How to Fix a Deviated Nasal Septum
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If you have a deviated septum you are not a rare bird. On an average day of 20 patients I might see one or two whose septum is NOT deviated.
The septum is a vertical column that divides the right and left nasal chambers. It is made up of cartilage and bone. It is easily injured. For most persons they had a straight septum in early childhood. Then when they ran into doors or forgot to duck someone’s fist, the blow “broke” the septum and now it is crooked.
Think of a stiff business card. Hold the card with the long side up. If you hit the top of the card it will bend, either to the right or left. When the septum is fractured, the septum remains in that position.
Usually the septum is bent so that one side – the convex side- is moved to the side of the nose. For example the septum may be bent or convex to the right. The opposite side – the concave side – now has a bow and the septum is further away from the left sidewall of the nose.
You would expect that the concave side would be the one that has lots of room to breathe, since it is roomier. What generally happens is that over time, the turbinate- a shelf on the side of the nose will enlarge to fill up that space and now there is blockage to breathing on the left side too.
Oddly, conditions such as blocked ears and fluid behind the eardrum occur more often on the concave side. This is because the air in the concave side is moving in a wider opening and is therefore with less pressure, therefore the nasal cilia move more slowly too.
Not every deviated septum needs to be straightened. Unless the septum significantly blocks sinus drainage or airway, certain factors need to be considered.
Patient’s age. If the boy is 17, you assume he will be doing sports and will probably strike his nose again. Better to wait until the football days are over.
If the patient is under 16, the nose is still growing. If you operate on such a growing nose, you may injure the growth centers of the septum and cause a cosmetic deformity as the nose continues to grow.
These are some of the factors to consider before septal surgery. The most important factor is whether straightening the nose will give a favorable outcome.
Judy S., age 30, has trouble breathing through her nose. She has a deviated septum, and has it made straight. Now she is just as blocked as before, because the cause of her blockage is nasal allergy.
However there are some instances where there is allergy and the septum is still corrected in order to aid the allergy symptoms.
John F., age 40 has a deviated septum and has heavy yellow/ green drainage. After the septum is straightened he continues to have heavy yellow/green drainage. His problem is a chronic sinus infection.
Clearly, even though the nasal septum is crooked and seems to reduce airway, one needs to clear up any nasal factors of allergy or infection first prior to deciding about septal surgery. Some patients may get along fine as long as the nose is free of allergy or infection. This is why, for most patients, doctors will place the patient on pulsatile irrigation first to clear the allergy or infection. If they are fine after pulsatile irrigation, then septal surgery may not be necessary. The reason doctors recommend pulsatile irrigation – such as, for example, the Hydro Pulse Nasal/Sinus Irrigator-is that pulsatile irrigation is effective for restoring good nasal cilia function, in addition to clearing chronic infection. When the nasal cilia are normal, they drain the sinus and remove dust and pollen.
Not every patient is tried on Hydro Pulse Irrigation though.
a. Septum is pushed hard against a main sinus opening and there is infection within the sinus. This type of blockage must be unblocked to avoid the sinus condition becoming worse.
b. The deviated septum may be causing sinus headache. If I have a complaint of sinus pain, and I see the septum pushed against the side wall, I can anesthetize that area. If the pain goes away, then straightening the septum is indicated to relieve that pain.
Frank P was having septal surgery under light anesthesia. When I moved over the septal bone that was adjacent to the nerve area he announced, “The pain is gone!”
Persons, who go for plastic surgery procedures, may have a deviated septum that is not too severe. Should the septum be corrected since you are already working in that area? Maybe if you don’t straighten it today, it may bother the patient later? This is a judgment call and requires lots of experience and consideration.
In summary, not every deviated septum must be corrected. The doctor must first eliminate factors of allergy and chronic infection using pulsatile irrigation. If the nose is fine after clearing a postnasal drip or a chronic nasal infection, then surgery would not be indicted.
Murray Grossan, M.D.
From Free Yourself from Sinus and Allergy Problems-Permanently