(Crooked septum) Scoliosis of the nasal septum
Scoliosis of the nasal septum (crooked septum) is a condition in which the septum, the cartilage and bone that separate the middle of the nose, is out of position or deviates to one side.
In fact, most people have some degree of a misaligned septum (about 80%) without knowing it, since they have never felt any noticeable discomfort. In them it is usually discovered incidentally during clinical examination by their otolaryngologist. However, there are also cases of patients with severe symptoms, which are attributed to significant scoliosis of their diaphragm. Often, scoliosis is accompanied by swelling of the nasal conchae, the fleshy structures that are normally present in the nose and help to ensure a smooth swirling flow of air, its cleansing and humidification.
Symptoms
The most common symptom is nasal congestion, with one side of the nose suffering more severely than the other on an almost daily basis, while in case of illness (common cold, rhinitis) the symptoms intensify and breathing through the nose becomes very difficult.
Difficulty in breathing may be evident during exercise, when the air inhaled through the nose is not sufficient and the patient has to breathe through the mouth, as well as during sleep, where a crooked diaphragm may be largely responsible for heavy breathing and snoring. In severe cases, it may even contribute to the occurrence of sleep apnoea, in which the patient, while snoring heavily, suddenly stops breathing for a few seconds and then, taking a deep breath, resumes his noisy sleep.
Recurrent or recurrent sinus infections (sinusitis) may be due to the crooked septum, since the disturbed anatomy of the inside of the nose can lead to blockage of the sinus drainage orifices, resulting in the accumulation of microbes and mucus and the creation or maintenance of inflammation.
Nosebleeds (bleeding from the nose) are common, as the inhaled air does not flow smoothly, causing the mucous membrane to dry out and become more sensitive. Other symptoms may include facial pain, headache and runny nose.
Diagnosis of a crooked septum
After taking a detailed history, a clinical examination is performed with an anterior rhinoscopy to check the position of the septum. An endoscopic examination of the nose is then carried out and the septum is checked along its entire length, the orifices of the paranasal sinuses are examined for their patency and the size of the nasal cones. Radiological examination in this way is not necessary for the diagnosis of a crooked septum. A CT scan may be requested in cases where endoscopic examination reveals other pathology (e.g. nasal polyps).
Causes
Trauma is the most common exogenous factor. Facial injuries and nasal fractures are often mentioned in the patients' history, even if they occurred at an early age. Moreover, the septum takes its final form towards the end of adolescence, when the formation of the nose is completed. However, in many patients there is no history of trauma, so the crooked septum is considered an anatomical defect.
Treatment of a crooked septum
In cases of minor deviated septum, nasal sprays combined with saline or hypertonic solution nasal washes can provide relief and make nasal breathing easier. However, if the septum is quite obstructed, then the treatment is surgical with straightening of the nasal septum.