A deviated nasal septum (DNS) is a common condition that affects millions of people worldwide, often without them even realizing it. While it might sound like a minor anatomical imperfection, a deviated septum can lead to a host of persistent and bothersome symptoms that impact your breathing, sleep, and quality of life. Whether it results from trauma, congenital development, or aging, this condition is frequently overlooked in primary care settings.
To simplify the understanding of its clinical presentation, we use a high-yield memory aid—the "NASAL" mnemonic—which highlights the most common and troubling symptoms associated with DNS:
- N – Nasal bleeding
- A – Acute nasal congestion
- S – Snoring
- A – Anterior or posterior nasal drip
- L – Loss of smell
This article breaks down each of these symptoms in depth while also exploring the causes, complications, diagnosis, and treatment options for a deviated nasal septum. Whether you're a medical student, ENT enthusiast, or someone struggling with chronic nasal issues, this guide offers everything you need to know.
What Is a Deviated Nasal Septum?
The nasal septum is the thin wall of bone and cartilage that separates the left and right nasal cavities. In an ideal anatomy, it lies centrally and allows even airflow through both nostrils. However, in approximately 80% of adults, the septum is slightly off-center. A significant deviation can obstruct airflow, alter drainage patterns, and irritate sensitive nasal tissues.
A deviated nasal septum occurs when this partition is displaced to one side—either due to trauma (like a sports injury or accident), congenital causes (present from birth), or age-related cartilage changes.
Understanding the “NASAL” Mnemonic
The mnemonic NASAL is a powerful tool to remember the five most common symptoms of a deviated septum. Let's explore each of them in detail.
N – Nasal Bleeding
A deviated septum often causes the inner nasal lining (especially the anterior septum or Kiesselbach’s plexus) to dry out due to uneven airflow. This dryness leads to crusting and minor trauma, which in turn causes episodic nasal bleeding (epistaxis).
Why It Happens:
- Exposure of the nasal mucosa on the deviated side
- Increased turbulence drying out the lining
- Fragile capillaries rupturing due to sneezing or nose picking
Clinical Significance:
- Patients may report recurrent nosebleeds, particularly in dry or cold weather.
- Bleeding may be spontaneous or triggered by blowing the nose or minor trauma.
A – Acute Nasal Congestion
Nasal blockage is perhaps the most classic symptom of DNS. Because the septum bulges into one nasal passage, it narrows the air space, making it harder to breathe through that nostril. Over time, this can cause chronic congestion on the affected side and compensatory hypertrophy of turbinates on the other.
Symptoms May Include:
- Difficulty breathing through one or both nostrils
- Feeling of constant nasal fullness
- Dependency on nasal decongestant sprays (risking rhinitis medicamentosa)
Severity Factors:
- Congestion worsens during upper respiratory infections, allergy seasons, or when lying down.
S – Snoring
Snoring results from turbulent airflow in the upper airway, especially when lying down. A deviated nasal septum narrows one airway, making airflow noisy and disruptive.
Additional Complications:
- Snoring may worsen during cold or allergy seasons
- DNS may contribute to obstructive sleep apnea (OSA) in severe cases
- Often accompanied by daytime fatigue and poor sleep quality
DNS is an often overlooked anatomical cause of snoring, especially in young adults.
A – Anterior or Posterior Nasal Drip (Postnasal Drip)
Nasal discharge that trickles down the back of the throat—commonly referred to as postnasal drip—can occur when mucus produced in the sinuses cannot drain properly due to the septal deviation.
How It Presents:
- Constant need to clear the throat
- A sticky or ticklish feeling at the back of the nose or throat
- Accompanied by chronic cough in some individuals
This nasal drip can lead to throat irritation, voice changes, and even halitosis (bad breath).
L – Loss of Smell (Hyposmia or Anosmia)
The olfactory receptors are located at the top of the nasal cavity. A deviated septum can prevent odor molecules from reaching these receptors on the affected side, leading to partial or complete loss of smell.
Impact on Daily Life:
- Reduced enjoyment of food
- Difficulty identifying hazards (e.g., gas leaks, smoke)
- Psychological effects such as depression and anxiety
In chronic cases, smell loss may be irreversible if not addressed in time.
Common Causes of Deviated Nasal Septum
Understanding what leads to septal deviation is crucial for both prevention and diagnosis. Major causes include:
- Congenital deviation: Present at birth due to abnormal development
- Trauma: Injury to the nose from sports, falls, or accidents
- Birth injury: Trauma during vaginal delivery
- Aging: Structural changes in cartilage and bone
- Previous surgeries: Poor surgical outcomes or scar contracture
Clinical Presentation: Signs Beyond the Mnemonic
While "NASAL" highlights key symptoms, patients may also present with:
- Recurrent sinus infections
- Mouth breathing
- Nasal speech quality
- Headaches from sinus pressure
- Asymmetrical nostrils or visible external deviation
Diagnosis of DNS
A comprehensive diagnosis involves:
1. History Taking
- Breathing difficulty, bleeding, snoring pattern
- Impact on sleep or physical activity
2. Physical Examination
- Using a nasal speculum or endoscope
- Inspecting both sides of the septum
3. Imaging Studies
- CT scan of paranasal sinuses (for surgical planning)
- Nasal endoscopy for real-time visual assessment
Types of Nasal Septum Deviations
| Type | Description |
|---|---|
| C-shaped deviation | Simple curve to one side |
| S-shaped deviation | Double curvature involving both nasal cavities |
| Spur formation | Bony projections irritating mucosa |
| Thickened septum | Cartilage hypertrophy causing blockage |
Treatment Options for Deviated Nasal Septum
Non-Surgical Management
- Nasal corticosteroid sprays to reduce inflammation
- Decongestants (short-term only)
- Saline irrigation for clearing mucus
- Antihistamines for allergic rhinitis
These are symptomatic relief measures and do not correct the deviation.
Surgical Treatment: Septoplasty
What is Septoplasty?
A septoplasty is a minor ENT surgical procedure that repositions or removes the deviated part of the septum. It’s usually done under local or general anesthesia.
Benefits of Septoplasty:
- Improved nasal airflow
- Better sleep and reduced snoring
- Decreased postnasal drip
- Enhanced sense of smell
Risks Involved:
- Bleeding
- Septal perforation
- Infection
- Recurrence or inadequate correction
DNS and Related Conditions
| Associated Condition | Explanation |
|---|---|
| Sinusitis | DNS can block sinus drainage, leading to recurrent infections |
| Allergic Rhinitis | Aggravated by poor nasal airflow |
| OSA (Obstructive Sleep Apnea) | DNS can narrow airway space and increase snoring/apnea risk |
| Nasal Polyps | May coexist and further block airflow |
Home Care Tips for Patients with DNS
- Use humidifiers to prevent drying
- Avoid smoking or secondhand smoke
- Practice nasal irrigation using saline sprays
- Avoid excessive nose-picking or aggressive blowing
- Get allergies and sinus infections treated early
FAQs on Deviated Nasal Septum
Is a deviated septum dangerous?
Not usually, but it can severely affect your quality of life and predispose you to infections and sleep disturbances.
Can DNS cause headaches?
Yes. Sinus pressure due to blocked drainage can lead to facial pain and headaches.
Will DNS go away on its own?
No. Structural deviations do not resolve spontaneously but symptoms may wax and wane.
Can I fix a deviated septum without surgery?
Only symptoms can be managed non-surgically. Correction of deviation requires septoplasty.
How long is recovery from septoplasty?
Recovery is generally 1–2 weeks. Nasal packing is often removed within the first 48 hours.
Is DNS common?
Yes, up to 80% of people have some degree of septal deviation, though not all are symptomatic.
Summary Table: The NASAL Mnemonic
| Mnemonic | Symptom | Clinical Impact |
|---|---|---|
| N | Nasal bleeding | Crusting, dryness, discomfort |
| A | Acute nasal congestion | Breathing difficulty, mouth breathing |
| S | Snoring | Poor sleep, potential sleep apnea |
| A | Nasal drip (Postnasal) | Throat irritation, chronic cough |
| L | Loss of smell | Reduced taste and hazard detection |
Final Thoughts
A deviated nasal septum may be a silent contributor to many everyday discomforts — from chronic nasal congestion to fatigue-inducing snoring and even smell loss. The “NASAL” mnemonic provides a simple yet powerful way to remember its key symptoms. Recognizing and addressing these signs early can significantly improve one’s quality of life, sleep, and respiratory health.
