How to Understand the Signs & Diagnose a Deviated Septum

A test being performed to diagnose a deviated septum


The symptoms which you may notice due to a deviated septum occur because of the direct and indirect effects on the proper nasal function because of the deviation. First some background information on the types of deviated septum’s which are present.

Classification of Deviated Septum’s

  • Impaction: This condition is marked by an angulation of the nasal septum, this occurs with a spur which is in contact with the lateral wall. Usually this obstructed space is not freed even after vasoconstriction, thus surgery is the only option.
  • Obstruction: If the nasal septum deviation touches the lateral wall of the nose it is known as obstructive deviated septum. Here no surgery is required; vasoconstriction will suffice as a cure.
  • Simple Nasal Deviation: This is the commonest condition which is encountered. Here there is no need for any type of treatment. Only a mild deviation of the nasal septum will be present.

Rhinoscopy & Other Tests for a Deviated Septum

Do you suffer from a Deviated Septum?

A septal deviation will be evident clearly when an anterior rhinoscopy is done. This is usually done without the insertion of a speculum, since its insertion will cause the nasal septum to straighten out. Similarly when the tip of the nose is lifted up, any deviation will be clearly visible to the naked eye. Sometimes, the nasal obstruction may be present in the opposite side of the deviated septum, a condition known as paradoxical nasal obstruction. This occurs due to hypertrophied turbinates.

Another major sign is heavy obstruction, this occurs when the deviation occurs in the region of the nasal valve. This occurs since this region of the nose is the narrowest. Usually a cottle rest is done to identify this. If narrowing is present, the cottle test will give a positive result. This test starts by asking the patient to pull his or her cheek outwards, this is supposed to open up the area to relieve blockage. When the exam is done, attention will be paid to both the nasal septum as well as the lateral wall of the nasal cavity.

However if recurring sinus infections occur, and sinusitis is suspected due to a obstruction of the sinus drainage channel, a X-ray must be done to diagnose the condition.

If you suspect that your new born child has a deviated septum, then check for any asymmetry of the nostrils such as an oblique columella and a tip which points in the opposite direction to the deviation. Children are usually diagnosed by using a Gray’s struts. Struts like these are usually 2mm thick and 4mm wide. They are usually lubricated and inserted into the nostrils of the child backwards along the floor of the nasal cavity.

Author: Perumal G.

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