Deviated septum

The nasal septum is a thin structure separating the two sides of the nose. Ifit is not in the middle of the nose, it is considered deviated.

The nasal septum has two parts. Toward the back of the head the nasal septumis rigid bone, but further forward it is cartilage. By placing one finger ineach nostril, this cartilage can easily be bent back and forth. If the nasalseptum is sufficiently displaced to one side, it will impede the flow of airand mucus through the nose. This condition, called a deviated septum, can cause symptoms and disease.

A deviated septum can be a simple variation in normal structure or the resultof a broken nose. Any narrowing of the nasal passageway caused by a deviatedseptum will threaten the drainage of secretions from the sinuses, which mustpass through the nose. It is a general rule of medicine that when flow is obstructed, whether it is mucus from the sinuses or bile from the gall bladder,infection results. People with hay fever are at greater risk of obstruction because their nasal passageways are already narrowed by the swollen membranes lining them. The result is sinusitis, which can be acute and severe or chronic and lingering.

It is easy to see that a septum is deviated. It is more difficult to determine whether that deviation needs correction. It is common for a patient to complain that he/she can breathe through only one nostril. Then the diagnosis iseasy. A deviated septum may also contribute to snoring, sleep apnea, and other breathing disorders.

The definitive treatment is surgical repositioning of the septum, accomplished by breaking it loose and fixing it in a proper place while it heals. Decongestants like pseudoephedrine or phenylpropanolamine will shrink the membranes and thereby enlarge the passages. Antihistamines, nasal cortisone spray, and other allergy treatments may also be temporarily beneficial.

Alternative treatments may include saline drops and sprays, which are very helpful in loosening mucus in the obstructed side and preventing drying in theother side, where all the air blows. Hot peppers, such as jalapenos, can produce enough tears and discharge to flush out many a stopped-up nose. An even more effective treatment is called a nasal lavage, often done using a small pot with a spout. Saline solution is poured into one nostril and allowed to flow out the other nostril. Then, the process is repeated in reverse. These therapies are all useful to take care of symptoms, but do not correct the problem. A procedure known as a nasospecific, in which a deflated balloon is inserted in the nostril and inflated to adjust the septal deviation, can be an alternative to surgery. A trained practitioner in the nasospecific procedure is necessary.

Surgical repair is curative and carries little risk. Chronic infection can bepainful and lead to complications until it is resolved. If there is continued obstruction, the infection will very likely return.

Avoidance of virus colds, airborne dusts, air pollution and known allergens will minimize the irritation and swelling of the membranes lining the nasal passages.

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