Deviated Nasal Septum (DNS) is one of the most common structural abnormalities of the nose, affecting a large portion of the population worldwide. It involves the misalignment of the nasal septum—the cartilage and bone structure that divides the two nasal cavities—resulting in one nasal passage being smaller than the other. DNS can significantly impact breathing, airflow and overall nasal function. Understanding DNS is crucial due to its widespread prevalence and its role in causing various respiratory symptoms and complications.
This blogpost will cover essential information on Deviated Nasal Septum (DNS), including its anatomy, causes, symptoms, diagnosis, treatment options and the latest information from the World Health Organization (WHO).
Anatomy of the Nasal Septum
The nasal septum is a vertical structure that divides the nasal cavity into left and right sections. It comprises three main parts:
- Septal cartilage / Quadrangular cartilage (located at the front of the nose, giving flexibility)
- Perpendicular plate of the ethmoid bone (forms the upper part of the septum)
- Vomer bone (forms the lower and posterior part of the septum)
The septum is covered by a mucosal lining and is rich in blood vessels. Its main functions are:
- To support airflow
- To moisturize inhaled air
- To provide structural support to the nose
Ideally, the septum should be positioned in the midline of the nasal cavity. However, in DNS, the septum is displaced to one side, leading to an asymmetrical nasal passage.
Prevalence and Epidemiology
Deviated Nasal Septum is extremely common, with studies estimating that up to 80% of people have some degree of septal deviation. However, not all cases are symptomatic or require treatment. According to the World Health Organization (WHO), DNS affects individuals of all ages and genders, though trauma-related DNS is more common in young males due to higher exposure to contact sports and accidents.
Causes of Deviated Nasal Septum
Several factors contribute to DNS, including:
- Congenital Causes: DNS may be present at birth. Some children are born with a deviated septum due to in-utero positioning or birth trauma.
- Trauma and Injury: The septum is vulnerable to injury from accidents, contact sports, or other physical impacts. A broken or displaced nose can lead to a septal deviation.
- Developmental Factors: As the body grows, the septum may grow unevenly, leading to deviation. This is particularly common during puberty, where the nasal structure undergoes significant changes.
- Genetic Predisposition: Family history may influence the likelihood of developing DNS. Certain genetic disorders that affect cartilage and bone development can lead to a deviated septum.
Classification of Deviated Nasal Septum
Medical professionals use various classification systems to describe the types and extent of septal deviations. One common classification divides DNS into:
1. Anterior deviation (deviation in the front part of the septum)
2. Septal thickening
3. C-shape deviation (one-sided, unilateral deviation)
4. S-shape deviation (deviation on both sides of the septum)
5. Septal Spur (small bone growth on the septum causing localized deviation and obstruction)
Symptoms of Deviated Nasal Septum
A mild DNS might not cause noticeable symptoms, but severe deviations can lead to various clinical manifestations. Common symptoms include:
- Nasal Obstruction: Difficulty breathing through one or both nostrils, particularly during respiratory infections or allergies.
- Frequent Nosebleeds: The deviated septum can cause drying and crusting, which can irritate the nasal mucosa and lead to frequent epistaxis (nosebleeds).
- Facial Pain: Chronic nasal obstruction or sinus infections can lead to pressure or pain in the face.
- Snoring and Sleep Apnea: DNS can contribute to airway obstruction during sleep, leading to snoring and, in severe cases, obstructive sleep apnea (OSA).
- Postnasal Drip: DNS can alter airflow and contribute to the accumulation of mucus in the back of the throat.
- Recurrent Sinus Infections: The obstruction can interfere with sinus drainage, increasing the risk of sinusitis.
- Loss of Smell (Hyposmia): Severe DNS can affect the sense of smell by obstructing airflow to the olfactory region.
These symptoms are often exacerbated by respiratory infections, allergies and environmental factors such as cold weather or dry air.
Diagnosis of Deviated Nasal Septum
Diagnosis of DNS typically involves a clinical examination along with a detailed patient history. Several diagnostic methods are used to assess DNS:
- Physical Examination: Using an otoscope or nasal speculum, doctors examine the nasal cavity to look for asymmetry or obstruction.
- Nasal Endoscopy: This involves inserting a small endoscope into the nose for a detailed view of the septum and nasal passages. This method is useful for evaluating the extent of deviation and associated conditions.
- Imaging Studies: Though not as detailed, X-rays can provide a basic view of the septum.Computed Tomography (CT scan) is more detailed and can reveal other nasal or sinus abnormalities.
- Rhinomanometry: This test measures nasal airway resistance, helping assess the impact of DNS on airflow.
As symptoms of DNS can overlap with other nasal conditions, such as allergic rhinitis or nasal polyps, a careful diagnosis is crucial.
Complications of Deviated Nasal Septum
When left untreated, DNS can lead to several complications:
- Chronic Sinusitis: Persistent nasal obstruction disrupts sinus drainage, leading to chronic infections and inflammation.
- Obstructive Sleep Apnea (OSA): DNS is associated with an increased risk of OSA, a serious sleep disorder characterized by repeated airway obstruction during sleep.
- Recurrent Otitis Media: DNS can impact eustachian tube function, potentially increasing the risk of middle ear infections.
- Reduced Quality of Life: Chronic nasal obstruction, recurrent infections and disturbed sleep can significantly impact a person’s well-being and daily functioning.
- Dental and Facial Abnormalities: In children, severe DNS can affect facial growth and lead to orthodontic issues.
Treatment Options for Deviated Nasal Septum
Treatment for DNS depends on the severity of the symptoms and the impact on the patient’s quality of life. Options include:
1. Conservative Management
- Decongestants: These medications reduce nasal congestion and help improve airflow, though they are not a permanent solution.
- Antihistamines: Useful for patients with allergic rhinitis, which can worsen DNS symptoms.
- Nasal Corticosteroids: These sprays reduce inflammation, aiding in symptom relief.
- Saline Nasal Sprays: Help moisten nasal passages and alleviate dryness and crusting.
Conservative measures are usually recommended for patients with mild symptoms or those not suited for surgery.
2. Surgical Treatment
For patients with persistent and severe symptoms, surgery is often the best option. The primary surgical procedure for DNS is Septoplasty.
- Septoplasty: A corrective surgery aimed at straightening the septum by removing or reshaping the deviated portions. This procedure is typically performed under local or general anesthesia and has a high success rate.
- Submucous Resection (SMR): This is an older surgical technique for septal correction, rarely used today due to better outcomes with septoplasty.
- Septorhinoplasty: In cases where cosmetic correction is also desired, septoplasty can be combined with rhinoplasty.
After surgery, most patients experience significant symptom relief and improved nasal function.
Role of WHO in Addressing Deviated Nasal Septum
While Deviated Nasal Septum is primarily managed at the local level, the World Health Organization (WHO) emphasizes the importance of understanding nasal and respiratory health as part of broader healthcare frameworks. According to recent WHO guidelines:
- Awareness Programs: WHO encourages health practitioners to raise awareness about the effects of DNS on respiratory health and quality of life.
- Research Initiatives: WHO supports ongoing research into cost-effective treatment methods for DNS, focusing on improving outcomes and accessibility.
- Global Health Policies: WHO recognizes DNS as part of the broader burden of respiratory disorders and advocates for integrated healthcare approaches that can manage DNS alongside other respiratory conditions.
Recent Advances and Research on Deviated Nasal Septum
Several areas of research are currently exploring improved diagnostics and treatment methods for DNS:
1. Advanced Imaging Techniques: High-resolution CT and MRI are enhancing diagnostic accuracy, allowing for better surgical planning.
2. Minimally Invasive Surgery: Endoscopic techniques are being refined, reducing recovery time and improving cosmetic outcomes.
3. Robotic-Assisted Surgery: Though in early stages, robotic techniques may offer greater precision in nasal surgery.
4. Biomaterials in Septoplasty: Researchers are exploring the use of synthetic implants to reinforce nasal structures during septoplasty, reducing the risk of relapse.