I was told that I have a deviated septum and that this makes my allergies worse. Do I need to have it surgically repaired?
The nasal septum is the small cartilaginous structure that divides the nose into halves. Approximately one-third of people have deviation of the septum toward one side of the nose or the other. This condition is either present from birth or is caused by trauma later in life. The external nose may look completely normal without any obvious deformity, or the nose may look shifted to one side. The vast majority of individuals who have a nasal septal deviation have no symptoms attributable to the deviation, and it is only detected during a routine physical examination.
A minority of patients, however, will notice blockage of the nose, with one side being sig-nificantly and consistently more blocked than the other side. Additionally, when the patient lies down, the sensation of obstruction becomes much worse due to the effects of gravity upon blood flow through the nose. An isolated nasal septal deviation will not cause other nasal symptoms such as nasal discharge, itching of the nose, or sneezing.A useful test in the office is to spray both sides of the nose with oxymetazoline topical decongestant nasal spray and wait 10 minutes. If the patient’s nasal congestion improves markedly on both sides of their nose, it would indicate that nasal swelling, rather than septal deviation, is the most prominent problem and should be dealt with prior to considering surgical intervention. If the deviation is extremely severe, with the septum touching the turbinates and resulting in complete blockage on that side of the nose, the patient can be referred to a head and neck surgeon for surgical repair of the septum (referred to as septoplasty).
In the case of patients with mild to moderate deviations of the septum and concomitant allergic rhinitis, a good approach is to first treat the rhinitis as completely as possible, including both allergen avoidance measures and anti-allergy medications. If, after a 1-month trial of treatment, the patient has minimal symptoms of congestion, the septal deviation will not require surgical correction. However, if the patient continues to notice bothersome one-sided nasal blockage on the side of the deviation, he or she is a good candidate for septoplasty. Patients should always ask exactly what procedures the surgeon is planning to perform. If the major anatomic problem is the septal deviation, then other nasal structures, such as the turbinates and paranasal sinuses , should be left undisturbed. Once the nose has undergone surgery, it is very difficult to reverse those changes.
Nasal septum
The small cartilagi-nous structure that divides the nose into halves.
Turbinate
A long, narrow, and curled bone that comes off of the lateral wall of the nasal passage and is important in the humidification, filtration, and warming of inspired air.
Paranasal sinuses
The air-filled spaces within the bones of the skull and face.