So how did he get that way?
And why are we personifying a body part and calling it a ‘he’? Too much beer, I suppose.
Actually, patients will present with a complaint, such as
nasal stuffiness or blockage. Some will actually state as a chief complaint, “I
have a deviated septum.” I’ll ask, “How
did you discover that?” Answer: “’Cause
my doctor told me so.” Okie-dokie.
Some of you are no doubt wondering aloud to anyone within earshot: “What/where
is the nasal septum, what’s its function, how does it become “deviated, and why
should I care?”
What and where:
The nasal septum, also referred to simply as “the septum” is
the partition or wall that separates the inside of the nose into right and left
sides. If you place your fingers inside
each nostril, you’ll feel the anterior-most part of the septum (that is, the
front-most part) between your fingers. The
diagram below shows a longitudinal view or sagittal
section of the face showing the right side of the septum (note: when labelling something right
or left, it is customary to name this from the patient’s perspective—i.e., right = the patient’s right side and left = the patient’s left).
Notice the front part is mostly cartilage, whereas farther
back (farther posteriorly, in medical
jargon) it is predominately bone.
The turbinates
(also knows as conchae) are
outpouchings of tissue, having bone as its core and surrounded with a
spongy-like soft tissue. The turbinates,
the septum and everything else inside the nose is lined with a pink, smooth
tissue called the mucosa. The mucosa secretes fluid and also emits
heat, as does any living tissue in the body. This serves a function.
Function:
The septum along with the turbinates allows for laminar airflow, where air flows in an
organized layered fashion. This allows
for proper warming and humidification of the air by the nasal mucosa before it
hits the trachea and lungs, which reduces the resistance to breathing air
through the nose. If there is no septum
or turbinates, then there is a condition of turbulent
airflow, where air molecules move in a disordered whirling and eddying
fashion. This type of flow prevents the
proper humidification and warming of the air, causing nasal and throat dryness
and irritation as well as irritation of the lining tissue of the trache and
lungs, making breathing unpleasant and less efficient.
With a deviated septum, one side is narrower than the
other. The septum deviates to one side
or the other in a variety of ways. The
figure below is an example, where the left drawing is closer to the front of
the nose (anterior) showing the cartilaginous septum displaced off the maxillary
crest and deviating to the left, abutting into the left inferior turbinate; the
right-hand drawing is farther back (posterior), showing a large bone spur
deviating to the left and impinging into the left inferior turbinate.
.
The narrow side is more restricted causing increased work of
breathing, while the other side has more space; however, both will cause
turbulent airflow. Due to this
phenomenon, some patients feel they have a more difficult time breathing on the
side opposite to the septal deviation.
Also, often the turbinates on the more open side tend to increase in
size to take up the extra space, something known as compensatory hypertrophy of the turbinates, and another reason
breathing can be difficult on that side.
This often occurs with the inferior
turbinate, which happens to be the largest of the three turbinates.
How a nasal septal
deviation occurs:
A deviated septum can occur from nasal injury. Sometimes patients recall a particular
incident, such as a sports-related injury, a fall, or a fist to the nose by
their kid sister who then ran off to mom and dad before the injured party could
deliver retribution.
Sometimes this is congenital, meaning formed during fetal
development. Another theory is trauma
during birth, where the septum gets bumped out of place as the fetus passes
through the birth canal, or perhaps as the doctor unknowingly had one finger wrapped
around the baby’s nose while she/he struggled to deliver the neonate. Amidst the scurry of action and excitement,
and while mother screams something to the dad (for instance, “This is all your
fault, you stupid, son of a…oooowwww!
Get that kid out of there!”) an inadvertent thing or two could occur
during childbirth, so I was told.
Why should you care?
A deviated nasal septum can cause problems. The main one is difficulty breathing through
the nose. This leads to mouth breathing
which is not natural. Since the normal
warming and moisturizing of air is bypassed by chronic mouth breathing, mouth
and throat dryness, sore throats, and irritation of the lungs can occur, making
life not-so-pleasant. Many people also
feel the cannot exercise well. Though
with increased physical activity one tends to breathe with the mouth open, it
is actually a combination of both mouth and nasal breathing. Trying exercising with a cold, or better yet,
go out for a run and plug both sides of the nose (I’ve done this)—it’s extremely difficult to continue
running in this fashion. Even at rest many
people find it difficult to breathe, thus negatively impacting their quality of
life.
Annoying crusting due to nasal dryness also can occur. This is due to mucous normally secreted by
the mucosa becoming caked up and solid, and entirely unpleasant condition. This leads to the phenomenon of digital trauma. Digital trauma has nothing to with computers
or the internet or high-tech stuff.
Here’s some simple math to explain it:
Digital = finger-related.
Trauma = injury. So, in other
words, Digital Trauma = Nose Picking.
Simple as that. Nose-pickers = a
subset of deviant human behavior.
Nose bleeds also can occur due to crusting and digital
trauma. Also, blood vessels on the
septum can become more prominent and more superficial. Such vessels bleed easily with the slightest
touch, sneeze of nose-blowing. Sometimes
they’ll bleed spontaneously.
Sometimes facial pain occurs especially when the
septum touches the side-wall of the nose, stimulating sensory nerves that can
radiate to the face. This can cause
migraine-like facial pain or headaches as well, especially with prominent bone
spurs impinging into the side -wall of the nose; think of a sharp hard object
stabbing your nasal cavity from the inside.
Also the deviated septum can impair sinus ventilation if it blocks the
middle meatus increasing risk of sinus infections and sinus pain.
Enough said about the septum. Despite his (or her) cries of not being loved
at the outset of this post, your nasal septum serves a vital function. So give it all the love and attention it justly
deserves, and keep your fingers away from it.
We’ll talk about surgery to fix this, known as a
“Septoplasty,” in another post.
©Randall S. Fong, M.D.
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