Deviated Nasal Septum (DNS)

Overview of Deviated Nasal Septum

• Generally, The nasal septum is the bone and cartilage in the nose that separates the nasal cavity into the two nostrils.
• Moreover, The cartilage is called the quadrangular cartilage and the bones comprising the septum include the maxillary crest, vomer and the perpendicular plate of the ethmoid.
• Normally, the septum lies centrally, also thus the nasal passages are symmetrical.
• A deviated septum is an abnormal condition in which the top of the cartilaginous ridge leans to the left or the right, causing obstruction of the affected nasal passage. Besides this, The condition can result in poor drainage of the sinuses.
• People can also complain of difficulty breathing, headaches, bloody noses, or of sleeping disorders e.g. snoring or sleep apnea.
• All in all, It is common for nasal septa to depart from the exact centerline; the septum is only considered deviated if the shift is substantial or causes problems.

Many people with a deviation are unaware they have it until some pain is produced. By itself, a deviated septum can go undetected for years and thus be without any need for correction.[1]

Causes Deviated Nasal Septum [DNS]

Trauma and errors of development form the two important factors in the causation of deviated septum.

[1] Trauma: such as by a blow to the face, during child birth.

[2] Developmental error:

[3] Racial factors. Specifically, Caucasians are affected more than black American.

[4] Hereditary factors. Several members of the same family may have deviated nasal septum.

[5] Congenital disorder

[6] Deviated septum is associated with genetic connective tissue disorders such as Marfan syndrome, Homocystinuria and Ehlers–Danlos syndrome.[1][2]

Types of Deviated Nasal Septum

Deviation may involve only the cartilage, bone or both the cartilage and bone.

1. Firstly, Anterior dislocation. Septal cartilage may be dislocated into one of the nasal chambers. Additionally, This is better appreciated by looking at the base of nose when patient’s head is tilted backwards.
2. Secondly, C-shaped deformity. Moreover, Septum is deviated in a simple curve to one side. Nasal chamber on the concave side of the nasal septum will be wider and may show compensatory hypertrophy of turbinates.
3. Thirdly, S-shaped deformity. Either in vertical or anteroposterior plane. Such a deformity may cause bilateral nasal obstruction.
4. After that, A spur is a shelf-like projection often found at the junction of bone and cartilage. Besides this, A spur may press on the lateral wall and gives rise to headache. It may also predispose to repeated epistaxis from the vessels stretched on its convex surface.
5. Lastly, It may be due to organized haematoma or overriding of dislocated septal fragments.[3]

Risk factors of Deviated Nasal Septum [DNS]

For some people, a deviated septum is present at birth — occurring during fetal development or due to injury during childbirth.

After birth, a deviated septum is most commonly caused by an injury that moves your nasal septum out of place. Risk factors include:

• Playing contact sports
• Not wearing your seat belt while riding in a motorized vehicle (4)

Pathogenesis of Deviated Nasal Septum

Pathophysiology of Deviated Nasal Septum

1. Spurs: These are sharp angulations seen in the nasal septum occurring at the junction of the vomer below, with the septal cartilage and/or ethmoid bone above. This type of deformity is the result of vertical compression forces. Fractures that occur through nasal septum during injury to the nose may also produce sharp angulations. These fractures heal by fibrosis that extends to the adjacent mucoperichondrium. This increases the difficulty of flap elevation in this area.

2. Deviations: may be C shaped or S shaped. These can occur in either vertical or horizontal plane. It may also involve both cartilage and bone.

3. Dislocations: In this the lower border of the septal cartilages displaced from its medial position and projects into one of the nostrils.

Deviations may affect any of the three vertical components of the nose causing: cartilaginous deviations, C deviations and S deviation.

1. Cartilaginous deviations: In these patients the upper bony septum and the bony pyramid are central, but there is a dislocation/deviation of the cartilaginous septum and vault.

2. The C Deviation: Here there is displacement of the upper bony septum and the pyramid to one side and the whole of the cartilaginous septum and vault to the opposite side.

3.The S Deviation: Here the deviation of the middle third (the upper cartilaginous vault and associated septum) is opposite to that of the upper and lower thirds. With deviations of the nose, the dominant factor is the position of the nasal septum, hence the adage ‘as the septum goes, so goes the nose’. The first step, therefore in treating the twisted nose is to straighten the septum, and if this objective is not achieved, there is no hope of successfully straightening the external pyramid.(5)

Clinical Features of Deviated Nasal Septum

Sign & Symptoms Deviated Nasal Septum [DNS]

Symptoms of a deviated septum i.e.

• Infections of the sinus
• Sleep apnea
• Snoring
• Repetitive sneezing
• Facial pain
• Headache
• Nosebleeds
• Mouth breathing
• Difficulty with breathing also mild to severe loss of the ability to smell.

Only more severe cases of a deviated septum will cause symptoms of difficulty breathing and require treatment.[1]

Clinical Examination

Diagnosis

1. A history of trauma to the nose is often present including trauma from the either process of birth or microfractures.
2. Physical examination [1].

Differential diagnosis of Deviated Nasal Septum [DNS]

• Hypertrophied turbinate
• Polyps [2]

Complications

• Recurrent sinusitis due to obstruction to drainage of sinus.
• Middle ear infection due to forcible blackening of nose or recurrent upper respiratory infection.
• Mouth breathing causing infection of pharynx, larynx, tracheobronchial tree.
• Asthma: DNS acts as trigger for bronchospasm.
• Atrophic rhinitis on the root side of nose.[2]

Investigations 

Treatment of Deviated Nasal Septum [DNS]

Minor degrees of septal deviation with no symptoms are commonly seen in patients and require no treatment. It is only When deviated septum produces mechanical nasal obstruction or the symptoms given above that an operation is indicated.

Medical therapy:

Nasal sprays including decongestants, antihistamines, or nasal corticosteroid sprays is typically tried first before considering a surgical approach to correct nasal septum deviation.

Moreover, Medication temporarily relieves symptoms, but does not correct the underlying condition. Non-medical relief can also be obtained using nasal strips.

A minor surgical procedure known as septoplasty can cure symptoms related to septal deviations. Additionally, The surgery lasts roughly one hour and does not result in any cosmetic alteration or external scars. Nasal congestion, pain, drainage, or swelling may occur within the first few days after the surgery. Besides this, Recovery from the procedure may take anywhere from 2 days to 4 weeks to heal completely,^] Septal bones never regrow. If symptoms reappear, they are not related to deviations. Lastly, Reappearance of symptoms may be due to mucosal metaplasia of the nose.

Currently, the most gentle and effective treatment is laser sept chondroplasty for the septal cartilage segment deformity and ultrasound septoplasty — effective for the septal cartilage and bone deformation.[1]

Prevention of Deviated Nasal Septum

• You may be able to prevent the injuries to your nose that can cause deviated septum with these precautions:
• Wear a helmet when playing contact sports, such as football and hockey
• Wear a seat belt when riding in a motorized vehicle (5)

Homeopathic Treatment of Deviated Nasal Septum [DNS]

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes 

• The medical history of the patient, 
• Physical and mental constitution, 
• Family history, 
• Presenting symptoms, 
• Underlying pathology, 
• Possible causative factors etc. 

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions. 

What Homoeopathic doctors do? 

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’? 

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. 

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines. 

Homeopathic Medicines for Deviated Nasal Septum [DNS]

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor. 

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Allium Cepa: 

Especially indicated in DNS. Sneezing, especially when entering a warm room. Copious, watery and extremely acrid discharge. Feeling of a lump at root of nose. Hay-fever. [Sabad.; Sil.; Psor.]. Fluent coryza with headache, cough, and hoarseness. Polypus. Catarrhal headache, mostly in forehead; worse in warm room towards evening.

aggravation from; evening, warm room. on the other hand, amelioration from; open air, cold room.[2]

Arsenic Album: 

Coryza with thin, watery, excoriating discharge. Nose feels stopped up. Sneezing without
relief. Hay-fever and coryza; worse in open air; better indoors. Burning and bleeding from nose. Headaches relieves by cold, other symptoms worse.

aggravation from, wet weather, after midnight; from cold, cold drinks, or food. Seashore. Right side. on the other hand, amelioration from; from heat; from head elevated; warm drinks.

Arum Triphyllum:

Specific medicine for DNS. Acridity is the keynote of the kind of action characteristic of Arum. Additionally; Soreness of nostrils. Acrid, excoriating discharge,
producing raw sores. Nose obstructed; must breathe through mouth. Boring in the nose. Coryza; discharge blood-streaked, watery. Nose completely stopped, with especially fluent, acrid discharge. Hay-fever, with pain over root of nose. Large scabs high up on right side of nose. Face feels chapped, as if from cold wind; feels hot. Constant picking at nose until it bleeds. Headache from too warm clothing, from hot coffee.

< northwest wind, lying down.[2]

Syphilinum:

Indicated for Caries of nasal bones, hard palate also septum, with perforation; ozaena.

aggravation from; at night, sundown to sunrise, seashore, in summer. on the other hand, amelioration from; inland and mountains, during day, moving about slowly.

Euphrasia: 

Good medicine for DNS. Patient is better in open air. Catarrhal affections of mucous membranes especially of eyes also nose. Profuse acrid lachrymation and bland coryza; worse, evening. Hawking up of offensive mucus.

< in evening, indoors, warmth; south winds; from light.

Ferrum Phosphoricum:

Useful medicine for first stage of colds in the head. Additionally, Predisposition to colds. Epistaxis; bright red blood. The typical Ferr. phos.
subject is nervous, sensitive, anemic with the false plethora and easy flushing of Ferrum. Besides this, Indicted in pale, anaemic subjects, with violent local
congestions. Haemorrhages are bright from any orifice.

< at night and 4 to 6 p.m.; touch, jar, motion, right side.by cold applications.

Kali Iodum:

Basically, the profuse, watery, acrid coryza that the drug produces serves as a sure guiding symptom, especially when associated with pain in frontal sinus. In detail, Violent headache in which pain intense over eyes and root of nose. Nose is red, swollen. Tip of nose red; profuse, acrid, hot, watery, thin discharge. Ozaena, with perforated septum. Sneezing. Nasal catarrh, involving frontal sinus. All in all, Stuffiness and dryness of nose, without discharge. Profuse, cool, greenish,
unirritating discharges.

< warm clothing, warm room, at night, damp weather.

> motion, open air [2].

Nux Vomica:

In general, Indicated for stuffing up of nose < at night especially. Also useful for Stuffy colds, snuffles, after exposure to dry, cold atmosphere; worse, in warm room. Coryza is fluent in daytime; stuffed up at night and outdoors; or alternates between nostrils. Bleeding especially; in morning. Acrid discharge, but with stuffed up feeling. Lastly, Frontal headache, with desire to press the head against something.

< morning, mental exertion, after eating, touch, spices, stimulants, narcotics, dry weather, cold.

> from a nap, if allowed to finish it; in evening, while at rest, in damp, wet weather, strong pressure.

Silicea:

There is Itching at point of nose. Dry, hard crusts form, bleeding when loosened. Nasal bones sensitive. Sneezing in morning. Obstructed and loss of smell. Perforation of septum. Headache in which pain begins at occiput, and spreads over head and settles over eyes. Silica patient is cold, chilly, hugs the fire, wants plenty warm clothing, hates drafts, hands and feet cold, worse in winter. Great sensitiveness to taking cold.

< new moon, in morning, from washing, during menses, uncovering, lying down, damp, lying on, left side, cold.

> warmth, wrapping up head, summer; in wet or humid weather.[2]

Mercurious Solubilus:

Useful for Cold & Coryza in which there is much sneezing, in sunshine. Coryza; acrid discharge, but too thick to run down the lip; worse, warm room. Nostrils raw, ulcerated; nasal bones swollen. Yellow-green, fetid, pus like discharge. Pain and swelling of nasal bones, and caries, with greenish fetid ulceration. Nosebleed < at night. Copious discharge of corroding mucus.

< at night, wet, damp weather, lying on right side, perspiring; warm room and warm bed.

Natrum Muraticum:

Better indicated in Deviated Nasal Septum [DNS]. Useful for violent, fluent coryza, lasting from one to three days, then changing into stoppage of nose, making breathing difficult.
Discharge thin and watery, like raw white of egg. Violent sneezing coryza. Infallible for stopping a cold commencing with sneezing.
Loss of smell and taste. Internal soreness of nose. Dryness. Frontal sinus inflammation.

< noise, music, warm room, lying down about 10 a. m at seashore, mental exertion, consolation, heat, talking.

> by open air, cold bathing, going without regular meals, lying on right side; pressure against back, tight clothing.

Aurum Metalicum:

Generally, Indicated for Ulcerated, painful, swollen, obstructed nose. Furthermore, Inflammation of nose; caries; fetid discharge, purulent, bloody. Boring pains in nose; especially, worse at night. Putrid smell from nose. Sensitive smell. Horrible odor from nose and mouth.
Besides this, Knobby tip of nose.

< in cold weather when getting cold. Many complaints come on only in winter; from sunset to sunrise.[2]

In case you have a concern or query you can always consult a specialist & get answers to your questions!

Diet & Regimen

• Eat less dairy products
• Eat diet rich in magnesium and calcium
• Boil water in a container and take steam from it regularly. This will help clear the nasal passage
• Deep breathing exercises help to remove blockage from the nose
• Firstly, Avoiding sweets, milk products, bakery products and heavy to digest foods is the first line of defense.
• Secondly, eat mindfully. Do not overeat. Food timing also eating when hungry work as essential remedies to treat this condition.
• Thirdly, avoid cold foods e.g. ice creams and certain fruit juices. (6)

Do’s & Don’ts

Terminology

Reference

1. https://en.wikipedia.org/wiki/Nasal_septum_deviation
2. https://www.lybrate.com/topic/deviated-nasal-septum-and-its-homeopathic-management/a815c4aa5e9c0e7082259fdfbbc48891
3. Disease of EAR, NOSE, AND THROAT&HEAD AND NECK SURGERY 6^TH EDITIONS BY P.L Dhingra, Shruti Dhingra.
4. Deviated septum – Symptoms and causes – Mayo Clinic
5. Deviated Nasal Septum (canestar.com)
6. Deviated Nasal Septum! – By Dr. Radhika A (Md) | Lybrate
7. International Journal of Pharmaceutical Research and Allied Sciences).
8. ournal of Evolution of Medical and Dental Sciences).
9. Scientific Research Publishing).
10. Various studies cited in ResearchGate article "Incidence of DNS as reported in various studies in relation to intrauterine position of fetus."
11. Cummings Otolaryngology Head and Neck Surgery 7th Edition by Paul W. Flint, Bruce H. Haughey, Valerie J. Lund, John R. Robbins, Jatin P. Shah, K. Thomas Robbins, and Clarence T. Sasaki, published in 2021 by Elsevier.

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