17779 Septoplasty

Overview

Septoplasty is an operation to straighten the septum — the thin wall of bone and cartilage that runs down the middle of your nose and separates your two nostrils. When this wall is bent or crooked (doctors call this a deviated septum), it can narrow the airway and make it hard to breathe through your nose. Septoplasty moves the septum back towards the centre so air can pass more easily. It is not the same as a 'nose job' (rhinoplasty), which changes the shape of the outside of the nose, although the two operations are sometimes done together.

Yes. A crooked septum is extremely common — many people have one and never know. Septoplasty is a routine operation carried out by ear, nose and throat (ENT) surgeons all over the world.

Anyone can have a deviated septum, and it affects men and women equally. In children it is usually watched rather than operated on until the nose has finished growing, often in the mid-teens or later. Adults who breathe through their mouth, snore loudly, or get repeated sinus infections are the ones who most often ask for help.

Symptoms

Common symptoms

• A blocked or stuffy nose, often worse on one side
• Breathing through the mouth, especially at night
• Loud breathing or snoring during sleep
• Dry mouth or a scratchy throat on waking
• Frequent nosebleeds from the same side
• Repeated sinus infections or colds that drag on
• Headache or pressure around the face
• Reduced sense of smell or taste
• Poor sleep and daytime tiredness

Symptoms in children

• Noisy breathing or snoring in sleep
• Trouble feeding comfortably at the breast or bottle
• Mouth breathing and dry lips
• Restless sleep and daytime grumpiness
• Frequent colds, ear infections or sinus infections
• Sometimes slower weight gain if feeding is difficult — this should be checked by a doctor

Symptoms in older adults

• Long-standing blockage that has slowly become more noticeable
• Loud snoring or pauses in breathing during sleep, which should be checked
• Dry mouth and throat from mouth breathing
• Symptoms that overlap with allergies, nasal polyps or age-related changes in the nose
• A need to review blood-thinning medicines with the doctor before any surgery

Causes

Main causes

• Being born with a septum that is bent or uneven — this is the most common reason
• An injury to the nose, such as from sport, a fall, a car crash or a fight
• Uneven growth of the bone and cartilage of the face during childhood and the teenage years
• Previous nose surgery that has left the septum slightly crooked
• Pressure from other problems in the nose, such as large ridges of bone or nasal polyps (soft fleshy growths)

Risk factors

• Playing contact sports without a mouthguard or face protection
• Not wearing a seatbelt in a car
• A past broken or bumped nose, even if it was not treated at the time
• Long-standing untreated allergies that keep the nose swollen and stuffy
• Some rare inherited conditions that affect the shape of the face

When to see a doctor

See a doctor urgently if:

• A nose injury with severe pain, heavy bleeding, or a nose that looks bent out of shape
• Sudden complete blockage of one side of the nose that is not improving
• Nosebleeds that are heavy or keep returning
• Fever with facial pain and thick discharge that is getting worse
• Breathing problems during sleep, such as long pauses or gasping

Book a routine appointment if:

• A blocked nose that has lasted more than a few weeks and is not settling
• Always breathing through your mouth, or waking with a very dry mouth
• Loud snoring, or a partner noticing you stop breathing at night
• Repeated sinus infections or colds that never seem to fully clear
• Frequent nosebleeds from one side
• A blocked nose that affects sleep, work, school or exercise

Diagnosis

A doctor can usually spot a crooked septum by asking about your symptoms and looking inside your nose. They will shine a light up each nostril and gently widen it with a small instrument to see the shape of the septum and how much air can pass. They may also press gently on the outside of your nose and check your breathing through each nostril in turn. Before suggesting surgery, they often try simple treatments first, such as salt-water rinses or a nasal spray, to see whether the blockage improves.

Tests that may be done

• Physical examination of the nose and a look at how you breathe through each nostril
• Nasal endoscopy — a very thin flexible tube with a tiny camera is passed into the nose after a numbing spray, to get a closer look
• A trial of medicines such as a salt-water rinse or a swelling-reducing nasal spray, to see if symptoms settle without surgery
• Allergy testing, if allergies could be adding to the blockage
• A CT scan of the sinuses in some cases, especially if sinus problems are suspected
• A sleep study, if snoring or pauses in breathing are a concern

What to expect at your appointment

The appointment is usually quick and painless. You may feel a little pressure or a tickle when the doctor looks inside your nose. If an endoscopy is done, a numbing spray is used first and it wears off within an hour or so. You can drive yourself home and go back to your normal day afterwards.

Treatment

Treatment starts with simple measures to see whether the blockage can be eased without an operation. If symptoms continue to affect your breathing, sleep or everyday life, and tests show the septum is clearly crooked, surgery may be suggested. The aim is always to make breathing easier and improve quality of life — not to create a 'perfect' nose.

Self-care at home

• Rinse your nose with salt water (saline) using a rinse bottle or spray — this is gentle and can be bought from a pharmacy without a prescription
• Use a humidifier in the bedroom, or breathe steam from a bowl of hot water to loosen a stuffy nose
• Drink plenty of water through the day to keep the lining of your nose moist
• Avoid cigarette smoke and smoky places, which make the nose swell
• Try adhesive nasal strips at night to open the nostrils a little
• Sleep with your head slightly raised on an extra pillow
• Treat allergies by keeping windows closed when pollen is high and washing bedding regularly

Medical treatments

Your doctor or pharmacist may suggest treatments to shrink swelling in the lining of the nose, such as a salt-water rinse, a steroid-type nasal spray, or a short course of allergy tablets. These often work best when used every day for several weeks. Decongestant sprays and tablets can open the nose quickly, but sprays should only be used for a few days — using them longer can cause 'rebound' stuffiness. Your pharmacist or doctor can advise on which options are safe for you, especially if you take other medicines or have other health conditions. No medicine can straighten a crooked septum; these treatments help by reducing swelling around it.

When is surgery considered?

Surgery is usually considered when the blockage is clearly caused by a crooked septum and simple treatments have not helped, or when the problem is affecting sleep, work, exercise or repeated sinus infections. Septoplasty is done under general anaesthetic (you are asleep) or sometimes with the area numbed and you lightly sedated. It usually takes around 30 to 90 minutes. The surgeon works inside the nostrils, so there is usually no cut on the outside of the nose and no visible scar. Many people go home the same day. If you decide to go ahead, your surgical team will explain exactly what will happen, what the risks are, and how to prepare.

Living with this condition

For the first few days after surgery you may have a stuffy nose, a little blood-stained discharge, and some discomfort — this is normal and usually settles with simple pain relief that your team recommends. Some people have small soft splints or dissolving stitches inside the nose. Do not blow your nose hard for the first week or two; sniff gently instead. Sleeping with your head raised helps reduce swelling. Most people feel ready for gentle daily activities within a few days, though tiredness is common for a week or so.

Lifestyle tips

• Avoid strenuous exercise, heavy lifting and swimming for about two weeks, and contact sports for around four to six weeks — ask your surgeon for your own timeline
• Stay away from smoky and dusty places while healing
• Use a seatbelt and wear a helmet or mouthguard for sport to protect the nose
• Avoid picking or poking inside the nose
• Keep up with salt-water rinses if your team advises them, as they help keep the nose clean and moist
• Be patient with your breathing — it can take several weeks for swelling to go down and for the full benefit to show

Diet and exercise

Eat normally and drink plenty of water. Some people find bland, soft foods easier for the first day or two. Including fibre — fruit, vegetables and whole grains — helps prevent constipation, which you want to avoid because straining can trigger bleeding in the first days. Gentle walking is fine once you feel up to it and actually helps healing. Hold off on running, gym weights, swimming, cycling and contact sports until your surgeon says it is safe.

Mental health and emotional wellbeing

A long-standing blocked nose can wear you down. Poor sleep from snoring or mouth breathing can affect mood, concentration and energy, and many people feel frustrated after years of not breathing comfortably. It is also normal to feel nervous before surgery or impatient during recovery. Talk to your doctor if low mood, worry or sleep problems are building up — help is available. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a crisis support service in your country straight away.

Prevention

You cannot prevent the shape of the septum you are born with, and some crookedness simply develops as the face grows. You can, however, lower the chance of making it worse: protect your nose from injury, treat allergies and long-standing stuffiness early, and avoid over-using decongestant sprays, which can keep the nose blocked. If you already have a crooked septum, keeping the lining of your nose healthy with salt-water rinses and by avoiding smoke can help you feel more comfortable.

Screening programmes

There is no screening programme for a deviated septum. It is found when you see a doctor about symptoms such as a blocked nose, snoring or repeated sinus infections.

Complications

If left untreated

• Ongoing blocked nose and habit of breathing through the mouth
• Dry mouth, sore throat and dental problems from mouth breathing
• Loud snoring and poor-quality sleep, with daytime tiredness and poor concentration
• Worsening of sleep apnoea (a condition where breathing pauses during sleep)
• More frequent sinus infections and nosebleeds
• Headaches or facial pressure
• Reduced sense of smell and taste, which can affect appetite

Long-term outlook

The outlook is generally good. Most people who have septoplasty notice easier breathing, better sleep and fewer nose-related problems, although it can take a few weeks to a few months for swelling to settle and for the full benefit to appear. As with any operation there are risks, including bleeding, infection, numbness of the upper lip or front teeth, a small hole in the septum, or rarely a change in the shape of the nose; your surgeon will talk these through with you. Some people still need allergy or sinus treatment afterwards. If surgery is not right for you, simple measures such as rinses, sprays and treating allergies can still make a real difference — and your doctor will help you find the plan that suits you.

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