What is a DNS [Deviated Nasal Septum]?

What is the Nasal Septum?
The nasal septum is a composite plate like structure made up of membrane,bone and cartilage.The nasal septum divides the two halves of the nose into right and left nasal cavities.

What is a DNS or Deviated Nasal Septum?
If the nasal septum which is ideally central, is deviated to one side or the other ,ENT Specialists refer to this as a deviated nasal septum or DNS for short.

Why does a DNS occur?
This is a question very commonly asked by my patients.
A DNS can be developmental in origin - it can bend over timeor the cause may be trauma such as a hit or an accident.

What are the types of DNS?
ENT Doctors describe a deviated septum based on the shape of the devaition,parts of the septum deviated and location of the deviation.So you may be having:
A C shaped deviation-Here the septumis bent in a C shaped manner producing narrowing of the airway onone side
S shaped deviation- produces airway narrowingin both the nasl cavities and can make the person prone to become symptomatic easily
A bony, cartilaginous or mixed type deviation
A high DNS[ upper part of the septumis deviated and this may even be associated with external nose shape deviation which can be noticeable to the patient and others fromt he outside]
A caudal dislocation[front most part is deviated]- often a smart patient comes to me after noticing the deviationof the septum in the mirror! Many a times such cases of DNS are caudal deviations and can be self diagnosed by lifting up the tip of the nose and looking in the mirror to see if any part of the nasl septum is protruding into the nasal cavity on one side and narrowing the airway on one side!
The photo shown is a patient with significant caudal dislocation of the nasal septum

Will my DNS create problems for me?
Not everyone with a deviated nasal seputm has symptoms due to it.Whether a deviated nasal septum will create problems depends on:-
Severity of the deviation
presence of additional Turbinate hypertrophy narrowing the nasal cavities further
Shape of the deviation
Allergic tendency- if you have allergic rhinits then the nasl septal deviation can contribute significantly to the problem and correcting the deviation can help the nasal obstruction symptoms to a certain extent depending on the individual case.

What are the problems caused by a deviated nasal septum?
A DNS can cause a variety of problems for an individual.The symptoms need not be present all the time and can develop any time in due course.
Nasal Block
Nasal discharge
Nose bleeds
Post nasal discharge[PND]- secretions dripping into the throat fromt the back of the nose
Snoring
Mouth breathing
Taste and Smell abnormalities
Sleep Apnoea
Dry mouth
Recurrent Throat infections- from abnormal drainage of secretions into the throat and mouth breathing
Recurrent Sinusitis
Recurrent Upper Respiratory Infections
Ear problems- by affecting the eusatchian tube connecting the ears and the back of the nose.

What is the treatment for a deviated nasal septum?
Treatment is tailored based on:-
Severity of the DNS
Symptoms of the patient
Age of the patient
Presence of additional conditions in the nose:
Turbinate hypertrophy
Concha bullosa
Chronic Sinusitis
Allergic boggy mucosa
Nasal polyps
A nasal endoscopy is a prerequisite for any treatment decisiona as it gives a direct visualisation of the nooks and crannies of the nose, the levels of nasal obstruction andthe precise location of the abnormal septal deviation.Your ENT Surgeon will perform a nasl endocopy and discuss the treatment options with you.
Someimes an additional CT scan is required to further evaluate the sinuses and tailor the managament of an individual patient.
Treatment options are broadly divided into Conservative medical management and Surgical management

What is the Surgery for the Nasal Septum Deviation?
The Surgery for a nasal septal deviation is a Nasal Septal Procedure.There are a variety of nasal procedures done in a patient with nasal septal deviation depending on the individual case.Dr Sonia will discuss which is best suited for you.
Conventional Septoplasty
Nasal Spurectomy
Endoscopic Septoplasty
Endoscopic Septoplasty + Endoscopic Sinus Surgery
Endoscopic Septoplasty + Turbinate Procedure
Endsocopic Septoplasty + FEELS [Functional endocospic endonasal LASER Surgery]
Septorhinoplasty [ correction of the external shape as well
Surgery may be performed under local anaesthesia or general anaesthesia.Dr Sonia prefers to use general anaesthesia in majority of the cases as it gives optimum comfort to the patient.The patient is completely asleep during the procedure and there will be no pain during the surgery at all in general anesthesia.

When can I go home after the procedure?
Generally speaking you can go home the same day or the next day depending on the individual situation.

Will there be a scar on my nose after the surgery?
The surgery is done through the inside of the nose and there will be no scar or stitches on the face or outer part of the nose.

By : Dr Sonia Suprabha Venugopal
drsoniasv.webs.com