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Nasal septal deviation - Symptoms and diagnosis
Last reviewed: 06.07.2025
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Symptoms of a deviated nasal septum
The main symptom of a deviated nasal septum is difficulty breathing through the nose, which may be unilateral or bilateral. With a significant shift of the nasal septum to the right or left (especially in the anterior sections), the patient complains of difficulty or lack of breathing through the corresponding half of the nose, but this is not necessary. Often, the subjective feeling of insufficient breathing through one or another half of the nasal cavity does not correspond to the shape of the nasal septum. More often, difficulty breathing through the nose is either constant, equally pronounced on both sides, or intermittent due to the nasal cycle. Other symptoms characteristic of diseases of the nasal cavity are less common with a deviated nasal septum, but with a long-term deformation due to the phenomena of developing secondary vasomotor rhinitis, patients may complain of nasal discharge, sneezing attacks. Olfactory impairment is not typical for this disease: patients, as a rule, are able to smell normally. Other symptoms of the disease are usually associated with concomitant diseases (sinusitis, otitis, etc.).
Diagnosis of nasal septum deviation
Correct collection of anamnesis allows to adequately build a plan of subsequent examination. The main attention when collecting anamnesis is paid to the presence of injuries. nasal fractures, which allows to confirm the traumatic genesis of the disease. It is necessary to more carefully identify anamnestic signs of diseases, one way or another associated with the curvature of the nasal septum, since the symptoms, for example, of chronic sinusitis, can be veiled by the existing deformation and the difficulty of nasal breathing caused by it. /
Physical examination.
Since curvature of the nasal septum (especially post-traumatic) is often combined with various deformations of the external nose, examination of the patient begins with a careful study of the shape of the nasal pyramid, paying attention to the structure of its bone and cartilaginous part. Typical changes in the shape of the nose, combined with curvature of the nasal septum, are scoliotic and saddle-shaped deformations, as well as deformation of the columella (subluxation of the caudal edge of the cartilage of the nasal septum). Scoliotic deformation often affects the more fragile and trauma-prone cartilaginous part, columella retraction develops as a result of previous abscesses, chondroperichondritis or unsuccessful operations on the nasal septum. In cases where septo- or rhinoseptoplasty is planned, it is necessary to conduct photo documentation of the findings. Preoperative photographs should be taken in portrait mode in at least three projections - direct (frontal), lateral (profile) and basal, showing the shape of the nostrils.
Palpation of the external nose can also reveal the nature of the deformation of the bone and cartilaginous structures,
Instrumental research
The main and in most cases sufficient method for diagnosing a deviated septum is anterior rhinoscopy. Examination of the nasal cavity begins without a nasal speculum, simply lifting the tip of the nose with the thumb and illuminating the vestibule of the nasal cavity with a frontal reflector. In some cases, to facilitate the examination, it is necessary to trim the hairs in the vestibule of the nose. Such an examination, in contrast to anterior rhinoscopy using a nasal speculum, allows you to evaluate the shape of the caudal part of the cartilage of the nasal septum and its relationship with the lateral cartilages of the nose and large cartilages of the wings, as well as the angle of the nasal valve and the transverse size of the vestibule of the nose (area of the nasal valve). In the stern, the angle of the nasal valve should be at least 15 degrees.
After examining the vestibule of the nose with anterior rhinoscopy, the deeper sections of the nasal septum are examined. For their detailed examination, it is better to first anemize the mucous membrane with a 0.1% solution of epinephrine or xylometazoline. Endoscopic examination, which is also carried out after anesthesia and anemization of the mucous membrane with an end rigid or flexible endoscope, helps in diagnosing deformations of the posterior sections of the nasal septum.
CT plays a certain role in the diagnosis of nasal septum deformities. This study is especially important for identifying spines and ridges located in the posterior sections, which are not visible during anterior rhinoscopy due to hypertrophy of the nasal turbinates or obstructing polyps in the nasal cavity.
Differential diagnosis of nasal septum deviation
Difficulty in nasal breathing due to a deviated nasal septum can also be caused by vasomotor and allergic rhinitis, chronic sinusitis, and adenoids.
Indications for consultation with other specialists
If there are clinical signs of allergic rhinitis, a consultation with an allergist is indicated (skin tests with allergens).
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