Source: Cleveland Clinic, ENT Health (AAO-HNS)

• What is a deviated septum?
• Symptoms of a deviated septum
• Causes and risk factors
• Types and grades of septal deviation
• How a deviated septum is diagnosed
• Treatment options
• Recovery after septoplasty
• Complications
• Prevention and living with a deviated septum
• When to see a doctor
• FAQ
• Sources

What is a deviated septum?

A deviated septum is a nasal septum that sits off-center or is bent, so one side of the nose is narrower than the other. The septum is the thin wall of bone and cartilage that runs down the middle of the nose and splits it into two passages. Its surface is covered by a moist lining, the mucous membrane, which carries many small blood vessels. When the septum is perfectly straight, the two nasal passages are about the same size. When it leans, one passage, or parts of both, can become narrow enough to block airflow.

Source: Cleveland Clinic, ENT Health (AAO-HNS)

A slightly crooked septum is very common and usually harmless. Cleveland Clinic says about 8 in 10 people have a septum that is a little off-center, and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) gives a similar estimate of up to 80%. Most of these people never notice it. A septal deviation only becomes a medical problem when it is large enough to cause symptoms such as a blocked nose, nosebleeds or repeated sinus infections.

Source: Cleveland Clinic, ENT Health (AAO-HNS)

Research figures vary a lot because studies count different degrees of deviation. A 2022 narrative review in Cureus found reported prevalence ranging from 26% to 97% around the world. Studies using cone-beam CT reported rates up to 86.6%, with higher rates in older age groups. In short, some degree of deviation is normal; what matters is whether it affects breathing and daily life.

Source: Cureus review (PMC)

Symptoms of a deviated septum

Many people with a deviated septum have no symptoms at all. When symptoms do appear, the most common one is difficulty breathing through the nose. It is often worse on one side, and some people notice that the blocked side seems to switch. Other symptoms include:

• Nasal congestion or a stuffy feeling on one or both sides
• Nosebleeds, because the surface of the septum can dry out
• Repeated sinus infections, since a crooked septum can get in the way of normal sinus drainage
• Noisy breathing or snoring during sleep
• Breathing through the mouth during sleep (in adults)
• Noisy breathing during sleep in babies and young children
• Facial pain and headaches
• A reduced sense of smell

Source: Cleveland Clinic, ENT Health (AAO-HNS)

A severe deviation can also change how the nose looks. The nose may appear crooked or off-center, and the nostrils may be uneven or different sizes. Symptoms can be made worse by other nasal problems that often appear alongside a deviated septum, such as allergies or swelling of the turbinates, the curled structures on the side walls of the nose that warm and moisten the air you breathe.

Source: Cleveland Clinic, ENT Health (AAO-HNS)

Causes and risk factors

A deviated septum has three main causes. Some babies are born with it, and a difficult delivery can injure the septum. In others, the septum gradually leans to one side as the nose grows; Cleveland Clinic describes this as the most common cause. Finally, an injury such as a broken nose can push the septum out of place. The AAO-HNS adds that a deviation can also exist with no history of injury, fracture or unusual growth at all.

Source: Cleveland Clinic, ENT Health (AAO-HNS)

Research supports the idea that birth plays a role in some cases. The Cureus review cites a study of newborns in India in which about 20% had a septal deviation at two days of age, with higher rates after first births and instrument-assisted deliveries. The review also separates two patterns: developmental deviations, which tend to be smooth C-shaped or S-shaped curves, and traumatic deviations, which are usually more irregular and dislocated.

Source: Cureus review (PMC)

Risk factors

Anything that raises the chance of a blow to the face raises the chance of a deviated septum. Cleveland Clinic lists car accidents, contact sports, falls and fights. Snorting drugs such as cocaine can also damage the septum. A septum that is only slightly crooked can become more off-center with age.

Source: Cleveland Clinic

Types and grades of septal deviation

Doctors describe a deviated septum by its shape, its location and how severe it is. There is no single universal system, but two are often used in research.

• Mladina classification: seven types (I to VII) based on where the bend is and how it is shaped. Type VII is a combination of two or more of the other types; the Cureus review notes it was the most common type in older age groups.
• Three-degree grading: based on how far the septum leans toward the inferior turbinate. Degree I does not reach the turbinate, degree II touches it, and degree III touches and presses on it.
• Shape: deviations are often described as C-shaped (one curve) or S-shaped (two curves), and some include a bony spur.

Source: Cureus review (PMC)

The type matters for surgery planning. According to the same review, a clinical exam alone can underestimate some types, and imaging changed the surgical plan in most cases in the studies it reviewed. Deviations at the very front of the septum, near the nostrils, can be harder to correct; the review reports that removing, straightening and replacing the septum (extracorporeal septoplasty) worked better than standard repair for this kind of front-lower deviation.

Source: Cureus review (PMC)

How a deviated septum is diagnosed

A primary care provider or an ear, nose and throat specialist (ENT, also called an otolaryngologist) can diagnose a deviated septum. The visit usually starts with questions about your symptoms and any past nose injuries or surgeries. The doctor then looks inside the nose with a lighted instrument and a nasal speculum, a small handheld tool that gently opens the nostrils. Often a decongestant spray is used first to shrink the lining so the septum can be seen clearly.

Source: Cleveland Clinic, ENT Health (AAO-HNS), Cureus review (PMC)

Further tests may include:

• Nasal endoscopy: a thin camera passed into the nose to see the back of the nasal passages, the turbinates and the sinus openings.
• CT scan: shows the bone and cartilage in detail, as well as the sinuses.
• Airflow tests: such as acoustic rhinometry and rhinomanometry, which measure how open the nose is and how much air passes through.

Source: Cleveland Clinic, Cureus review (PMC)

Doctors also look for other causes of a blocked nose that often occur at the same time. The AAO-HNS lists enlarged lower turbinates, an air pocket in a middle turbinate (concha bullosa), collapse of the nasal valve, and sinusitis. Finding these matters because they can be treated at the same time and may explain why symptoms continue. Cleveland Clinic describes a simple check you can try at home, closing one nostril and breathing in, then the other, but only a provider can confirm the diagnosis.

Source: ENT Health (AAO-HNS), Cleveland Clinic

Treatment options

Most people with a deviated septum need no treatment. If symptoms are mild, the first step is to treat the swelling and congestion that make a narrow passage feel worse. This does not straighten the septum, but it can make breathing easier.

Source: Cleveland Clinic, ENT Health (AAO-HNS)

Medicines

• Nasal steroid sprays: reduce swelling of the nasal lining.
• Antihistamines: help when allergies add to the congestion.
• Decongestant sprays: give short-term relief, but Cleveland Clinic advises not to use them for more than three days in a row because they can cause rebound congestion.

Source: Cleveland Clinic

Septoplasty

Septoplasty is surgery to straighten the septum, and Cleveland Clinic calls it the only way to actually correct a deviated septum. The AAO-HNS describes it as the preferred surgical treatment. Surgery is usually considered when the septum is clearly crooked, the symptoms are significant, and medical treatment has not helped. The surgeon works through the nostrils, lifts the lining off the septum, then removes, reshapes or repositions the bent bone and cartilage before laying the lining back. Splints, soft packing or dissolving stitches hold everything in place while it heals.

Source: Cleveland Clinic, ENT Health (AAO-HNS), ASPS

The operation usually takes 30 to 90 minutes according to Cleveland Clinic; the AAO-HNS gives an average of about 1 to 1.5 hours depending on the deformity. It is done under general anesthesia, local anesthesia or intravenous sedation, and most people go home the same day. Because the work is done inside the nose, there is usually no visible scar. A turbinate reduction or sinus surgery may be done during the same operation. A 2023 meta-analysis of 13 randomized trials with 735 patients found that endoscopic septoplasty, done with a small camera, caused less bleeding and was faster than the conventional approach, although most included trials were small.

Source: Cleveland Clinic, ENT Health (AAO-HNS), ASPS, Ann Med Surg meta-analysis (PMC)

How well does septoplasty work?

The best evidence comes from the NAIROS trial, published in The BMJ in 2023. It randomly assigned 378 UK adults with at least moderate nasal blockage from a deviated septum to septoplasty or to six months of steroid and saline nasal sprays. At six months, symptom scores (SNOT-22) were 19.9 after surgery versus 39.5 with sprays, a gap more than twice the 9-point difference considered meaningful to patients. At 12 months, the benefit was smaller but still present (21.2 versus 30.4). The authors concluded that adults with this problem should be offered septoplasty.

Source: BMJ (NAIROS trial)

Smaller studies point the same way. The Cureus review reports satisfaction rates after septoplasty for nasal blockage ranging from 50% to 100% across studies, and about 70.6% of patients in one study said their sense of smell improved.

Source: Cureus review (PMC)

Rhinoplasty and septorhinoplasty

Rhinoplasty reshapes the outside of the nose. The American Society of Plastic Surgeons (ASPS) notes that it can also correct breathing problems caused by structural defects, and it names a deviated septum as one of the most common causes of impaired breathing. When a person wants to change the shape of the nose and fix a blocked airway, septoplasty and rhinoplasty can be done in one operation, often called septorhinoplasty. In combined or difficult cases, the surgeon may use a small cut across the columella, the strip of skin between the nostrils. Combined surgery can cause more swelling and bruising than septoplasty alone.

Source: ASPS, ASPS, Cleveland Clinic, ENT Health (AAO-HNS)

Children

Sources differ on timing. Cleveland Clinic says surgery for children is usually delayed until the mid-teens, when the nose has finished growing, and the AAO-HNS says it is usually avoided in young children unless the problem is severe. The Cureus review, however, cites research supporting earlier correction in selected children to improve outcomes and preserve cartilage. Decisions for children are made case by case with an ENT specialist.

Source: Cleveland Clinic, ENT Health (AAO-HNS), Cureus review (PMC)

Recovery after septoplasty

Recovery after septoplasty is usually quick compared with many other operations, though the inside of the nose keeps healing for months. Pain is usually mild to moderate and fades within a few days. Bloody drainage, a stuffy nose, mild headache, swelling and a feeling of fullness in the ears are common early on.

Source: Cleveland Clinic

Time after surgery	What to expect (Cleveland Clinic)
Day of surgery	Most people go home the same day
First 2 days	Gauze under the nose until drainage stops
About 1 week	Follow-up visit; splints or packing that have not dissolved are removed; light activity such as walking
1 to 2 weeks	Initial recovery; avoid blowing your nose and spicy food
About 1 month	Return to strenuous activity
Several months	Bone and cartilage fully heal

Source: Cleveland Clinic

Typical aftercare advice includes sleeping on your back with your head raised, sneezing with your mouth open, using saline rinses, and avoiding aspirin, ibuprofen and naproxen around the time of surgery unless your surgeon says otherwise, because they raise bleeding risk.

Source: Cleveland Clinic

Complications

Complications of the condition

A significant deviation that is left untreated can lead to long-term sinus infections (chronic sinusitis), a constantly blocked nose, dry mouth from mouth-breathing, and repeated nosebleeds. Severe blockage that forces breathing through the mouth at night can make sleep problems worse, and Cleveland Clinic lists sleep apnea among possible complications. In children, it may be linked to frequent or long-lasting ear infections. Studies summarized in the Cureus review also link septal deviation with headaches and higher rates of anxiety and depression, but these are associations rather than proof of cause.

Source: Cleveland Clinic, ENT Health (AAO-HNS), Cureus review (PMC)

Risks of septoplasty

Serious complications are rare. Possible risks include bleeding, infection, a hole in the septum (septal perforation), a collection of blood in the septum (septal hematoma), scarring inside the nose, a reduced sense of smell, temporary numbness of the upper teeth and nose, and a change in the outer shape of the nose. Toxic shock syndrome and a leak of the fluid around the brain are very rare. In the NAIROS trial, 4% of patients who had septoplasty were readmitted with bleeding and 12% needed antibiotics for an infection. The Cureus review cites one series with infection in 3.3% and nosebleeds needing treatment in 4.5% of patients.

Source: Cleveland Clinic, ENT Health (AAO-HNS), BMJ (NAIROS trial), Cureus review (PMC)

Prevention and living with a deviated septum

You cannot prevent a deviated septum that is present from birth or develops as the nose grows. You can lower the chance of an injury-related one by protecting your face: wear a seatbelt in the car, and use a helmet and a face guard or midface mask for contact sports. Avoiding snorting drugs also protects the septum.

Source: Cleveland Clinic

Most people with a mild deviation live normally and need nothing more than occasional treatment for congestion. Cleveland Clinic notes that a deviated septum usually does not affect quality of life. Keeping allergies under control, using saline sprays when the nose is dry, and using decongestant sprays only for short periods can help keep symptoms in check. If you have a nose injury, do not try to push the septum back into place yourself.

Source: Cleveland Clinic

When to see a doctor

See a doctor if a blocked nose is affecting your breathing, sleep or daily life, if you have frequent nosebleeds, or if you keep getting sinus infections. Useful questions to ask include how severe the deviation is, whether anything else in the nose is adding to the blockage, and whether medicines or surgery are the better choice for you.

Source: Cleveland Clinic, ENT Health (AAO-HNS)

Source: Cleveland Clinic, Cleveland Clinic

Related treatments

Deviated septum: frequently asked questions

Sources

1. Cleveland Clinic — Deviated Septum: Symptoms, Causes & Treatment
2. Cleveland Clinic — Septoplasty: Procedure & Recovery
3. ENT Health (AAO-HNS) — Deviated Septum
4. Cureus (PMC) — Nasal Septal Deviation: A Comprehensive Narrative Review (Alghamdi et al., 2022)
5. Annals of Medicine and Surgery (PMC) — Endoscopic septoplasty versus conventional septoplasty for nasal septum deviation: a systematic review and meta-analysis of randomized clinical trials (2023)
6. BMJ Group — Surgery more effective than nasal sprays for symptoms of a crooked septum (NAIROS trial, BMJ 2023)
7. ASPS — Septoplasty
8. ASPS — Septoplasty Procedure Steps
9. ASPS — Rhinoplasty

This page is part of the Morepital medical reference. It is for general health education and does not replace a consultation with a qualified doctor. Last reviewed: October 2026.