What is the nasal septum?
The nasal septum is a composite plate like structure made up of membrane,bone and cartilage.The nasal septum divides the two halves of the nose into right and left nasal cavities.
What is a DNS or Deviated Nasal Septum?
If the nasal septum which is ideally central, is deviated to one side or the other ,ENT Specialists refer to this as a deviated nasal septum or DNS for short.
Why does a DNS occur?
This is a question very commonly asked by my patients.
A DNS can be developmental in origin – it can bend over time or the cause may be trauma such as a hit or an accident.
What are the types of DNS?
ENT Doctors describe a deviated septum based on the shape of the deviation,parts of the septum deviated and location of the deviation.So you may be having:
A C shaped deviation-Here the septum is bent in a C shaped manner producing narrowing of the airway on one side
S shaped deviation- produces airway narrowing in both the nasal cavities and making the person prone to become symptomatic easily.
A bony, cartilaginous or mixed type deviation
A high DNS[ upper part of the septum is deviated and this may even be associated with external nose shape deviation which can be noticeable to the patient and others from the outside]
A caudal dislocation[front most part is deviated]- often a smart patient comes to me after noticing the deviation of the septum in the mirror! Many a times such cases of DNS are caudal deviations and can be self diagnosed by lifting up the tip of the nose and looking in the mirror to see if any part of the nasal septum is protruding into the nasal cavity on one side and narrowing the airway on one side!
Will my DNS create problems for me?
Not everyone with a deviated nasal septum has symptoms due to it. Whether a deviated nasal septum will create problems depends on:-
- Severity of the deviation
- Presence of additional Turbinate hypertrophy narrowing the nasal cavities further
- Shape of the deviation- If the septum is deviated at certain key areas it can produce more problems.
- Allergic tendency- if you have allergic rhinitis then the nasal septal deviation can contribute significantly to the problem and correcting the deviation can help the nasal obstruction symptoms to a certain extent depending on the individual case.
What are the problems caused by a deviated nasal septum?
A DNS can cause a variety of problems for an individual.The symptoms need not be present all the time and can develop any time in due course.
- Nasal Block – If the bent of the nasal septum is severe or the nasal septum is deviated at certain key areas it can produce more problems. Your nose may feel blocked on one particular side or it may be both sides. Some people get so used to the blockage they no longer are consciously aware of the nasal block .
- Nasal discharge – due to the altered drainage architecture, increased nasal discharge can occur or nasal discharge may be due to the increased incidence of upper respiratory infections.
- Nose bleeds- can occur due to the turbulence created by the air stream in contact with the bent nasal septum. This can lead to drying of the delicate nasal mucosa lining and easy injury with resultant bleed.
- Post nasal discharge[PND]- secretions dripping into the throat from the back of the nose can be a chief complaint in some persons with DNS .
- Snoring– when the DNS is severe it can result in significant nasal block and snoring
- Mouth breathing– this may be a constant occurrence or be present only at the times of a cold.
- Taste and Smell abnormalities
- Sleep Apnoea – this is a serious condition with effects on the various vital body systems such as the heart . Obstruction at the level of the nose in the form of a deviated nasal septum[ DNS ] with a turbinate hypertrophy can contribute to the development of OSA or Obstructive sleep apnoea.
- Dry mouth- nasal block and consequent mouth breathing leads to dry mouth and increased sore throats.
- Recurrent Throat infections-results from abnormal drainage of secretions into the throat and also due to mouth breathing
- Recurrent Sinusitis– is a direct consequence of an abnormal nasal anatomy sucha s a DNS [ deviated nasal septum]
- Recurrent Upper Respiratory Infections
- Ear problems– the ears can be affected by way of the eustachian tube connecting the ears and the back of the nose.
What is the treatment for a deviated nasal septum?
Treatment is tailored based on:-
- Severity of the DNS
- Symptoms of the patient
- Age of the patient
- Presence of additional conditions in the nose:
- Turbinate hypertrophy
- Concha bullosa
- Chronic Sinusitis
- Allergic boggy mucosa
- Nasal polyps
A nasal endoscopy is a prerequisite for any treatment decision as it gives a direct visualisation of the nooks and crannies of the nose, the levels of nasal obstruction and the precise location of the abnormal septal deviation.Your ENT Surgeon will perform a nasal endoscopy and discuss the treatment options with you.
Sometimes an additional CT scan is required to further evaluate the sinuses and tailor the management of an individual patient.
Treatment options are broadly divided into
Conservative medical management
The decision on whether a surgery is required or not is made based on the individual case.
What is the Surgery for the Nasal Septum Deviation?
The Surgery for a nasal septal deviation is a Nasal Septal Procedure.There are a variety of nasal procedures done in a patient with nasal septal deviation depending on the individual case.Dr Sonia will discuss which is best suited for you.
- Conventional Septoplasty
- Nasal Spurectomy
- Endoscopic Septoplasty
- Endoscopic Septoplasty + Endoscopic Sinus Surgery
- Endoscopic Septoplasty + Turbinate Procedure
- Endsocopic Septoplasty + FEELS [Functional endocospic endonasal LASER Surgery]
- Septorhinoplasty [ correction of the external shape as well]
Surgery may be performed under local anaesthesia or general anaesthesia.Dr Sonia prefers to use general anesthesia in majority of the cases as it gives optimum comfort to the patient.The patient is completely asleep during the procedure and there will be no pain during the surgery at all in general anesthesia.
When can I go home after the procedure?
Generally speaking you can go home the same day or the next day depending on the individual situation.
Will there be a scar on my nose after the surgery?
The surgery is done through the inside of the nose and there will be no scar or stitches on the face or outer part of the nose.
What are the precautions after the procedure?
The exact precautions will depend on the exact surgery performed but in general it will be advised to avoid contact sports and avoid getting hit for 2 weeks after the procedure.
If you have any further queries discuss them in detail.