July 8, 2011
Dear Mayo Clinic:
Is a deviated septum that causes only slight problems worth getting fixed? I have mild sinus problems from time to time but would like to avoid surgery. Is surgery something I'll eventually have to consider?
Generally, a deviated septum that causes minor symptoms doesn't require treatment. But whether it's worth getting fixed is your decision.
If your symptoms aren't bothersome and don't interfere with your quality of life, then the risk of treatment may be more than the benefit. You may find it useful to have your condition evaluated to look for the cause of your sinus symptoms, which could be something other than a deviated septum.
The septum is the thin wall of cartilage and bone between the two airway passages of the nose. A deviated septum occurs when that wall is displaced to one side, making one nasal passage smaller than the other. Septal deviations are common. About 70 to 80 percent of people have a septal deviation that's noticeable to an examiner. In many people, the condition doesn't cause symptoms, or symptoms are minor and no treatment is required.
A deviated septum that is moderate to severe can result in nasal obstruction. When this happens, some people may notice difficulty breathing through the nostril on the side of the obstruction. Others may notice obstruction on the side opposite to the septal deviation, due to a process known as the nasal cycle. As you breathe through your nose, more of the air you breathe in passes through one nasal passage, while the other permits a decreased amount of air. After a while, it switches and the other passage handles most of the airflow. If it wasn't for the nasal cycle, your nose could become too dry.
Usually, the nasal cycle isn't noticeable, although it may be more apparent when you have a cold. But for people with a deviated septum, when the nasal cycle obstructs the side opposite the septal blockage, breathing through their nose may become difficult or uncomfortable.
Reasons other than a deviated septum could be causing your occasional mild sinus problems. If you decide to have the condition evaluated, your doctor can check for other underlying conditions — for example, allergy, nonallergic rhinitis or sinusitis. Treatments such as saline irrigations, nasal cortisone sprays, antihistamines, decongestants and avoiding exposure to allergens often can help reduce those symptoms.
Fixing problems directly related to a deviated septum requires surgical correction (septoplasty). During this procedure, the surgeon works through an incision inside the nose to reposition the septum to the midline to create two open nasal air passages. As with any surgical treatment, there are risks. Complications of nasal surgery include those from anesthesia, bleeding, and the possible need for revision surgery.
After investigation of your symptoms, you can decide whether to pursue further treatment — based on how much those symptoms affect your quality of life.
— John Pallanch, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.