What Is a Deviated Nasal Septum — and Do I Have One?

A deviated nasal septum (DNS) is an abnormal deflection of the bone and cartilage that divides the inside of your nose into two chambers. It is more common than a straight septum, it can affect far more than just your breathing, and it does not always require surgery — but when it does, the right evaluation makes all the difference.

If you have ever struggled to breathe through one side of your nose, woken up congested on one side but not the other, or been told by a doctor that your septum is “off,” you may have a deviated nasal septum. It is one of the most common structural findings in the human nose — and one of the most misunderstood.

What exactly is a deviated nasal septum?

The nasal septum is the wall of bone and cartilage that divides the inside of your nose into two chambers — left and right. A deviated nasal septum (DNS) is an abnormal deflection or structural abnormality in how that bone and cartilage has grown. As the facial bones go through the maturity process, the bones and cartilages shift in structure — typically at the union lines where different bones and cartilage meet. The result is that the septum leans to one side, sometimes dramatically, sometimes subtly.

Here is something I tell every patient: in my clinical opinion, it is more normal to have a deviated septum than to have a perfectly straight one. In fact, when I examine a nose and find a perfectly straight septum, the first thing I ask is whether the patient has ever had surgery on their septum. If they say no, I tell them to buy some lottery tickets on the way home — because they are genuinely lucky. A perfect septum is the exception, not the rule.

How do I know if I have one?

You may not need a doctor’s office for a first impression. There are four things you can check on your own:

1. Breathing difficulty. If you consistently struggle to get air in and out through one nostril — or both — that is the most common symptom of a deviated septum.

2. The mirror test. Tilt your head back slightly and look in the mirror. If the line from the tip of your nose to your upper lip does not appear to be centered — if it shifts to one side — you may have a deviated septum contributing to that asymmetry.

3. The sniff test. Look straight on at your nose in the mirror and inhale as fast as you can through your nose. If one nostril collapses and the other does not, that collapse pattern is characteristic of a deviated septum affecting nasal valve dynamics on that side.

4. The sleep test. If you find yourself needing to sleep with your head turned to one particular side, and when you turn to the other side you develop nasal obstruction within a few minutes, a deviated septum is a likely contributing factor.

Can a deviated septum cause more than just difficulty breathing?

Yes — and this is where many patients are surprised. A deviated septum is not just a breathing problem. It can affect your sinuses, your sleep, and your head.

Sinus infections. A DNS can displace the middle turbinate laterally, crowding the middle meatus and the ostiomeatal complex — the critical drainage pathway for the maxillary, frontal, and anterior ethmoid sinuses. That extra narrowing in an already tight anatomical space reduces drainage and ventilation, setting the stage for chronic sinus infections on the obstructed side.

Headache and facial pain. When a deviated septum forms a septal spur — a sharp projection of bone or cartilage — that spur can press directly into the inferior turbinate or the lateral nasal wall. That contact generates localized pressure and pain that patients often describe as a chronic one-sided headache or facial pressure that does not respond to typical headache treatment.

Sleep disruption and breathing at night. A DNS creates an imbalance in the nasal airway that increases airway resistance. That resistance contributes to mouth breathing, snoring, increased nighttime arousals, and in more significant cases, a higher risk for obstructive sleep apnea. Nasal obstruction from a DNS is not a minor inconvenience — it has downstream consequences for sleep quality and cardiovascular health.

How is it diagnosed?

A deviated nasal septum is diagnosed with an anterior nasal examination using a nasal speculum or nasal endoscopy — a small camera that allows the physician to see the full extent of the deviation, including whether it involves the anterior cartilage, the bony septum posteriorly, or both. A CT scan of the paranasal sinuses is also helpful to confirm the diagnosis and to assess the impact the deviation is having on the sinuses — specifically whether the ostiomeatal complex is compromised and whether there is evidence of sinus disease on the obstructed side.

Does everyone with a deviated septum need surgery?

No. Non-surgical options are always considered first. Saline nasal irrigation followed by a nasal steroid spray can reduce mucosal swelling and improve airflow around a deviation. Oral decongestants can open the airway temporarily but are not recommended for regular use because of their effects on blood pressure, heart rate, and sleep quality. Afrin nasal spray can provide short-term relief but must be strictly limited to three days as directed — longer use creates a dependency and rebound congestion that is more difficult to treat than the original problem. Allergy testing and treatment is also an important consideration, since untreated allergic inflammation compounds nasal obstruction in patients with an underlying DNS.

Surgery becomes a serious recommendation in specific circumstances: when the deviation is so severe that I cannot visualize the middle turbinate on anterior rhinoscopy; when a severe DNS is causing documented sinus obstruction and chronic rhinosinusitis on one side; when the deviation is preventing treatment of a nosebleed or blocking access for a planned procedure; or when conservative management has been exhausted and symptoms significantly impair quality of life despite treatment.

What makes SAWC’s approach different?

When a patient presents to the Sinus & Allergy Wellness Center of North Scottsdale, we always think conservatively first. If we can work around a septal deviation and achieve the patient’s treatment goals without operating, we will. That is our default position.

When surgery is indicated, we offer traditional septoplasty performed under IV sedation in our office — not in a hospital operating room or surgery center. That approach eliminates facility fees, reduces overall cost to the patient, and maintains the same standard of safety: a board-certified anesthesiologist is present for every IV sedation procedure we perform. In selected cases, a balloon-assisted septoplasty is an option — though we reserve this for low anterior deviations only, as attempting it higher in the nasal cavity risks trauma to the superior nasal structures near the skull base.

Having corrected thousands of deviated septums over more than three decades in Scottsdale and the greater Phoenix area, the experience we bring to this conversation is not theoretical. If you are dealing with nasal obstruction, chronic sinus infections, or sleep disruption and have been told you have a deviated septum — or suspect you might — a consultation at SAWC is the right first step.

Want to Understand More?

This post is part of the Understanding Your Symptoms series on the Airway & Sinus Wellness Review.

→ What Is Balloon Sinuplasty — and Are You a Candidate?

→ Can Sinusitis Cause Daily Headaches?

→ Why Do I Keep Getting Sinus Infections After Treatment?

→ Does Balloon Sinuplasty Actually Work?

Airway & Sinus Wellness Review — Full Publication

This post is part of the Understanding Your Symptoms series.

About the Author

Dr. Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience treating sinus and airway disease in Scottsdale and the greater Phoenix metropolitan area. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale and performed the first balloon sinuplasty in Pennsylvania. He holds dual Entellus Centers of Excellence certifications and specializes in office-based nasal and sinus procedures — including septoplasty — performed under local or IV sedation anesthesia without the need for a hospital operating room or surgery center. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis, a clinical framework identifying pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis. ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. Please consult a qualified physician for evaluation and treatment of your specific condition.