Diagnosing Deviated Septum

Doctors at NYU Langone have the experience and resources to diagnose a deviated septum. The septum is a thin strip of cartilage and bone that separates the right and left nasal passages. When the septum is located in the center of the nasal passages, air flows easily through both nostrils when you breathe. 

If the septum is shifted to one side, or deviated, it may block airflow and make breathing through the nose difficult. Some people experience congestion and difficulty breathing through one nostril and not the other. For others, the congestion may alternate sides, or breathing through the nose may not be possible, because the septum completely obstructs the nasal passage. 

In addition to obstructed breathing, symptoms of a deviated septum can include nosebleeds, a feeling of pressure or pain behind the face, and snoring.

Many people have a slightly deviated septum and don’t realize it. A deviated septum that doesn’t cause symptoms is generally considered to be harmless.

A deviated septum is sometimes present at birth, and as the nose and other internal nasal structures grow and change over time, the deviation may worsen. Other causes of a deviated septum include sports injuries, a car accident, a fall, or any blunt force that injures or breaks the nose. 

A deviated septum may also interfere with the way sinuses, which are air-filled cavities located within facial bones, drain mucus and other fluids. If these fluids don’t drain, germs and bacteria trapped in the sinuses may cause an infection that leads to inflammation in the sinuses. If the septum is not fixed, inflammation may persist, a condition called chronic sinusitis.

Rarely, a deviated septum that causes significant nasal obstruction may contribute to obstructive sleep apnea, a disorder in which a person’s breathing is repeatedly interrupted during sleep. 

Our otolaryngologists, also known as ear, nose, and throat, or ENT, doctors, and our plastic surgeons use diagnostic tests and sophisticated imaging technologies to determine whether treatment is necessary to improve your breathing.

Medical History

Your doctor may ask a variety of questions about your current and past health, including when you first noticed that breathing through the nose was difficult.

He or she may also ask if you had an injury to the nose recently or in the past, if you've been tested for or diagnosed with allergies, or if you have frequent sinus infections or nosebleeds. Tell your doctor if breathing is difficult in one or both nostrils, or if breathing through the nose is more difficult at night.

Physical Exam

During a physical exam, doctors thoroughly examine the internal and external structures of your nose. You may be asked to breathe in deeply through the nose or to take short, quick inhalations. This allows doctors to assess any asymmetry or instability of the cartilage that forms the nasal passages. 

Doctors also take a close look at the inside of your nasal passages using a light and a hand-held instrument called a speculum. The speculum is used to gently widen the nostrils, so doctors can see the interior tissues and bone structure of the nose, including the septum. 

Fiber-Optic Nasal Endoscopy

Fiber-optic nasal endoscopy is a diagnostic exam that provides a detailed view of the nasal passages. Doctors use endoscopy to determine the position of the septum and confirm whether any other structural damage or abnormalities contribute to obstructed breathing. 

To perform this procedure, the doctor first sprays the nose with a decongestant to open up the nasal passages and a local anesthetic solution to reduce any discomfort during the procedure. The doctor then inserts a thin fiber-optic instrument called an endoscope through each nostril.

This procedure takes only a couple of minutes and takes place in your doctor’s office. 

CT Scans

If your nose is seriously injured or broken, doctors typically use CT imaging to assess the extent of damage to the nose and face.

CT scans use X-rays to create computerized two- and three-dimensional images of bones, cartilage, and other nasal structures. This enables doctors to examine the nose from a variety of angles.