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Nasal Septal

Nasal septal deviations are common. In fact, it is rare to see a perfectly straight nasal septum. Septal deviations do not always cause problem. The main problem that is commonly caused by a septal deviation is airway obstruction. Nasal septal deviations can also cause sinus pain and contribute to infections.

The most common problem arising from nasal septal deviations is that you just can't breath well through your nose. This is especially likely to bother people at night. It is not usually clear that the problem is entirely from the septal deviation.

For many symptomatic deviations, the only effective treatment is surgery.

Medical treatment for nasal septal deviations

Nasal steroids sprays are the best medical treatment for problems associated with nasal septal deviations. These medicines do not change the position of the crooked bone or cartilage, but they do reduce the thickness of the mucous membranes and allow a bit more room for airflow. Shrinking the mucous membranes can also be helpful when contact points cause sinus pain or pressure.

You should try to obtain one of the preferred brands of steroid spray and use 2 squirts in each side of your nose before bed every night. Steroid sprays are OTC in other countries and are available online (sorry no specifics available). Sometimes it is all that is needed to tip the scale in your favor. Give this type of medicine about a week before drawing any conclusion about its effectiveness. You may need to see a doctor just to get a prescription.

If the problem is more intermittent, you should get a decongestant spray, dump half of the bottle out, fill with saline nasal spray to dilute this in half. You can use this diluted decongestant spray sparingly and not have a great chance of developing the rebound phenomenon. You can use it at full strength, but it works fine at 1/2 strength, and you can us it longer before it causes problems. I would guess that if you could limit yourself to 8 total pumps per week of 1/2 strength, you will be OK even for the long haul. Try treating just one side each night, alternating, and see if that can allow you to get more total comfort out of this medicine despite its limitations. Beware the urge to use it more frequently, people end up with worse nasal congestion if they exceed a certain amount of use.

If this problem is every night and day, then you need to see a specialist. Sometimes, simple minor procedures done in the office can relieve the problem, other times minor outpatient surgical procedures are needed. Trouble breathing through the nose is the symptom that is most reliably correctable if surgery is needed.

Surgery for deviated nasal septum - When is it needed?

The wall the separates the left and right sides of your nose is called the nasal septum. In the front of your nose it is made of flexible cartilage. Farther back in your nose, it is made of bone. Almost no one has a perfectly straight nasal septum. Minor abnormalities are very common and usually don't cause any problems.

People benefit from a septoplasty when they have:
  • a significant nasal septal abnormality
  • symptoms that typically result from nasal septal deviations
  • medications have not adequately relieved the symptoms
The most common reason for a septoplasty is when a patient doesn't breath well though one or both sides of the nose. When a significant deviation is present, correcting this abnormality can improve the airflow.

When a nasal septal deviation interferes with sinus drainage, it can be a contributor to repeated infections or chronic infections. In conjunction with endoscopic sinus surgery, correcting significant septal deviations can help improve drainage. In some cases it is necessary to correct septal deviations during sinus surgery simply to help access the sinus cavities.

Sinus pain can be caused when the septum is deviated such that it touches the side wall of the nose or indents one of the turbinates. Pain from a septal deviation may be felt in the ear or on the side of the face or near the eye.

Surgery for deviated nasal septum - How is it performed?

The nasal septum is made of cartilage in the front and bone deeper in the nose. Each side is also covered by the mucous membrane on the surface. A small incision is made through the covering layers near the front where you can touch with your finger. In some cases, an endoscope is used to begin the operation farther back, skipping over the front part if it is not crooked. Special instruments are used to lift up the membranes and to access the crooked area of the bone or cartilage directly. All of the work takes place with an attempt made to avoid making any unwanted holes in the mucous membrane that covers the septum.

Once certain crooked portions are removed and others are repositioned and special straightening techniques are used, then the covering layers are returned to their original position. Dissolvable sutures are used to sew the membranes down to the septal bone and cartilage. In some cases, it is necessary to place foam type material in the nasal passages on each side. This places additional pressure on the membranes so that they will heal down to the bone/cartilage. This "packing" may stay from 1 to 3 nights. If the membranes do not heal directly to the septal bone, blood can accumulate under the layers which is not very good for the healing process.

OTC Meds: A common
starting point.

Nasal septal deviations

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