Generality
The nose consists of two distinct parts: an external, palpable and raised part called the nasal pyramid, and an internal one represented by the two nasal pits (or cavities). The latter communicate with the outside through the nostrils and are sagittally separated by a thin osteo-cartilaginous lamina, called the nasal septum .
The deviated nasal septum is, in many situations, asymptomatic (ie it does not cause any disturbance), but in some cases it can lead to different manifestations, such as frequent epistaxis, disturbed sleep, respiratory disorders, etc.
The diagnosis is generally based on an accurate physical examination.
If the ailments are unbearable, it is necessary to resort to septoplasty, or surgery for the straightening of the deviated nasal septum.
What is the deviated nasal septum?
The deviated nasal septum is a disorder that occurs when the osteo-cartilaginous lamina interposed between the two nasal cavities undergoes a deviation to the right or to the left.
This deviation, in many people, narrows the channel of the affected nostril, reducing the flow of air through it. If this reduction is so severe as to constitute a real impediment to the passage of air, we speak of nasal obstruction (or nasal congestion) of pathological type.
The deformities caused by the deviation of the nasal septum are permanent.
WHAT IS NASAL (OR NASAL) PATHOLOGICAL INSTRUCTION?
The pathological nasal obstruction, more commonly known as pathological nasal congestion or stuffy nose, is a very common respiratory disorder, which can arise for one or more of the following reasons:
- Accumulation of mucus inside the nasal cavities (due, for example, to a cold, to an allergy, to a form of sinusitis, to rhinorrhea, etc.)
- Inflammation of the lining tissues (mucosa) of the nasal cavities
- Deviated nasal septum
- Gastric reflux
- Nasal polyposis
- Adenoid enlargement
Causes
The nasal septum can be deviated from birth, or it can deviate in the course of life, due to a traumatic event that damages the nose.
Furthermore, as we will see later, aging also plays a decisive role.
SEPTAL NASAL DEVIATED TO BIRTH
The deviation of the nasal septum, present from birth, can be the effect of an event that occurs during fetal development (a totally imponderable eventuality), or the consequence of a problematic birth.
In these situations, in general, the deviation is not so obvious and problematic; however, it can become so throughout life, due to aging or one or more repetitive traumas.
Special case . Some individuals, who are born with serious genetic diseases such as Marfan syndrome, homocystinuria or Ehlers-Danlos syndrome, may have, among various pathological features, the deviated nasal septum.
SEPTAL NASAL DEVIATED FROM TRAUMA TO THE NOSE
In most cases, the deviated nasal septum arises as a result of traumatic episodes, which occur during childhood, adolescence and adult life.
When you are small or adolescent, the most common causes are involuntary falls or clashes with other peers during a game.
When you are an adult, on the other hand, the most common reasons are sports injuries (especially in contact sports, such as soccer, rugby, boxing, etc.), domestic ones and road accidents (especially those where you don't wear a seat belt) .
SEVEN DEVELOPED NASAL AND AGING
Most common risk factors:
- Contact sports (football, rugby, boxing, etc.)
- Road accidents, especially those in which the driver does not use seat belts
Less common risk factors:
- Particular congenital diseases (Marfan syndrome, homocystenuria, syndrome)
The normal aging process influences the anatomy of the nasal cavities, worsening, in some cases, the deviation of the nasal septum and making it problematic. This process translates into the need, in adulthood, to resort to surgery, although significant traumatic events have never occurred.
Symptoms and Complications
In many cases, the deformities of the deviated nasal septum do not cause any symptoms, so that patients do not even know they are affected.
In other people, however, they can give different ailments, some even very annoying:
- Obstruction of one or both nostrils . The deviation of the nasal septum can be so accentuated that the patient breathes with difficulty. This possibility may affect one or both nostrils. Often, the problem is accentuated by the onset of a cold or an allergy, as they further restrict the passage for air.
- Frequent nose blood (epistaxis) . Due to the deformity of the septum, the lining tissues of the nasal cavities (the mucosa) dry out, increasing the risk of epistaxis, or blood from the nose.
- Facial pain . It seems (but is still debating the veracity of this hypothesis) that the deviated nasal septum causes pain in the face, on the same side where the nostril is partially occluded.
- Respiratory disorders in sleep . In particular, babies and children suffer. Often, they are the result of the simultaneous presence of a deformity of the nasal septum and an inflammation of the tissues lining the nasal cavities.
- Awareness of the nasal cycle . The nasal cycle is a physiological process of humans and other animals, during which the nasal cavities alternate with congestion and decongestion. In other words, the nostrils are never pervasive at the same time, but once the one on the right is, another time it is the left one. A special feature of this process is the fact that it is completely imperceptible. When suffering from a deviated nasal septum, however, one can see how the nasal cycle unfolds.
- Sleep preferably on one side of the body . Some patients find that they sleep better on either side of the body, as this position allows them to breathe better.
COMPLICATIONS
A very deviated nasal septum can be the cause of the situation that was previously defined as pathological nasal congestion .
The latter, when it occurs, involves one or more of the following complications: dry mouth, sense of pressure to one of the nasal cavities and disturbed sleep .
The so-called dry mouth (or xerostomia ), is caused by the fact that the patient, unable to breathe effectively through the nose, constantly breathes through the mouth.
Similarly, disturbed sleep also depends on poor breathing: the patient cannot find a position in the bed that is conciliatory with sleep.
WHEN TO REFER TO THE DOCTOR?
It is advisable to consult your doctor, for a consultation, when you develop continuous sinus infections, when you are subjected to repeated episodes of epistaxis or, finally, when the blocked nose does not improve with the various sprays and decongestant medicines.
This last case deserves special attention: the deviated nasal septum is, as has been said, a permanent condition, therefore the nasal congestion, which could derive from it, is equally so; on the contrary, a nasal obstruction caused by inflammation of the mucosa is a temporary situation, which can be cured with decongestant sprays and appropriate drugs.
Diagnosis
The most adopted procedure, to diagnose the deviated nasal septum, is to subject the patient to an accurate physical examination and ask him to describe all the symptoms felt.
During the check-up, the doctor uses a very bright light and a special instrument, called a nasal speculum, capable of opening the nostrils well. It is very common for the nasal cavities to be observed both before and after a decongestant treatment, so that one can see what the appearance of the internal tissues of the nose is.
In some particular cases, a more invasive diagnostic examination is required than the simple objective examination: nasal endoscopy .
Deepening: what is nasal endoscopy?
Nasal endoscopy is a minimally invasive diagnostic procedure, through which the structures and inner lining of the nasal cavities are observed in detail. It involves the use of an endoscope, that is a thin rigid tube equipped, at one end, with a light source and a video camera; this device, once light and camera have been put into operation, projects the images of what "sees" on a monitor.
Nasal endoscopy is not particularly painful, however it can be annoying, especially if the patient suffers from a deviated nasal septum or severe inflammation of the internal mucosa.
It lasts about 20 minutes and requires, before execution, a decongestant treatment and the use of a local anesthetic.
Treatment
The only way to correct the deviated nasal septum, when it creates unbearable disorders, is by surgery, known as septoplasty .
Pending the operation, very often the patient is subjected to some pharmacological treatments, such as nasal decongestants, antihistamines etc., which relieve symptoms and allow relief, at least temporarily.
PHARMACOLOGICAL TREATMENT WAITING FOR THE INTERVENTION
The drugs, reported below, do not heal from the deviated nasal septum, but they are, however, a good temporary solution.
You can use:
- Decongestants . In the form of pills or sprays, these medicines reduce the thickness of the inner lining tissues of the nose. This guarantees a wider opening of the nostrils and a better passage of air through them.
Side effects: frequent use can be addictive and / or worsen the intensity of symptoms once their intake is stopped. They also cause anxiety, high blood pressure and tachycardia. For all these reasons, it is best to take these medicines with extreme caution.
- Antihistamines . They are usually taken to prevent allergies and some associated disorders, such as itching of the nose and nasal obstruction, but they can also have beneficial effects in the case of colds and other non-allergic events.
Side effects: they can make you sleepy, therefore, before you start driving a vehicle or doing other similar activities, you should not use them.
- Cortisonic spray . Cortisone, which is the active ingredient of these drugs, is a powerful anti-inflammatory. Cortisonic sprays are particularly suitable when the patient suffers not only from a deviated nasal septum but also from an inflammation of the internal tissues of the nose.
Side effects: cortisone-based medicines cause many side effects, from osteoporosis to diabetes, from hypertension to increased body weight. Therefore, it is generally advisable to hire them for a limited period of time, ranging from a minimum of one to a maximum of three weeks.
SURGICAL INTERVENTION: THE SETTOPLASTICA
During septoplasty, the surgeon straightens and repositions the deviated nasal septum in the center of the nasal cavities.
The procedure can be performed under general anesthesia or under local anesthesia, based on the characteristics of the patient (age, allergies to anesthetic drugs, etc.) and the intentions of the operating surgeon.
Septoplasty guarantees excellent results, even if, obviously, the best benefits are those who have only a slightly deviated nasal septum.
Important note : Septoplasty does not solve the problem of allergic manifestations, such as a stuffy nose and an itchy nose. These, in fact, occur independently of the deviated nasal septum; therefore, those who are habitually subject to it will continue to be so even after septoplasty.
Prognosis
Who wants to recover from the disorders caused by the deviated nasal septum, can only resort to the intervention of septoplasty. This intervention is safe, effective and is an outpatient type, therefore the prognosis is positive.
On the other hand, anyone who exhibits a deviation of the nasal septum does not show any symptoms, can even do without the intervention.
PREVENTION
Wear the appropriate protections during contact sports, put the seat belt in the car, proceed with caution during household chores, etc., are the most recommended precautionary measures to prevent the deviated nasal septum or its deterioration.
