Deviated Septum
Understanding Symptoms, Causes and Septoplasty Treatment Options
A deviated septum occurs when the thin wall of cartilage and bone that separates the two nasal passages is displaced to one side.
When this partition is significantly bent, it can narrow one or both nasal airways, leading to persistent nasal blockage, difficulty breathing through the nose, sinus infections or disturbed sleep.
Mild deviation may not require treatment. However, when symptoms affect daily comfort or sleep quality, further assessment is advisable.
Management may involve medication to control inflammation or a surgical procedure known as septoplasty to straighten the septum and improve airflow. Read on to learn more about septal deviation and the available treatment options in Singapore.
What is a Deviated Septum?
The nasal septum is the internal partition that divides the nose into left and right passages. Ideally, it sits centrally, allowing air to flow evenly through both sides.
In many people, the septum is slightly off centre. This is common and often does not cause problems. A deviated septum becomes clinically important when the displacement is pronounced enough to obstruct airflow or interfere with sinus drainage.
Unlike turbinate hypertrophy, which involves soft tissue swelling, a deviated septum is a structural misalignment. The cartilage and bone are physically bent. In practice, however, both conditions often coexist and together contribute to long-term nasal obstruction.
Symptoms of a Deviated Septum
Not everyone with a deviated septum experiences symptoms. In fact, mild deviation is common and may go unnoticed for years.
Symptoms tend to develop when the structural narrowing significantly affects airflow or interferes with sinus drainage. In some individuals, symptoms appear gradually. Others notice worsening nasal obstruction after a cold, allergy flare or injury.
Because septal deviation is a structural issue, symptoms often feel persistent rather than episodic. However, the severity may fluctuate depending on inflammation within the nasal lining.
You may experience:
Persistent nasal blockage
One side of the nose may feel constantly blocked or narrower than the other. | Difficulty breathing through the nose
Breathing may feel restricted, especially during sleep, exercise or when lying down. | Recurrent sinus infections or facial pressure
Impaired sinus drainage can contribute to repeated infections or a sense of facial heaviness. |
Snoring or mouth breathing
Ongoing nasal obstruction often leads to mouth breathing and disrupted sleep. | Nosebleeds
Altered airflow may dry the nasal lining, causing crusting or occasional bleeding. | Headaches or facial discomfort
Contact between internal nasal structures may trigger localised discomfort. |
Many patients also report that their nasal blockage alternates in intensity. While the underlying deviation remains fixed, normal swelling and shrinking of the nasal lining can make symptoms feel more pronounced at certain times.
If these symptoms are persistent, worsening or affecting sleep and daily comfort, further assessment may help determine whether structural deviation is contributing to your nasal obstruction.
Dr. Ong Yew Kwang
Senior Consultant ENT Specialist & Rhinologist
Dr Ong Yew Kwang is an experienced ENT specialist with over 20 years of clinical practice. He graduated with honours from Trinity College, University of Dublin and completed ENT specialist training in 2008, earning the gold medal in the national exit examination. He later undertook subspecialty fellowship training in Rhinology and Endoscopic Skull Base Surgery at the University of Pittsburgh Medical Center, USA.
Before entering private practice, Dr Ong served as Senior Consultant and Director of Clinical Service at the National University Hospital (NUH), where he co-led the endoscopic skull base programme. He also holds a Master of Medicine in Sleep Medicine and a Post-Graduate Certificate in Allergy.
Causes of a Deviated Septum
A deviated septum may arise from:
- Congenital development, where the septum forms unevenly
- Growth-related changes during adolescence
- Previous nasal trauma from sports injuries, falls or accidents
- Prior nasal procedures
In some individuals, the deviation may have been present for years before symptoms became noticeable.
Even a moderate deviation can become symptomatic when combined with chronic inflammation. For example, patients with allergic rhinitis may develop turbinate swelling, which further narrows an already tight nasal passage.
Over time, the turbinate on the wider side may enlarge in response to airflow imbalance. This compensatory change can worsen overall obstruction.
Understanding these contributing factors is important because treatment often needs to address both the structural deviation and the surrounding inflammation.
How is a Deviated Septum Diagnosed?
Diagnosis begins with a detailed consultation and nasal examination.
Your ENT specialist will discuss your symptoms, how long they have been present and whether they vary with allergies, infections or environmental triggers.
A history of nasal injury or long-standing one-sided obstruction can provide helpful clinical clues.
A focused examination of the nasal passages is then performed. In many cases, septal deviation can be identified during anterior rhinoscopy.
For a more comprehensive assessment, a nasal endoscopy may be carried out in-clinic.
This allows direct visualisation of the septum, turbinates and sinus openings, helping to determine:
- The location and degree of septal deviation
- Whether the septum is contacting adjacent structures
- If turbinate enlargement is contributing to obstruction
- Whether there are signs of chronic sinusitis or nasal polyps
Imaging, such as CT scanning, is not routinely required. It may be considered when sinus disease is suspected or when surgical planning is necessary.
A careful evaluation ensures that symptoms are accurately attributed to structural narrowing rather than inflammation alone.
Can a Deviated Septum Improve Without Surgery?
The structural bend of the septum does not correct itself over time.
However, symptoms may fluctuate depending on the level of inflammation within the nasal lining. When allergies are well controlled or infection settles, breathing may feel temporarily improved even though the underlying deviation remains.
If nasal blockage persists despite appropriate medical therapy, it suggests that the structural component is likely playing a significant role.
In such cases, further discussion about treatment options may be appropriate.
Deviated Septum Treatment
The treatment for a deviated septum is guided by symptoms and the degree to which nasal obstruction affects daily activities, sleep or sinus health.
Non Surgical Management
For patients with mild to moderate symptoms, treatment initially focuses on reducing surrounding inflammation. Options may include:
- Regular saline nasal irrigation to improve nasal hygiene
- Intranasal steroid sprays to reduce mucosal swelling
- Antihistamines where allergic rhinitis is present
These measures do not straighten the septum itself, but they may improve airflow by reducing turbinate swelling and nasal lining inflammation.
When symptoms remain troublesome despite consistent medical treatment, structural correction may be considered.
Septoplasty Surgery
Septoplasty is a procedure performed to straighten the deviated septum and improve nasal airflow.
The surgery is carried out through the nostrils, without external incisions. The deviated portions of cartilage and bone are reshaped or repositioned to achieve a more central alignment and wider nasal passage.
The aim of septoplasty is to improve nasal breathing and support better sinus ventilation. It does not usually alter the external appearance of the nose unless performed alongside cosmetic rhinoplasty.
In some patients, septoplasty may be combined with turbinate reduction when both structural deviation and soft tissue enlargement contribute to obstruction.
Suitability for surgery depends on individual anatomy, symptom burden and overall nasal structure, which can be carefully assessed during consultation.
Concerned about a deviated septum?
If you have persistent nasal blockage or difficulty breathing through one side of your nose, a specialist assessment can help clarify whether septal deviation is contributing to your symptoms and discuss appropriate treatment options.
At Advanced Sinus & Skull Base Centre, a structured evaluation of your nasal anatomy is performed to determine the degree of septal deviation and whether other factors such as turbinate enlargement or sinus inflammation are also present.
Management is tailored to your individual symptoms, whether through medical treatment or consideration of septoplasty where appropriate.
Appointments are available for assessment and second opinions.