Deviated Septum: Symptoms, Causes and Treatment

The nasal septum is the wall of bone and cartilage dividing your nose into two passages. When it sits off-centre, one passage is narrower than the other — that is a deviated septum, or deviated nasal septum.

It is extraordinarily common. Studies of unselected adults find some degree of septal deviation in roughly 70 to 80 per cent of people, which makes a perfectly straight septum the exception rather than the rule. Most deviations cause no symptoms at all and need nothing done.

The useful question is therefore not “do I have a deviated septum” — you probably do — but “is mine causing a problem worth fixing”. This guide answers that: what it looks like, how to check at home, why a spray sometimes helps a structural problem, what the NHS will and will not do, and where septoplasty genuinely helps.

What Is a Deviated Septum?

The septum is made of cartilage at the front and thin bone behind, covered on both sides by mucosa. When straight, it divides the nose into two roughly equal channels.

A deviated septum bows, buckles or tilts to one side. The airway on that side narrows; the other side is often wider than normal to compensate. Deviated septum meaning, in plain terms: the dividing wall is off-centre.

What does a deviated septum look like?

From the outside, usually nothing. This surprises people. The septum sits inside the nose, and unless the deviation involves the front portion, the external nose looks entirely normal. A visibly crooked nose is a separate matter, though the two often occur together after injury.

From the inside, it appears as a wall leaning into one passage — sometimes a smooth curve, sometimes a sharp bony ridge. You may glimpse this yourself with a torch, but the front of the nose is the least informative part, and what most people mistake for a deviated septum is a swollen turbinate.

Types of deviation

• C-shaped — a single smooth curve to one side. The most common pattern.
• S-shaped — curving one way high in the nose and the other way lower down, so both sides can be obstructed at different levels.
• Spur — a sharp bony projection into one passage, often where cartilage meets bone. Small spurs can cause disproportionate symptoms and sometimes contact the turbinate, causing headache.
• Caudal deviation — the front portion near the nostrils tilts to one side. This is the type most likely to be visible externally and the most technically demanding to correct.

Deviated Septum Symptoms

• Blocked nose, worse on one side. The cardinal symptom. Usually the same side consistently.
• Difficulty breathing through the nose during exercise, when airflow demand is highest.
• Mouth breathing, particularly at night, with dry mouth and sore throat on waking.
• Snoring and disturbed sleep. See snoring and sleep apnoea.
• Recurrent sinus infections, where the deviation impedes drainage.
• Nosebleeds, because the deviated portion is exposed to airflow and dries out.
• Crusting on the narrowed side.
• Facial pain or headache where a spur contacts the turbinate.
• Post-nasal drip, from altered airflow and impaired clearance.
• Noisy breathing during sleep.

Does a deviated septum cause headaches?

Sometimes, but it is over-diagnosed as a cause. Genuine septal headache is typically caused by a contact point — a spur pressing against the turbinate — producing pain around the eye or temple on that side. Where this is the mechanism, correcting it helps.

Most headaches in people with a deviated septum are not caused by it. Migraine and tension headache are far commoner, and operating on the nose will not improve them. A trial of local anaesthetic applied to the contact point is a useful test before committing to surgery.

Does a deviated septum cause snoring?

It contributes rather than causes. Nasal obstruction increases the effort of breathing in, which encourages mouth breathing and increases collapse of the throat. Correcting a septum reduces snoring in some people and not others, because most snoring originates at the palate rather than the nose.

The clearer benefit is in people who cannot tolerate CPAP because of nasal blockage — there, septal correction can make treatment usable.

Does a deviated septum cause post-nasal drip?

It can contribute by disturbing airflow and mucus clearance, particularly with an associated spur or sinus involvement. But post-nasal drip has many causes — rhinitis, reflux, sinusitis — and septal correction alone often does not resolve it. Worth being realistic about before surgery.

How to Tell If You Have a Deviated Septum

1. Block one nostril with a fingertip and breathe in through the other. Then swap.
2. Compare. Is one side clearly harder than the other?
3. Repeat at different times — morning, evening, after exercise, lying on each side.

The pattern is what matters. If the same side is consistently worse, a structural cause such as the septum is likely. If the blockage swaps sides, that is the normal nasal cycle acting on turbinates — and turbinate swelling, not the septum, is the treatable part.

A further clue: if a decongestant spray temporarily opens the nose completely, much of the obstruction is mucosal rather than structural.

This is a guide, not a diagnosis. Confirmation requires nasal endoscopy.

What Causes a Deviated Septum?

• Developmental. The commonest cause. Cartilage and bone grow at different rates through childhood and adolescence, and the septum buckles as a result. No injury required, and it becomes more apparent in the teens.
• Birth. Compression during delivery can deviate the septum, sometimes noticed only years later.
• Injury. A blow to the nose — sport, a fall, an accident. Often the injury seemed minor and the connection is only made later. See broken nose surgery.
• Untreated septal haematoma. Blood collecting after injury kills the cartilage, causing deviation or collapse into a saddle nose deformity. This needs draining within days.
• Previous nasal surgery. Incomplete correction, or recurrence as cartilage remembers its original shape.
• Ageing. Cartilage weakens and existing deviation can become more pronounced.

Can a deviated septum get worse?

Yes, in two ways. The deviation itself can increase slowly as cartilage weakens with age. More often, the symptoms worsen while the anatomy stays the same — because allergy, rhinitis or turbinate enlargement adds mucosal swelling on top of a fixed narrowing that was previously just about tolerable.

That second mechanism explains why people describe a nose that was fine for decades and then became blocked.

Why Sprays Sometimes Help

This confuses more people than anything else on the subject, and the answer is simple.

A spray cannot straighten your septum. But almost nobody has narrowing from the septum alone. There is usually turbinate swelling or mucosal inflammation on top of it, and that part is treatable. Reduce the swelling and the same deviation may leave a perfectly usable airway.

Practically: if a steroid spray used correctly for six to eight weeks makes a real difference, treating the mucosal component may be all you need. If it makes no difference at all, the obstruction is structural and surgery is the option that will change it.

That trial is worth doing before surgery, and any surgeon who skips it is skipping the cheapest useful test available.

How to fix a deviated septum without surgery

The honest answer: you cannot straighten a septum without surgery. No exercise, device, manipulation or remedy repositions cartilage and bone.

What can help the symptoms:

• Steroid nasal sprays — reduce mucosal swelling. Technique matters: angle outward toward the ear on the same side, using the opposite hand.
• Saline rinsing — clears mucus and improves spray delivery.
• Antihistamines where allergy contributes.
• External nasal strips — these open the nasal valve, not the septum. They help some people considerably, and if they work well that points to nasal valve collapse as part of the problem.
• Sleeping position — lying on the more open side often helps.

Can you push a deviated septum back into place? No, and do not try. Manipulation causes bleeding and can worsen matters. The one exception is a fresh fracture, where an ENT surgeon can sometimes reposition the septum within the first one to two weeks — which is a reason to be seen promptly after a nasal injury.

Septoplasty and Septorhinoplasty

Septoplasty straightens the septum through incisions inside the nose. No external cuts, no change to appearance, no bruising in most cases. Deviated portions of cartilage and bone are removed or repositioned, preserving the lining and enough structure to support the nose — taking too much causes collapse later.

Day case under TIVA, 30 to 60 minutes. Splints may be placed for a week to hold the septum and prevent adhesions.

Septorhinoplasty corrects the septum and reshapes the external nose in one operation. Appropriate where the nose is externally crooked as well, typically after injury, or where you want the appearance changed at the same time.

Turbinate reduction is frequently done alongside, because the turbinate on the wider side often enlarges to compensate and remains obstructive once the septum is straightened. See turbinate reduction.

Recovery

Blocked and congested for one to two weeks — frequently worse than before surgery initially, which is normal and catches people out. Splints removed at around a week. Desk work within a week, exercise at three to four weeks. Breathing improves progressively over four to eight weeks as swelling settles.

Does septoplasty change the shape of your nose?

It is not intended to and usually does not. Occasionally a small external change is noticeable where a severe caudal deviation was distorting the external framework. Deliberate shape change requires septorhinoplasty, planned in advance.

How successful is it?

Good, with a caveat. Most people report meaningful improvement in nasal breathing. Where it disappoints, the usual reasons are that turbinate enlargement was not addressed, that nasal valve collapse was the real problem, or that expectations included resolving snoring or post-nasal drip that had other causes.

A small proportion have residual or recurrent deviation, as cartilage has memory. Revision is possible but more complex.

Deviated Septum on the NHS

Septoplasty is available on the NHS, but access has tightened considerably.

Most integrated care boards apply threshold criteria under the Evidence Based Interventions programme — typically requiring documented nasal obstruction significantly affecting quality of life, a confirmed deviation on examination, and a failed trial of medical treatment first, usually a steroid spray for a defined period.

Purely cosmetic nasal surgery is not funded. Where the septum is being corrected for breathing but you also want the external shape changed, the cosmetic element is not covered.

Your GP is the route to referral. Waiting times vary widely by area — deviated septum NHS waiting list times of a year or more are not unusual for a procedure classified as routine, which is the main reason people consider going privately.

Deviated Septum Operation Cost

Private cost depends on whether septoplasty alone is required or whether turbinate reduction or external correction is included, and on the anaesthetic. Septorhinoplasty costs more than septoplasty because it addresses both function and appearance.

Your exact cost is confirmed in writing after in-person consultation and examination. Finance is available through Chrysalis Finance, subject to status — see our finance options.

Deviated Septum FAQs

Nasal Airway Assessment at Centre for Surgery

Assessment begins with establishing whether the septum is actually the problem, because most obstructed noses have more than one cause and the septum is often not the dominant one.

Examination includes nasal endoscopy to assess the septum, turbinates, nasal valve and lining together. Where mucosal swelling is a significant part of the picture, we will suggest treating that first — and if a spray resolves it, you will not need surgery.

Our ENT surgeon and rhinologist leads nasal airway assessment. Where surgery is appropriate we will be clear about what it will and will not change, including the specific point that septoplasty reliably improves nasal breathing but does not reliably resolve snoring, headache or post-nasal drip.

All surgery is performed by GMC-registered surgeons at our own day-surgery facility at 95–97 Baker Street, Marylebone. We are regulated by the Care Quality Commission and rated Good overall. We recommend a two-week cooling-off period before any surgery is booked.

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Phone: 020 7993 4849
Email: contact@centreforsurgery.com
Address: 95–97 Baker Street, Marylebone, London W1U 6RN
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Related Reading

• Septoplasty (deviated septum surgery)
• Septorhinoplasty
• Turbinate reduction surgery
• Nasal turbinates: why they swell
• Nasal valve collapse
• Nasal polyps
• Nasal synechiae (adhesions)
• Saddle nose deformity
• Broken nose surgery
• Snoring and sleep apnoea
• How septoplasty and turbinate reduction help you breathe better
• Nose shapes: the common types