The bone and cartilage that divides the inside of the nose in half is called the nasal septum. The bone and cartilage are covered by a special skin called a mucous membrane that has many blood vessels in it. Ideally, the left and right nasal passageways are equal in size. However, it is estimated that as many as 80 percent of people have a nasal septum that is off-center. This is called a deviated septum, which may or may not cause certain symptoms.

What Are the Symptoms of a Deviated Septum?

The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose, which is usually worse on one side. In some cases, a crooked septum can interfere with sinus drainage and cause repeated sinus infections. You may experience one or more of the following:

• Difficulty breathing through one or both nostrils
• Nosebleeds
• Sinus infections
• Noisy breathing during sleep in infants and young children
• Mouth-breathing during sleep in adults

What Causes a Deviated Septum?

Injury or trauma to the nose can cause the septum to become deviated or crooked. However, even people with normal growth and development, and without a history of injury, trauma, or broken nose, can have a deviated septum.

What Are the Treatment Options?

Discuss your symptoms and any known nose damage or surgeries with your primary care provider or an ENT (ear, nose, and throat) specialist, or otolaryngologist. They will examine your nose inside and out, and might recommend additional tests based on your individual needs. When there is clearly a crooked/deviated septum, and the symptoms are severe enough to warrant intervention, the ENT specialist may suggest surgery as an option if medical treatment fails.

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is typically not performed on young children, unless the problem is severe, because facial growth and development are still occurring. Septoplasty is a surgical procedure that is usually performed through the nostrils, so there is no bruising or outward sign of surgery; however, each case is different and special techniques may be required depending on the individual patient.

The time required for the septoplasty operation averages about one- to one-and-a-half hours, depending on the type of deformity. It can be done with a local or a general anesthetic, usually on an outpatient basis. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose. Surgery may be combined with a rhinoplasty that changes the outward shape of the nose; in this case swelling and bruising may occur. Septoplasty may also be combined with sinus surgery.

Are There Related Factors or Conditions?

• Inferior turbinate hypertrophy—turbinates are finger-like structures in your nose that warm and moisten the air you breathe, and sometimes the lower ones can get too big 
• Concha bullosa of the middle turbinate—this is when one of the turbinates next to your sinus openings gets a big air bubble in it
• Nasal valve collapse (internal or external)
• Sinusitis (acute, recurrent, chronic)  
• Headaches (contact point)  
• External nasal deformity (change in the shape of the nose)
• Decreased sense of smell

Are There Potential Dangers or Complications?

Sometimes a deviated septum may lead to repeated nose bleeds. If the blockage is severe, it may force mouth-breathing at night, which can worsen sleep disorders. However, potential complications from septoplasty (surgery) can include:

• Anesthesia complications
• Bleeding
• Infection
• Creation of a hole connecting the right and left sides of the nasal cavity (called a septal perforation)
• Numbness of the upper teeth and nose
• Cerebrospinal fluid leak (extremely rare)
• Change in the external shape of the nose

What Questions Should I Ask My Doctor?

1. I’ve been experiencing some of these symptoms. Is it possible that I have a deviated septum and, if so, how severe do you think it is?
2. Is there anything about my nose that might be interfering with my breathing? 
3. Are there any other conditions that may be contributing to my nasal congestion/obstruction? 

Copyright 2021. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Last reviewed April 2020.