The distinction that matters
A deviated septum is extremely common and usually silent. So the useful question at a consultation is not whether your septum is straight. It is whether the deviation is severe enough, and in the right place, to account for the symptoms you have.
I ask it that way round because the alternative leads to operations that do not help. A septum can be visibly bent while the real cause of a blocked nose is swollen turbinates, allergy, or inflammation, none of which septoplasty addresses.
Symptoms a deviated septum can explain
Blockage on one side, or alternating sides. The most characteristic pattern. Often worse lying down, and worse on one side than the other.
Congestion that does not behave like a cold or hay fever. Persistent rather than seasonal, and not much helped by antihistamines.
Noisy or mouth breathing during sleep, and snoring.
Recurrent nosebleeds, where the airflow over a deviated septum dries and irritates the same spot repeatedly.
Always sleeping on one side to keep the better nostril clear. Patients rarely mention this until asked, and it is one of the more telling signs.
A reduced sense of smell, where airflow cannot reach the upper part of the nose.
What it does not explain
This matters as much as the list above.
Snoring and obstructive sleep apnoea. A deviated septum can contribute to snoring and to disturbed sleep, but it is rarely the only cause. These problems are usually multifactorial, and the tongue (its size and position), the position of the jaw, the pharynx and the tonsils often contribute more than the nose does. Correcting a deviated septum may make breathing through the nose easier, including for people using CPAP, but I cannot guarantee that it will fix snoring, and it is not a treatment for sleep apnoea. Apnoea is diagnosed on a sleep study and treated on its own terms.
Sinus infections, on its own. A blocked nose can impair drainage, but recurrent sinusitis usually has more going on than a bent septum, and the assessment needs to cover that.
Headache or facial pain, in most cases. These are commonly blamed on the septum and are usually something else.
How it is assessed
Examination of the inside of the nose, including with an endoscope, and a discussion of what your breathing is actually like through the day and at night. I use a validated questionnaire to record nasal obstruction before and after surgery, so that improvement is measured rather than remembered.
Where the outside of the nose is visibly crooked as well, the septum and the external shape are usually part of the same problem and are best assessed together.
What septoplasty does
Septoplasty straightens or removes the deviated part of the septum to open the airway. It is done through the inside of the nose and it does not change the external appearance. Where the turbinates are also contributing, they are reduced in the same operation.
Where the nose is crooked on the outside as well as blocked on the inside, straightening the septum alone will not straighten the nose. That needs the two done together, which is a larger operation and a different conversation.
What to expect afterwards
Most people are back to ordinary activity within ten days to two weeks, and back to exercise later than that. The nose is usually more blocked, not less, for the first week or two while it is swollen inside. Breathing improves as that settles, over several weeks.
I will tell you before surgery what I expect it to change and what I expect it to leave alone, and I will not promise a result the anatomy does not support.
When it is worth considering
Where the obstruction is affecting your sleep or your daily activity, where the septum is the substantial cause of it on examination, and where simpler measures have been tried and have not been enough.
I do not offer surgery to everyone who consults me. Where I do not think an operation will give you a worthwhile and lasting improvement I will say so and explain why.
Next step
Consultations are at Indooroopilly, Springfield and Ipswich, and the first consultation can be done by video for patients travelling from outside Brisbane, although meeting in person is ideal. Send an enquiry and we will reply within one business day.
Before and after
Patients treated for this, with the time since surgery on each photograph.
