1) Disease Description (Causes and Symptoms)
- Definition: Nasal septal deviation is a condition in which the cartilage and bone forming the center of the nose (nasal septum) bend to one side, altering the shape of the airway. It is observed to some degree in most people. It is considered a pathological condition when symptoms are present and cause functional problems.
- Causes: Congenital developmental abnormalities, trauma (nasal injury), deviation caused by pressure or the growth process, etc.
- Pathophysiology: When nasal septal deviation narrows the space in one nasal cavity, localized airflow changes occur. The mucosa on the narrowed side may become enlarged (hypertrophy), or dryness, crusting, and bleeding may develop. Impaired drainage can cause sinusitis (rhinosinusitis) and postnasal drip. Airway obstruction may cause sleep apnea, snoring, and mouth breathing.
- Main symptoms: Persistent or unilateral nasal obstruction, snoring and sleep disturbance, mouth breathing, postnasal drip (foreign-body sensation in the throat and phlegm), worsening nasal obstruction during frequent colds, perinasal pain, and, rarely, decreased attention and memory.
- Prevalence (reference): Nasal septal deviation is common, and depending on the report, it is known to be observed in approximately 78% of men and 68% of women.
2) Treatment Methods
- Conservative (symptomatic) treatment
- Nasal saline irrigation to relieve mucosal dryness and crusting.
- Topical steroid nasal spray (to relieve chronic rhinitis symptoms).
- Short-term use of vasoconstrictors (topical nasal decongestants) is effective, but long-term use (usually 5–10 days or more) should be avoided (risk of rebound nasal congestion).
- Medications according to symptoms, such as antihistamines and mucolytics.
- Correction of sleeping position and lifestyle improvements for snoring and sleep apnea (such as weight control).
- Surgical treatment
- Septoplasty: Corrects structural abnormalities of the nasal septum to improve persistent nasal obstruction and functional impairment. It is the standard treatment and is generally recommended after age 17, when nasal septal development is complete; however, conservative or limited surgery may be considered in children when symptoms are severe and significantly interfere with daily life.
- If accompanying lesions such as turbinate hypertrophy are present, turbinate reduction may be performed, or functional endoscopic sinus surgery (FESS) may be performed concurrently when sinus disease is also present.
- Postoperative care
- Hemostatic gauze or a sponge is inserted into the nose and is usually removed within 1–2 days. Silicone splints (plastic membranes) for internal support are usually removed after 5–7 days.
- To prevent postoperative bleeding and infection, strenuous exercise, impacts, and nose blowing should be avoided for a certain period. Cold prevention, disinfection, and outpatient follow-up are recommended.
- Prognosis
- Symptoms improve at a high rate with appropriate surgery, but symptoms may remain when complete correction is not possible or when accompanying mucosal disease is present.
- The main purpose of conservative treatment is temporary improvement, and recurrence is highly possible.
3) Checklist Before an Outpatient Visit (Items, Records, and Example Questions)
- Items/records to bring
- List of medications currently being taken (including anticoagulants and antiplatelet agents), with records of medication doses and administration times
- History of previous surgery or trauma (whether there was a nasal injury), and previous otolaryngology examination results (such as endoscopic images and CT scans) and reports
- Allergy history, chronic diseases (such as hypertension and diabetes), and information related to bleeding tendency
- Symptom diary: when symptoms began, whether they are unilateral and on which side, severity of nasal obstruction (changes during the day and night), sleep disturbances (snoring or suspected apnea), frequency of nosebleeds, etc.
- Factors that worsen symptoms (colds, seasons, exercise, etc.) and lifestyle habits (smoking, alcohol consumption, and occupational exposure)
- Useful examinations for the visit (prepare in advance if possible)
- Recent sinus CT, if available, and previous endoscopic findings
- Example questions (items to check yourself before the outpatient visit)
- Is the nasal obstruction mainly on the left or right side? At what time of day is it worst?
- Do you have breathing pauses or severe snoring during sleep?
- Do you have frequent nosebleeds? How long does it take for the bleeding to stop?
- Among the medications you are currently taking, are there any anticoagulants (such as warfarin, aspirin, or clopidogrel)?
4) General Examples of Questions to Ask the Doctor
- What are the expected effects and common side effects of this medication (for example, a nasal steroid)?
- If symptoms do not improve with conservative treatment, what is the next step?
- What are the risks and complications of septoplasty (such as bleeding, infection, nasal septal perforation, and changes in appearance), and how often do they occur?
- What is the recovery period after surgery, and when can I return to daily activities (work and exercise)?
- What is the prognosis regarding the possibility of recurrence or the need for additional treatment?
5) Examples of Disease-Specific Questions
- If I undergo septoplasty, what is the likelihood that my current nasal obstruction and sleep disturbance will completely disappear? (This varies greatly depending on the degree of left or right nasal septal deviation.)
- In children (adolescents), until what age should surgery be postponed, and in what cases is early surgery recommended?
- If turbinate hypertrophy or sinusitis is also present, what additional surgery should be performed at the same time?
- I am taking anticoagulants. How should they be managed before and after surgery (including when to stop them)?
(Note: The above content is a summary organized based on the clinical information provided and general medical knowledge. Diagnosis and treatment according to an individual's condition should be determined through consultation with the treating medical team.)