Q. My husband has a deviated septum. The condition runs in his family, and both his mother and uncle had unsuccessful surgeries to correct theirs. As a result, he refuses to consider surgery. What can be done?
A. In people with a deviated septum, one nasal passage inside the nose is wider than normal and one is narrower. This alters the pattern of airflow in the nose and sometimes blocks airflow on the narrowed side.
The nasal septum is the wall between the left and right sides of the nose. It is firm but bendable. Ideally, the nasal septum should lie exactly in the center, forming two equal nasal passages. Yet in about 80 percent of us, the nasal septum is a little off-center. Most of us never notice this. Less often, the septum is more dramatically off-center.
A deviated septum can be a very uncomfortable condition. Like your husband, some people are just born with it. Others have a deviated septum caused by injury to the nose during birth or later in life. A blow to one side of the head can knock the nasal septum out of position.
Symptoms of a deviated septum can include:
• Blockage of one or both nostrils;
• Nasal congestion, sometimes on one side;
• Frequent nosebleeds;
• Frequent sinus infections;
• Facial pain, headaches, postnasal drip;
• Noisy breathing during sleep in infants and young children;
• Sleep interrupted by difficulty breathing, including an inability to sleep on one side (because sleeping on that side blocks breathing).
The first step for your husband would be to speak with an otolaryngologist (ear, nose and throat specialist) or plastic surgeon about treatment options.
Initial treatment usually involves medicines. Steroid nasal sprays may reduce nasal allergies. Such allergies can cause tissues in the nose to swell, which further narrows the nasal passage on the side of the deviated septum. Some people use over-the-counter nasal sprays, such as oxymetazoline. These can open up nasal passages for a few days, but if these sprays are used more than that, they can cause the nasal passages to close down again.
Sometimes surgery -- called a septoplasty -- is needed. In this procedure, the surgeon moves the septum to a normal position. In some cases, the surgeon also will reshape the external appearance of the nose in a procedure called rhinoplasty. When the two procedures are done at the same time, the surgery is called a septorhinoplasty.
Success rates for septoplasty are actually quite high, from the research I've read -- greater than 80 percent. Perhaps your husband's mother and uncle were just unlucky. I'd say it's worth it for your husband to try the surgery if he's uncomfortable enough to take action. And maybe you'll sleep better, too. Look for an ear, nose and throat surgeon who has done a large number of septoplasty operations in his or her career, and in the past couple of years, in particular. Practice does make perfect.
• Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: AskDoctorK.com.