Two common causes of nasal obstruction are deviation of the nasal septum—the wall that divides the nose into right and left sides—and enlargement of the turbinates (the structures people commonly refer to as nasal tissue). These two conditions often occur together; one can gradually make the other more noticeable.
The following information is provided for general educational purposes. The actual cause of the complaint, the appropriate approach, and treatment decisions are determined through physician examination; the recovery process and results achieved vary from person to person.
What is deviated septum and turbinate enlargement?
The septum is a partition composed of cartilage in front and bone in back that divides the inside of the nose into right and left halves. Deviation of this partition from the midline is called septal deviation. The deviation can result from a congenital developmental difference or can occur following nasal trauma sustained in childhood or adulthood. Some degree of deviation is quite common in the population, and not every deviation causes symptoms.
Turbinates are bony structures located on the side walls of the nasal cavity, covered with mucosa, and shaped like scrolls. They humidify, warm, and help clean the inhaled air. Due to factors such as allergies, prolonged irritation, hormonal changes, or improper nasal spray use, these structures can enlarge; this condition is called turbinate hypertrophy.
In individuals with septal deviation, the turbinate on the wider side of the nose tends to gradually enlarge, filling the remaining space. For this reason, the two conditions are usually evaluated together and the treatment plan is made considering both.
- Septum: the cartilage and bone partition dividing the nose
- Turbinate: structures on the nasal side walls that humidify and warm air
- Deviation: displacement of the septum from the midline
- Hypertrophy: enlargement of the turbinate in volume
Symptoms and when to see a physician
The most commonly reported complaint is nasal obstruction. The obstruction can be constant or can shift sides throughout the day or depending on sleeping position. A person who cannot get enough air through their nose tends to breathe through their mouth; this can lead to dry mouth, throat burning sensation, and a feeling of not resting well, especially during sleep.
When air does not reach the smell center in the upper part of the nose, this can lead to reduced sense of smell. Disrupted airflow in the nose can also affect the ventilation of sinus openings, potentially setting the stage for recurring sinusitis. In some individuals, snoring, morning fatigue, and headaches accompany the condition.
When symptoms persist for more than a few weeks, affect daily life or sleep patterns, an evaluation by an otolaryngologist is recommended.
- Persistent nasal obstruction on one or both sides
- Mouth breathing during sleep, dry mouth and throat in the mornings
- Reduced sense of smell
- Sinusitis occurring several times per year
- Snoring and difficulty breathing comfortably during sleep
- Crusting inside the nose and occasional nosebleeds
- History of nasal trauma
How is diagnosis made?
Evaluation begins with taking a detailed history. When the symptoms started, which side is more affected, whether there are seasonal changes, any accompanying allergy symptoms, and previously used medications guide the diagnosis.
Following initial nasal examination, endoscopic examination is performed when necessary. Using a thin endoscope, the back portions of the nasal cavity, the posterior part of the septum, the condition of the turbinates, the nasopharynx, and the sinus openings can be directly visualized. This examination helps identify posterior septal deviations or additional causes such as adenoid enlargement or nasal polyps that may not be apparent from external examination.
Turbinate size can also be evaluated by comparing appearance before and after application of a vasoconstrictor spray. This helps determine whether the enlargement is due to swelling (reversible) or structural growth. If allergy is suspected, allergy testing may be ordered; if sinusitis is suspected, imaging studies may be requested.
Medical treatment options
Not every deviation requires surgery. Depending on symptom severity and underlying cause, initial treatment with medications to relieve airway obstruction may be attempted.
Intranasal corticosteroid sprays aim to reduce mucosal swelling and inflammatory response; their effects typically become apparent within a few weeks of regular use. If an allergic basis exists, antihistamine medications can be added. Nasal washing with saline solutions can help reduce crusting and irritation.
Using over-the-counter vasoconstrictor (decongestant) sprays for more than a few days can lead to increased obstruction when the medication is stopped. This condition, called medication-induced rhinitis, is one of the common causes of turbinate enlargement; for this reason, continued use of such sprays without physician recommendation is important to avoid.
Medical therapy reduces mucosal swelling; however, it does not change the cartilage and bone structure of septal deviation. If the complaint is primarily due to a structural cause, the expected benefit from medical treatment may be limited.
Surgical treatment: septoplasty and turbinate reduction
If symptoms persist despite adequate medical treatment and examination findings are consistent with these symptoms, surgical options may be considered. Septoplasty aims to widen the airway by correcting or removing curved cartilage and bone components. The procedure is performed through the nose; there is no incision visible on the face.
The goal of septoplasty is not to change the external appearance of the nose. When changes in external shape are also desired, septorhinoplasty—which addresses both function and appearance—requires separate planning; this preference is discussed separately during examination.
Turbinate reduction can usually be performed during the same session. During radiofrequency application, controlled heat energy is delivered to the internal tissue of the turbinate through a fine probe; the goal is to reduce volume while preserving the outer surface of the mucosa and its function as much as possible. The effect does not occur immediately but becomes apparent over weeks during the healing process. For more advanced enlargement, methods in which part of the turbinate is surgically reduced may be preferred.
Anesthesia type (general or local), the scope of the procedure, and the patient's general health status are taken into consideration in planning. Which method is appropriate is determined by evaluating examination findings and the patient's expectations together.
Postprocedure process and healing
Today, following septoplasty, the solid packing materials of the past—which caused discomfort upon removal—have largely been replaced by silicone splints with an air passage down the middle. These splints support the septum while allowing limited nasal breathing and are typically removed within a few days in the clinic. The material used and duration of stay vary depending on the procedure performed.
Days following the procedure, nasal fullness, mild drainage, and swelling are expected findings. Pain perception varies from person to person and is generally managed with pain relievers recommended by the physician. Even after splint removal, some crusting and occasional obstruction sensation may continue; this is a natural part of the healing process.
Healing of the nasal mucosa is a process taking several weeks. Generally, this period must be completed for proper evaluation of changes in breathing. Follow-up examinations are important for monitoring healing and performing internal nasal cleaning.
- Splint or packing removal timing is planned based on the method used
- Nasal care with saline solution is continued as prescribed by the physician
- Nose blowing, straining, and heavy lifting are avoided for a period
- Warm environments, saunas, and intense exercise are temporarily avoided
- Cigarette smoke and dusty environments are limited during the healing period
- Keeping follow-up appointments facilitates monitoring of healing
Important considerations
The cause of nasal obstruction is not always septal deviation or turbinate enlargement. Allergic rhinitis, adenoid enlargement, nasal polyps, sinusitis, and other less common conditions can also cause similar symptoms. For this reason, examination aimed at determining the cause of symptoms forms the foundation of the treatment plan.
Like all surgical procedures, septoplasty and turbinate reduction carry potential risks including bleeding, infection, internal nasal adhesions, septal perforation, changes in sense of smell, and persistence of part of the complaint. Not everyone experiences these conditions; detailed discussion with the physician before the procedure and completion of the informed consent process is appropriate.
During the postoperative period, the following findings should be evaluated without waiting for the follow-up appointment: persistent or recurrent nosebleeds, progressively increasing unilateral obstruction accompanied by pressure and pain inside the nose, high fever, spreading redness and swelling around the nose. Blood accumulation in the septum (septal hematoma), in particular, is time-sensitive as it can impair cartilage nutrition if not drained early.
The obtained result varies depending on factors such as the shape and degree of deviation, the structure of the mucosa, whether an allergic basis exists, tobacco use, and individual healing characteristics. Over time, additional treatments may be considered in some individuals. The information presented here is for general educational purposes and does not replace physician examination. For appointments and information, you may contact us.