Deviated Nasal Septum (Septal Deviation): Examination and Surgery (Septoplasty)
A deviated nasal septum is very common and only requires treatment if it causes symptoms – typically nasal congestion on one side, poor sleep at night or frequent sinus infections. The symptoms can be relieved with surgery in which the nasal septum is straightened through the nostrils.
At Charlottenlund Private Hospital, the preliminary examination is carried out by specialists in ear, nose and throat conditions at several locations across Denmark, while the operation is performed in Charlottenlund.
What is a deviated nasal septum?
The nasal septum, septum nasi, divides the nose into two halves and consists of cartilage at the front and bone at the back. Ideally, the two sides are equal in size, but in most people the septum is deviated to some degree.
According to a 2025 review article in Ugeskrift for Læger, a deviated nasal septum is the most common anatomical cause of nasal congestion, and septoplasty is one of the most common nasal operations, with more than 4,000 procedures performed annually in Denmark.
Often, the reason is that the nasal septum has grown in such a way that it no longer fits the height or length of the nose and therefore bends to one side. A deviated nasal septum is not a disease in itself – it only needs treatment if it causes symptoms.
What symptoms does a deviated nasal septum cause?
The typical symptom is persistent nasal congestion, often affecting one side. Many people breathe through their mouth at night, snore and sleep poorly.
A deviated nasal septum may also contribute to headaches, facial pressure, a reduced sense of smell and frequent sinus infections. Because the airflow through the nose changes, the mucous membrane may also dry out, leading to crusting or nosebleeds.
If the symptoms are particularly pronounced at night, or if you are very tired during the day, you should also be assessed for sleep apnoea.
Is it the nasal septum or the mucous membrane that is blocking the nose?
It is not always the nasal septum. Nasal congestion often has several causes at the same time, including swollen mucous membranes due to allergies, enlarged nasal turbinates, nasal polyps, chronic sinusitis or overuse of over-the-counter decongestant nasal spray.
A useful indication is how the nose responds to over-the-counter decongestant nasal spray. If the congestion improves significantly, the problem is more likely to be caused by the mucous membrane and nasal turbinates. If the spray provides almost no relief, the obstruction is more likely to be caused by cartilage and bone.
If the symptoms are caused by both a deviated nasal septum and enlarged nasal turbinates, Ugeskrift for Læger recommends correcting both during the same procedure.
Deviated nasal septum
- The obstruction is caused by cartilage and bone
- Often blocked on the same side all the time
- Over-the-counter nasal spray provides little relief
- Corrected with septoplasty
Enlarged nasal turbinates
- The obstruction is caused by swollen mucous membrane
- Alternates between sides – worst at night
- Over-the-counter nasal spray provides clear relief
- Reduced by turbinoplasty
How is a deviated nasal septum examined?
The specialist examines the external shape of the nose and looks inside the nose using a thin endoscope – both before and after the mucous membrane has been made to shrink – to determine how much of the congestion is caused by the nasal septum and how much is caused by the mucous membrane.
At the same time, the specialist checks for nasal polyps and signs of sinusitis. If an allergy is suspected, the examination is supplemented with allergy testing, and in some cases a CT scan of the sinuses is reviewed.
If the mucous membrane is swollen, treatment with a corticosteroid nasal spray is tried before deciding whether surgery is necessary.
When should a deviated nasal septum be operated on?
Surgery is relevant when the nasal septum is deviated and the patient has symptoms that can be explained by the deviation – and once any condition affecting the mucous membrane has been treated first.
If the nasal septum is deviated but does not cause symptoms, it should not be operated on, regardless of how pronounced the deviation is.
Septoplasty may also be necessary to create enough space for sinus surgery, as part of the treatment of frequent nosebleeds, or when a deviated nasal septum makes it difficult to use a CPAP mask for sleep apnoea.
How is septoplasty performed?
Septoplasty is performed through the nostrils. The surgeon makes a small incision inside the nose, exposes the nasal septum and straightens it by adjusting the sections of cartilage and bone that curve outwards so that the septum fits properly within the nose again.
The operation is performed under general anaesthesia and takes approximately one hour. It takes longer if the nasal turbinates, nasal polyps or sinuses are also operated on at the same time.
There are no visible scars, and the external shape of the nose does not change. Thin silicone splints are often placed along the nasal septum to hold it in position while it heals. Nasal packing is not used.
You are observed after the operation and can go home the same day.
If the symptoms are also caused by the shape of the external nose, correction of the external nose may be considered. This procedure is also performed at Charlottenlund Private Hospital and is arranged separately.
How long do you need to take off work after septoplasty?
Most people return to work within one week. According to Ugeskrift for Læger, strenuous physical activity should be avoided for at least one week, and people with physically demanding or dusty work should take the same period off work.
Strenuous physical activity should be avoided for a couple of weeks, while sport and activities involving a risk of being hit on the nose should be avoided for two to three months.
During the first few nights, it is helpful to sleep with your head elevated, and the nose should be rinsed daily with saline.
The silicone splints are removed at a follow-up appointment after approximately 10 days, which can take place at any of the hospital's locations.
Slight blood-stained discharge during the first few days is expected. Heavy bleeding, increasing pain, swelling or fever should be assessed by a doctor.
What are the outcomes of surgery for a deviated nasal septum?
Most patients experience improved airflow through the nose, but not everyone does.
According to the review article in Ugeskrift for Læger, 60–70% of patients are satisfied after septoplasty. A Danish study with more than 10 years of follow-up found improved nasal airflow in 68% of patients, while a Swedish registry study found that 76% experienced improvement after six months. Around one in five continued to have symptoms, while up to 10% reported that their symptoms had worsened.
The outcome depends particularly on whether the nasal septum is actually the cause of the symptoms. This is why the preliminary examination is important – and why swollen mucous membranes, allergies and overuse of nasal spray are treated before deciding whether surgery is appropriate.
When should you see a doctor?
A nose that has been blocked for several months, particularly on one side, and which interferes with sleep or causes frequent sinus infections should be assessed by an ear, nose and throat specialist.
The same applies if you can only keep your nose open with daily use of over-the-counter nasal spray.
Nasal congestion affecting only one side, particularly when accompanied by blood-stained discharge, should always be investigated.
The treatment pathway at Charlottenlund Private Hospital
The treatment pathway begins with a preliminary examination by an ear, nose and throat specialist – either in Charlottenlund or at one of the hospital's other locations.
The specialist determines whether the symptoms are caused by the nasal septum, the mucous membrane or both, and whether medical treatment should be tried first.
If surgery becomes relevant, it is agreed whether the nasal septum should be operated on alone or together with the nasal turbinates or sinuses.
The operation is performed in Charlottenlund by ear, nose and throat specialists, including Jacob Fisker and Kåre Håkansson.
The follow-up appointment to remove the silicone splints can take place at whichever hospital location is most convenient.
Referral
Most patients at Charlottenlund Private Hospital are treated through private health insurance. Insurance companies typically require a referral from your GP and prior approval.
Self-paying patients do not require a referral, and prices are available in the price list.
If the waiting time in the public healthcare system exceeds 30 days, you may be entitled to treatment paid for by the region through the extended free choice of hospital scheme – with no out-of-pocket payment.
The hospital also has a public-sector agreement within the ear, nose and throat specialty for patients referred from the Capital Region of Denmark. This treatment is provided in Charlottenlund.
Frequently asked questions
What is a deviated septum?
The septum divides the nose into two halves, which are ideally equal in size. However, most people have some degree of deviation—in a study of 2,500 ear, nose and throat patients, this applied to 89%—so it is entirely normal.
In some cases, the deviation causes problems that are difficult to live with. It changes airflow and can lead to nasal congestion, dryness and crusting. Some people are completely unaware that they have a deviated septum, while others are greatly affected by it. If you have symptoms, surgery can relieve them in most cases; if you have no symptoms, there is of course no need for surgery. The surgeon will discuss this with you in detail before any operation.
How does a deviated septum develop?
A deviated nasal septum can be congenital or develop over time, for example after a blow to the nose. In practice, it is rarely possible to establish the cause with certainty: no one knows whether the septum was crooked from birth, became so during childhood or after a football match in ninth grade. Health insurers often ask whether the condition is congenital or caused by an injury, as this can affect coverage, but it is a question the doctor usually cannot answer. What matters, therefore, is not the cause but the symptoms: if the septum is deviated and bothersome, surgery may help; if it causes no problems, it does not need to be operated on, however deviated it may be.
How long are you off work after septoplasty?
Most people return to work within a week. If your job involves heavy physical work or dust, you should take at least a week off work, strenuous physical activity should be postponed for a couple of weeks, and sports with a risk of being hit on the nose should be avoided for two to three months.
What are the outcomes of the operation?
According to Ugeskrift for Læger, 60–70% of patients are satisfied after septoplasty, and a Danish study found improved airflow in 68%. Up to 10% experience a worsening. The result depends especially on whether the septum is actually the cause of the symptoms, which is determined at the initial consultation.
Is surgery for a deviated nasal septum free?
The operation may be covered by health insurance. If the waiting time in the public healthcare system is more than 30 days, you may be entitled to treatment funded by your region under the extended free choice of hospital scheme—with no out-of-pocket cost. If you are paying for treatment yourself, the price is listed in the price list.