Introduction

There are numerous causes of nasal congestion, a few examples include allergies, inflammation, environmental influences, growths such as polyps and structural changes. Nasal congestion has been described as difficulty in nasal breathing, due to an increased vascular thickness of nasal mucosa.¹

One type of structural change is a deviated septum, that is defined as a deviation of the nasal septum from its normal position that results from a developmental abnormality or trauma and it may be asymptomatic or cause nasal obstruction and predispose to sinusitis and nosebleed.² Understanding the importance of the connection between nasal congestion and a deviated septum will help to identify some symptoms shown and the options available for the ones who may be experiencing these issues. 

How are a deviated septum and nasal congestion connected?

To understand this, first one needs to understand the basic anatomy of a nose. The basic structure of a nose is made up of three parts – the nasal septum, turbinates and nasal passages.

• The turbinates are bony structures whose main role is to filter, warm and add moisture to our. air
• The nasal passages lead on from the nasal cavity, which consists of cartilage and tissue, that are shaped to create valve-type structures that control the flow of air through the nose. The more narrow the cavity is, the harder it is for the air to flow through. This airflow is vital to the nose function but with nasal congestion, this function can be lost³      
• The nasal septum is the partition that divides the nasal cavity into two equal areas and is formed from cartilage and bone. It forms the nasal passages⁴ 

With these parts functioning correctly, a person is able to draw breath through their nose rather than the mouth. By passing air through this filtering system it reduces the chances of causing infection compared to breath taken via the mouth.

Nasal congestion

Nasal congestion can lead to difficulty breathing through the nose, making the person use the mouth to breath. It causes an unpleasant high pressure feeling in the nose.

Mucus contributes to maintaining balance within the nasal cavity because of both chemical and physical contributions. With the disturbance in n this balance, rhinitis, rhinosinusitis, and some other upper respiratory tract and lower respiratory tract disorders may appear.³

The changes in the mucosa seen in a person with a deviated septum can vary depending on the shape and position of the abnormality. Both sides show a change in the mucosa such as the nasal cavity with the reduced space may have an increased number of inflammatory cells with a decreased ability to clear mucus formed. The larger of the nasal cavities can also show issues such as mucosal thinning from forming of the deviation. This means that mucus formed is commonly seen and often complains about the symptoms with a deviated septum that cause the feeling of pressure in the nose.

Deviated Septum

Deviated septums are found in up to 80% of the population according to the American Academy of Otolaryngology. The degree of deviation varies widely and therefore the impact on a person also varies. The most common causes are developmental, autoimmune conditions or trauma related. Developmental issues can arise from even before birth, if pressure is applied to the developing nose in the womb right up to old age related causes where weakening in the cartilage can cause changes in the nose structure. Trauma cases are typically caused by blunt force to the nasal area of the face due to sports or a traumatic accident.⁵

Besides nasal congestion,  other symptoms that can lead to a suspicion of a deviated septum. These symptoms are nasal obstruction and/or discharge, headaches and/or facial pain, nosebleeds, snoring and sore throats.⁵ 

As a diagnosis, the doctor gets several tests done. The doctor before examining asks for the concerns and symptoms and goes for a clinical examination. He examines the external nose and then looks into the nasal cavities with the help of a speculum, widens the cavities to find out any visible deviation.

Following this, there are several further imaging options which include;

• Nasal endoscope examination. (passing a small camera up the nasal cavities)
• Acoustic rhinometry, the sound reflections are used to help ‘map out’ structures in the nose.
• Rhinomanometry,the use of pressure and airflow measurements the amount of resistance in the nasal structures can be produced
• Nasal sound spectral analysis where sound is again used but this time to measure airflow affecting the turbinates

All these methods have pros and cons, that the doctor decides as to which test or combination of tests can be used for the investigation of deviated septum. More advanced imaging such as CT and MRI scans can also be used, however, these come with a significant cost, additional radiation exposure and are less available without providing much more useful information then the other tests.⁶

Treatment options

Non surgical options

Once a deviated septum has been diagnosed and the severity has been established by the doctor, the next is the most appropriate treatment for that patient. There are both surgical and non surgical options available and several options may be used together as part of a plan to resolve the symptoms.

Non surgical options are medications that may help with the causes of the inflammation or treat the inflammation itself. A non medicinal approach would be to start using a saline nasal rinse. The saline is used to wash through the nasal cavity. The benefits include helping to add moisture to the mucosal surfaces, clearing out any allergens present and clearing out any mucosal build up which can cause congestion or a runny nose.

The most common medications that may be used are;

• Decongestants –which will help with the congestion caused by the build up of mucous
• Nasal steroids – which will help to reduce the inflammation of mucosal lining
• Antihistamines – which will help with the inflammation caused when the nasal mucosa comes in contact with something the body reacts to an allergen

It is possible that some of these treatments may be used initially before the decision to have surgery.

Surgical Options

Septoplasty is the main surgical choice to correct a deviated septum, where the deviation will be corrected by the septum being moved back to a central position, or as close to centre as possible, in the nasal cavities. The operation is carried out under general anaesthesia. The incisions are made within the nose meaning that is an internal incision. Typically the patient needs to be in the hospital for a day of the surgery.

It is usually advised to rest for two weeks after surgery. It can take up to three months to have a full recovery but generally the surgery has a high success rate. Septal surgery - ENT UK⁷ People who suffer with nasal congestion and suspect that it may be due to a deviated septum should seek medical advice if one or more of the mentioned symptoms affects regularly and negatively impacts their life.

Summary

Nasal congestion can be a frustrating and painful condition for the people who experience it. By working out the cause of the congestion, it can help to find out how best to deal with it and relieve the symptoms to some degree. When this congestion is caused by a deviated septum, it is good to know that there are options to help minimise its impact on day-to-day life or to resolve it completely.