But a septoplasty can improve treatment compliance with traditional sleep apnea therapies like a CPAP device or an oral appliance.

And another common question we get is: Can the septum become deviated after the surgery? And the answer to that is yes, it can be. First of all, when you’re doing a septoplasty surgery, it can be very difficult to get your septum completely 100 percent straight. And part of that is because, you know, your septum actually provides a structural component to your nose. And so, there are certain parts of the septum that are very difficult or not possible to make completely straight. So that’s one issue.

And the other issue is that, over time, your nose changes. And as we age, your nose changes shape a little bit and droops down a little bit. And so, small deviations in the septum can become exacerbated as time goes on.

And the final question I get is: Is septoplasty considered cosmetic surgery or plastic surgery? And generally speaking, no. Septoplasty is considered a medically necessary surgery for patients who have symptoms and is generally covered through insurance if authorized through insurance, and is not considered plastic or cosmetic surgery.

Hopefully, that answers a lot of your questions, and it was nice seeing you guys on this episode. We’ll catch you on the next one.