Feb 23, 2021

Interviewer: You have a deviated septum. Should you get surgery to fix that?

Dr. Marc Error is an ENT at University of Utah Health. And Dr. Error, I'm going to go ahead and throw myself into this. I was in a doctor's office one time and they commented that, "Oh, you've got a deviated septum. Did you break your nose?" And I don't remember ever breaking my nose, but I definitely do notice if I push on one side and try to breathe, it's harder than the other side. Should I come see you and have that fixed?

Dr. Error: A deviated septum can definitely make it more difficult to breathe through one side or the other. The septum is the curtain between the left and the right nostril. And it starts at the very front and travels all the way to the very back of the nose where it ends and opens up into one big cavity. And if that divider is crooked at all, it can block off one nostril or even both if it has an S-shaped deformity to it. So, if you're having trouble breathing through your nose and that bothers you, absolutely, you should have that checked out because that is something that can be repaired and fixed and made so that you can breathe easier through both sides of your nostril.

Interviewer: So that was something I had never considered before. I do notice when I have allergies, so sometimes when I'm having allergies or have a cold, then it's really difficult to breathe through that right nostril. But I don't know, I mean, tell me a little bit about the surgery so I could weigh the pros and the cons. If I was to come into your office and give you the same scenario I just gave you, where would that conversation between us start?

Dr. Error: Well, first of all, we'd really need to assess what's going on completely with the nose. A deviated septum, which is what a septoplasty does and corrects can only be a piece of the puzzle. The nose is a complex organ that has many potential areas that can cause nasal obstruction. And you alluded to the fact that it does change. You know, when you have a cold or when you have allergies, you notice that it's even worse. And this is because there's other structures in the nose that are swelling and causing trouble. Those structures are called turbinates, much like they come from the Latin word turbine that have to do with mixing of air. And these are structures that we all have that are there to humidify air, but over time or if they become irritated, they can get too big and they can block your nose.

So, first of all, we'd really have to assess your nose and say, "What's contributing to your problem? Is it the septum alone? Is it the turbinates?" There's also some cartilages in the nose that can be a little bit weak or floppy. When you breathe in, it creates negative pressure and that can make it so that it's a little bit . . . if those cartilages don't hold the nasal soft tissues open, it can make your nose collapsed. And so these are things that we would take a look at and really assess, why are you having troubles through your nose?

Once we figure that out, the first line treatment for anybody with difficulty breathing through your nose and you included, Scot, would be using a nasal steroid spray regularly. Something like a Flonase or a Rhinocort or fluticasone. There are many that are over-the-counter. These are safe to use long term. They do have some local side effects where they touch or where you put them in the nose, where they can dry out the nasal linings and cause some nasal bleeding. So you have to watch for that, but these ones are safe to use long term.

They work by reducing inflammation in the nose. They don't change the cartilage and the structure of a deviated septum, but they can make it so there's less inflammation and there's more room for air to flow. These take a long time to work, three to four weeks at a minimum to really get the maximum benefit and many people, including myself, if we're to get throwing ourselves into this, I use it pretty regularly because my nose gets plugged, but I can use that and it opens it up enough that I do okay.

But if the nasal steroid spray is inadequate at helping you breathe better through your nose, at that point we'd explore interventions and invasive interventions to help you breathe better, such as a septoplasty or a turbinate reduction or a combination of those procedures to help you open up the nose and breathe better.

Interviewer: So, and my original thought here was, you know, the physician that I saw, this was just a very casual diagnosis, right? So it might not even be accurate, but it looks like you broke your nose. I've noticed that my right nostril seems smaller. I have difficulty breathing. Is that really even a deviated septum is causing that, or is that because I broke my nose and something else is going on?

Dr. Error: No, that is most likely a deviated septum. When you break your nose, you know, we discuss the nose as a complex structure. You know, it's complex three-dimensional structure. And if you break the nasal bones, that frequently will cause influence and may cause a shifting of the septum over to one side or the other.

Kind of a check to see if you have a deviated septum is just as you had mentioned, if one side is more plugged than the other. That usually is a sign that that septum is pushed over. And it tends to be that it's always one side or the other. Like you mentioned, your right side is usually worse than the left side. That's a sign of a deviated septum.

Now, a lot of people will have something where one side is always plugged, but it switches. It goes from right to left. And even if they lay down, they may notice that the side that's closer to the floor, we call it the dependent side swells shut, and if they flip to the other side, the other side swells shut. That's a sign of something else going on in the nose called turbinate hypertrophy or turbinate growth. The turbinates will switch from one side to the other, and those are predominantly treated with, as we discussed, the nasal steroid spray, but there's also procedures that can be done to shrink them down and make them smaller as well.

Interviewer: When somebody is in your office and you've weighed out all these particular options, is there like kind of a final thing that you'd like to say to them to, you know, give them to think about as they consider whether or not the surgery would be for them?

Dr. Error: Well, it really is just based off of, you know, how bad does this bother you? If it's on your mind at all and bothering you at all, you know, it's a week of some discomfort, but it's something that you get benefits for the rest of your life as long as you don't break your nose again. It also can help with some sleep issues if you notice that you're waking up and your nose is plugged. There are people that wake up and they have to get up and walk around until their nose decongest before they can fall back asleep. And so all those things, it can help and just improve your quality of life.

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