Septal deviation

Background: A deviated nasal septum is common. For some, there is a developmental deviation of the septum, for others, it occurs following episodes of trauma which may not necessarily be remembered by the patient.

Typically, patients with a deviated septum will present with persistent, unilateral nasal obstruction. Often, there are no other symptoms. Occasionally, the septum can take a tortuous course resulting in bilateral nasal obstruction.

Nasal obstruction that changes throughout the day is unlikely to be due to septal deviation.

In addition, obstruction that varies from side to side throughout the day is more likely to be due to the normal nasal cycle whereby the turbinates on one side engorge for several hours only to shrink when the contralateral side engorges instead.

How to assess:

Examine the nose with a light / otoscope

How to manage:

All patients should undergo a trial of treatment with at least 6 weeks of sterimar nasal spray and nasal steroid sprays – this aims to minimise any oedema of the turbinates and may give an adequate nasal airway in some patients, avoiding the need for referral

Referral guidance:

If topical nasal steroid sprays have failed, refer to ENT on a routine basis