Nasal Septal Deviation: Symptoms, Treatment and UK GP Advice

The nasal septum is the structure made of bone and cartilage that divides your nasal cavity into two equal halves. In a perfect scenario, this wall sits exactly in the middle, allowing for even airflow through both nostrils. However, it is estimated by NHS England sources that up to 80% of people have some degree of septal deviation, though most do not realise it.

A deviated septum occurs when this wall is significantly off-centre, making one nasal passage smaller than the other. When the deviation is severe, it can block one side of the nose and reduce airflow, leading to a range of respiratory and ENT concerns. This condition can be present from birth (congenital) or result from an injury, such as a broken nose sustained during contact sports or a fall.

While many people live with a slightly deviated septum without any issues, more pronounced cases typically present with specific symptoms. Patients in the UK often report the following:

• Nasal Obstruction: Difficulty breathing through one or both nostrils, which may feel worse when you have a cold or hay fever.
• Frequent Nosebleeds: The surface of a deviated septum can become dry, increasing the risk of bleeding (epistaxis).
• Facial Pain or Headaches: Severe deviation can lead to pressure on the internal nasal walls.
• Noisy Breathing and Snoring: Restricted airflow often leads to mouth breathing and vibrations in the throat during sleep.
• Preference for Sleeping on a Specific Side: Some patients find they must sleep on a particular side to optimise breathing through the 'open' nostril.

Before considering surgery, British clinical guidelines often suggest conservative management to alleviate the swelling of the nasal lining (mucosa), which can exacerbate the feeling of blockage. You might find relief through:

Nasal Saline Irritation

Using a saline douche or 'neti pot' can help clear crusting and mucus from the nasal passages, making breathing feel clearer.

Over-the-Counter Medications

Antihistamines or decongestants may be useful if you also suffer from allergies. However, NICE (National Institute for Health and Care Excellence) warns against the long-term use of over-the-counter decongestant sprays, as they can cause 'rebound congestion' (rhinitis medicamentosa).

Environmental Adjustments

Using a humidifier in the bedroom or elevating the head during sleep can sometimes reduce the impact of nighttime congestion.

If your nasal congestion is persistent and does not respond to simple pharmacy treatments, it is time to seek professional advice. Speaking to an online doctor in the UK is a convenient way to start this journey. During an online consultation, you can discuss the history of your symptoms and any previous trauma to the nose.

An online GP can provide medical advice on using prescription-strength nasal steroid sprays, which are often the first line of treatment to shrink the nasal lining and improve airflow. If these treatments are ineffective over a period of 4 to 6 weeks, the doctor can facilitate a referral to an Ear, Nose and Throat (ENT) specialist for a physical examination using a nasal endoscope. They can also provide a sick note if your symptoms or subsequent treatments require time off work.

If conservative measures fail, the definitive treatment is a surgical procedure called a septoplasty. Under NHS guidelines, surgery is usually reserved for cases where the deviation causes significant functional problems, such as severe airway obstruction or recurrent sinusitis.

The surgery is typically performed under general anaesthetic as a day case. The surgeon works through the nostrils, making an incision in the septum and repositioning the bone or cartilage. Unlike a 'nose job' (rhinoplasty), a standard septoplasty is designed to improve breathing rather than change the outward appearance of the nose, although the two procedures can sometimes be combined (septorhinoplasty).

Leaving a severe deviation untreated can lead to secondary health issues. One common complication is chronic sinusitis, where the sinuses cannot drain properly due to the physical blockage, leading to repeated infections. Furthermore, impaired nasal breathing often leads to chronic mouth breathing, which can cause a persistently dry mouth and contribute to dental issues or sleep apnoea over time. Finding a suitable treatment path early can prevent these long-term impacts on your quality of life.