How to tell if you have a deviated septum

Your septum is the structure between your two nasal passages, made up of cartilage and bone. It separates the two sides of your nose, where your nostrils are.

In an ideal world, where we were all built perfectly symmetrical, this wall would sit neatly in the middle of your nose. But, as Mr Samit Unadkat, Consultant ENT Surgeon at My Nose London, explains, that’s very rarely the case.

“A deviated septum means this wall is off-centre, and it usually arises in one of two ways,” he says. “Either it develops as your nose grows, so many people are effectively born with it, or it follows an injury – a knock in sport, a fall, sometimes something as early as birth itself.”

Unadkat points out that deviated septums are extremely common. Studies suggest that the majority of us have some degree of deviation, and for most people, it doesn’t cause any issues at all.

The signs of a deviated septum can be subtle. You may experience a combination of symptoms that you’ve simply got used to over time, but that doesn’t mean they aren’t there.

One of the most noticeable signs is feeling like your nose is permanently blocked on one side.

Unadkat explains that many people find they can only sleep comfortably on one side, as lying on their ‘good’ side can cause the blocked nostril to become even more restricted.

“None of these on their own confirms a deviated septum,” says Unadkat. “But together they build a picture worth investigating.”

If you suspect you have a deviated septum, it’s best to speak to your doctor rather than trying to work out what’s causing your symptoms yourself. While having one isn’t usually dangerous and may not require treatment, getting a proper diagnosis can help you understand how best to manage them.

Even if the condition itself isn’t harmful, ongoing symptoms can start to affect your overall wellbeing. So, if they’re becoming a nuisance, it’s worth getting them checked out rather than simply putting up with them.

Unadkat says that, for the majority of people, a deviated septum is more of a quality-of-life issue than a serious health concern. It’s usually an annoyance rather than a danger, but over time, it can affect your sleep, comfort, and ability to exercise.

“I would be cautious about dismissing it entirely as ‘just’ trivial,” he warns. “Where a significant obstruction contributes to disrupted, poor-quality sleep, or plays a part in obstructive sleep apnoea (OSA), the knock-on effects on daytime alertness, mood and, over time, cardiovascular health are not something to take lightly.

“Persistent obstruction can also predispose to recurrent sinus infections and nosebleeds. So while the septum itself is seldom dangerous, what it sets in motion sometimes is. That’s the distinction I want people to understand.”

To diagnose a deviated septum, your doctor will start by asking about your medical history and symptoms before carrying out a physical examination. This may include looking inside your nose with a thin endoscope.

“This helps your doctor to see not just that the septum is deviated, but precisely where,” Unadkat explains. “The exact location matters, because it shapes everything about how they will treat it.”

Your doctor will also look for other, treatable causes that may be contributing to your symptoms, such as allergies or swollen turbinates. These are small structures inside your nose that can become swollen, narrowing your nasal passages and making it harder to breathe.

“Occasionally, if the sinuses are involved, a computed tomography (CT) scan adds useful detail,” says Unadkat. “What happens next is rarely a rush to surgery. In most cases, the sensible first step is to treat anything reversible and see how much of the issue that resolves.”

You can’t physically straighten a deviated septum without surgery. However, being diagnosed with one doesn’t necessarily mean you need an operation. If your symptoms are manageable, there are several ways you can improve your breathing and reduce discomfort without surgery.

Unadkat recommends the following at-home treatments:

• Saline rinses – simple but effective, these can help clear your nose and wash away irritants.

• Steroid nasal sprays – these may reduce inflammation and turbinate swelling, which often occur alongside a deviated septum and can make nasal blockage worse.

• Allergy treatment – if hay fever or a house dust mite allergy is contributing to your symptoms, treating the allergy properly could make a noticeable difference to how open your nose feels.

• Nasal dilator strips – wearing one at night can help open your nasal passages, particularly if the nasal valve is also contributing to the blockage.