November 23, 2011

With A Deviated Septum, Why Does Nasal Obstruction Come and Go?

A deviated septum is a well known factor causing nasal obstruction in people. However, many patients with a deviated septum will also state that there are times when they can breath just fine from their nose. As such, can a deviated septum truly be the cause of their nasal obstructive symptoms? Shouldn't the obstruction be constant?

The blunt answer is ABSOLUTELY nasal obstruction can be intermittent OR constant with a deviated septum!!! It's more a question of degree.

To begin with, a deviated septum is when the wall that separates the right and left nasal cavities is bent one way (green arrow) instead of being perfectly straight.

If there is no mucosal swelling, a person with a deviated septum is able to breath from both sides just fine. However, if there is the slightest bit of mucosal swelling from turbinate hypertrophy, allergies, upper respiratory infection, or any other environmental irritation, the side that is more narrow will obstruct much more readily with less swelling given there is just "less room" for swelling to occur before obstruction occurs.

Below is the same exact nose and septum as above, but with mucosal swelling present.
As you can see, with the same exact amount of swelling present, the deviated septum significantly influences how much space is present for air to pass through compared with a straight septum.

As such, even though a deviated septum may not technically be obstructive, given there is less room for any swelling to be accomodated, a patient will complain of nasal congestion and obstruction much more readily compared to someone with a straight septum due to the slightest changes in mucosal swelling.

How is a deviated septum fixed? Click here to read more.

Of course, one can try and control the mucosal swelling to avoid any surgical intervention, typically with steroid or anti-histamine nasal sprays. The downside is that such medications need to be used daily to prevent swelling from occurring in the first place.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.


Augenlidstraffung said...

So that's what I've been experiencing for a couple of days now! Was really getting annoyed why on earth isn't it going away and now I know why.

Is there any other treatments besides the one you've mentioned?

Helikopterflug said...

Well this will definitely be a more common this season since Winter's coming, if not it'd already started really. With the temperature being cold than ever, having cold with nasal obstruction would surely be troublesome in line with the celebration of this fruitful season coming.

As Augenlidstraffung asked, what can one do to avoid this?

Zahnärzte Düsseldorf said...

And speaking of the last paragraph - isn't it bad in general to use such sprays daily?

Fauquier ENT said...

Steroid and anti-histamine nasal sprays are safe to use daily for prolonged periods of time.

Decongestant nasal sprays, however, should never be used more than 3-4 days consecutively, otherwise risk "addiction".

Read more at:

Anonymous said...

I love your articles, always informative and practical. I'd like that share that I learned from a nurse that long-term use of topical steroids does have negative impacts. Long term use of topical steroids that can lead to skin atrophy & fragility. Breathing easy is important but so is skin integrity. People should be aware of the side effects so they can make an informed decision.

Anonymous said...

I have a type C caudal septal deviated tip that reduces airflow on my right hand side and contributes to clear chronic nasal discharge. I have seen three ENT surgeons for consultations and non have explained things as clearly as you have. The last surgeon was in the Los Angeles southbay, triple board certified and with my curved caudel septal diviation and large nasal turbinates would not offer me any assurances that the success rate would be worth the surgery. While my deviated septum contributes to less airflow on my right nostril, the nasal turbinate cycle, the alternating swelling of the nasal turbinates, obviously is more severe on the deviated side.

At this point I have been pitched several solutions including Coblation turbinate reduction in office $1,500), the common L strut approach septoplasty ($5,000), septorhinoplasty with caudel septal replacement ($9,000-$15,000). The only common response from doctors was from a high success rate using Coblation Turbinate Reduction. Only one doctor said I would see a 30% improvement in air flow if I got the Coblation turbinate reduction. I'm not going under the knife if the success rate is low. That's money and cartilage down the drain. I believe I'm going to get the turbinate reduction as I am not satisfied with the low success rate. So far 50% success rate on Coblation turbinate reduction and its lower cost seems more reasonable. What complications might a raise from Coblation turbinate reduction? How might I avoid those complications?

mashireman said...

I use a CPAP. All of a sudden my nose started to click shut upon exhaling and I feel it in my throat,then I can exhail through my mouth? HELP!

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