Deviated Nasal Septum: When a Crooked Septum Affects Your Breathing

A deviated nasal septum — where the cartilage dividing the nose is off-centre — is extremely common and in most people causes no symptoms. When it causes persistent nasal obstruction affecting breathing, sleep, or exercise, surgical correction (septoplasty) performed entirely through the nostrils can provide lasting improvement and is generally claimable under Medisave in Singapore.

• A deviated septum is extremely common and causes no symptoms in most people

• When it narrows the nasal passages significantly, it causes persistent obstruction affecting breathing, sleep, and exercise

• Septoplasty — performed entirely through the nostrils — can provide lasting improvement

• The procedure is generally claimable under Medisave in Singapore

A deviated septum narrows one or both nasal passages, restricting airflow and forcing mouth breathing during sleep and exercise. Septoplasty corrects the deviation entirely through the nostrils — no external incisions and no change to the external shape of the nose.

A deviated nasal septum is one of the most common findings on ENT examination. The nasal septum — the wall of cartilage and bone that divides the nasal cavity into left and right — is rarely perfectly straight. In most people, some degree of deviation is present and causes no symptoms whatsoever. In others, the deviation is significant enough to narrow one or both nasal passages, causing a persistent blocked nose, disrupted breathing, and a range of secondary problems that affect sleep, exercise, and quality of life.

This article explains what a deviated septum is, how to know if yours is causing problems, and what can be done about it.

What Is the Nasal Septum?

The nasal septum runs from the tip of the nose to the back of the nasal cavity. It is made up of cartilage at the front and bone further back. Ideally it sits centrally, dividing the nose into two passages of roughly equal size.

In practice, this ideal is the exception rather than the rule. Studies suggest that the majority of people have some asymmetry in their septum, most of which is clinically insignificant. The septum develops throughout childhood and early adult life, and minor trauma — including the passage through the birth canal — can introduce deviations that persist into adulthood.

What Causes a Deviated Septum?

The most common causes are:

• Developmental — the septum simply grows unevenly during childhood and adolescence

• Trauma — a blow to the nose from sport, an accident, or a fall can displace the septum acutely or cause a deviation that becomes apparent over time

• Previous nasal surgery — inadequate or complicated surgery can occasionally cause or worsen septal deviation

In many patients, no specific cause is identified. The deviation is simply how their septum has always been.

What Symptoms Does a Deviated Septum Cause?

The primary symptom is a persistently blocked nose — usually more pronounced on one side, though a high septal deviation can affect both sides depending on how it contacts the lateral wall of the nose.

Associated symptoms include:

• Mouth breathing — particularly during sleep and exercise when nasal airflow is insufficient

• Snoring — reduced nasal airflow increases the tendency to breathe through the mouth during sleep, which causes the soft palate and throat structures to vibrate

• Sleep-disordered breathing — in some patients, significant nasal obstruction contributes to or worsens obstructive sleep apnoea

• Reduced exercise tolerance — difficulty breathing through the nose during physical activity

• Recurrent sinus infections — if the deviation narrows a sinus drainage pathway, it can predispose to sinusitis

• Nosebleeds — turbulent airflow over a prominent part of the septum can dry and damage the nasal mucosa, making nosebleeds more likely

• Headaches — some patients experience pressure-type headaches related to contact between the septum and the lateral nasal wall

It is important to note that a deviated septum is not the only cause of a blocked nose. Enlarged turbinates, nasal polyps, allergic rhinitis, and chronic sinusitis can all produce similar symptoms — often in combination with septal deviation. A thorough ENT assessment is needed to identify the relative contribution of each factor before deciding on treatment.

How Is a Deviated Septum Assessed?

Assessment begins with a detailed history of nasal symptoms — how long the blockage has been present, whether it affects both sides or one, what makes it better or worse, and whether there is any history of nasal trauma or previous surgery.

Nasal endoscopy — a brief, well-tolerated in-clinic examination using a thin flexible telescope — provides a direct view of the entire nasal cavity, including areas not visible on external examination. This allows me to assess the extent and nature of the deviation, the size and state of the turbinates, and whether any other contributing pathology is present.

Where chronic sinusitis or significant structural complexity is suspected, a CT scan of the sinuses provides detailed anatomical information that guides surgical planning.

Do I Need Surgery for a Deviated Septum?

Not necessarily. Surgery is only recommended when:

• The deviation is causing significant, persistent symptoms that are affecting quality of life

• Conservative measures such as nasal steroid sprays, allergy management, and saline irrigation have been tried and have not provided adequate relief

• The structural nature of the problem means that medication alone cannot correct it

Many patients with a mildly deviated septum do well with medical management of any accompanying inflammation or allergy, even if the deviation itself remains. Surgery is not a routine intervention — it is indicated when the structural component of the obstruction is the primary driver of symptoms.

Septoplasty: What the Operation Involves

Septoplasty is the surgical procedure to correct a deviated nasal septum. It is performed entirely through the nostrils — there are no external incisions and no change to the external appearance of the nose.

Under general anaesthetic, I make a small incision inside the nose and lift the lining of the septum to access the underlying cartilage and bone. The deviated portions are reshaped or removed, and the lining is replaced. The procedure typically takes thirty to sixty minutes.

Key points patients often ask about:

• Will it change the shape of my nose? No. Septoplasty corrects the internal structure only. If you also wish to change the external appearance of the nose, this can be addressed simultaneously with a septorhinoplasty, which combines internal correction with external reshaping.

• Will I have packing in my nose afterwards? I use dissolvable stitches rather than nasal packing in most cases, which significantly reduces post-operative discomfort.

• How long is recovery? Most patients take one to two weeks off work. Nasal congestion and some crusting are expected during the first week as the lining heals. Strenuous exercise and contact sport should be avoided for four to six weeks.

• When will I notice the improvement? Significant improvement in breathing is usually apparent within two to four weeks as the swelling settles. Full improvement develops gradually over two to three months.

Septoplasty Combined With Other Procedures

Septoplasty is frequently performed in combination with other procedures that address contributing factors:

Turbinate reduction — the inferior turbinates are scroll-shaped structures that help humidify and filter the air we breathe. When persistently enlarged, they narrow the nasal airway and compound the obstruction caused by septal deviation. Reducing their size alongside septoplasty significantly improves the functional outcome.

Functional endoscopic sinus surgery (FESS) — if the deviation is associated with chronic sinusitis or nasal polyps that have not responded to medical treatment, sinus surgery may be performed at the same time.

Septorhinoplasty — if there is also a significant cosmetic concern about the external shape of the nose, internal and external correction can be addressed in one operation.

Frequently Asked Questions

Can a deviated septum cause snoring? Yes, in some cases. Nasal obstruction from any cause increases the tendency to mouth breathe during sleep, which in turn promotes snoring. Correcting the obstruction can improve snoring, though it does not always eliminate it — particularly if there are other contributing factors such as palate length or tongue position.

Can a deviated septum cause sleep apnoea? A deviated septum can worsen sleep-disordered breathing by forcing habitual mouth breathing, but it is rarely the sole cause of obstructive sleep apnoea. If OSA is suspected alongside significant nasal obstruction, a sleep study should be arranged before or alongside surgical planning.

I have always breathed this way — is it worth having surgery? This is a very reasonable question. The fact that symptoms have been present for a long time does not mean surgery is not worth considering — many patients who have lived with nasal obstruction for years are surprised by the improvement in their quality of life after correction. A consultation allows us to discuss what improvement is realistic for your specific anatomy.

Is septoplasty covered by insurance in Singapore? Septoplasty performed for functional indications — that is, for breathing difficulties rather than cosmetic reasons — is generally claimable under Medisave and most integrated shield plans, subject to your plan terms. The clinic team can assist with pre-authorisation and claims.

Book a Nasal Assessment

If you have a persistently blocked nose that is affecting your breathing, sleep, or daily life, an ENT assessment can identify whether a deviated septum is the cause and what treatment options are appropriate.

Dr Vyas Prasad consults at Absolute ENT, Camden Medical Centre, 1 Orchard Boulevard, #09-08, Singapore. Contact by WhatsApp on +65 8060 8079 or by email at camden.mmc@gmail.com.