A deviated nasal septum can contribute to persistent blockage, but it is not the only reason breathing feels restricted. Turbinate enlargement, nasal-valve narrowing, allergy, inflammation and fluctuating mucosal congestion may coexist. Septoplasty is most relevant when symptoms and examination point to the septum as an important mechanical cause.
The multicentre NAIROS randomised trial enrolled 378 adults with symptomatic septal deviation across 17 NHS hospitals. At six months, people allocated to septoplasty reported greater improvement in SNOT-22 symptoms than those assigned to medical management. The surgical group also experienced more adverse events, so the result supports careful selection rather than automatic surgery for every visible deviation.
What the trial changes
NAIROS provides stronger comparative evidence than case series because it tested surgery against a defined medical pathway in routine practice. Improvement was greater among those with more severe baseline symptoms. The study does not show that septoplasty cures every breathing complaint, nor does it decide whether cosmetic rhinoplasty should be performed at the same time.
Why examination still matters
The clinician needs to relate the site of deviation to the patient’s symptoms and assess the turbinates, mucosa and nasal valve. A decongestant response, allergy history, prior trauma or previous surgery may alter interpretation. Photographs can document external shape but cannot replace an internal examination or functional history.
- Which structure is thought to cause the blockage?
- Has medical treatment been tried where appropriate?
- Is nasal-valve support part of the problem?
- How will functional and cosmetic goals be recorded separately?
Possible reasons symptoms persist
Residual deviation, scarring, valve collapse, untreated inflammation and unrealistic expectations can all contribute. Surgery can also cause bleeding, infection, septal perforation, altered sensation or a change in shape. These events are not inevitable, but they belong in consent and follow-up planning.
Using the evidence in a combined plan
When septoplasty and rhinoplasty are discussed together, ask which steps are functional and which are aesthetic. Confirm how breathing will be assessed before and after surgery and who will manage persistent obstruction. The presence of a deviated septum on a scan or photograph is not enough by itself to predict benefit.
Sources and further reading
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| Medically reviewed by | Senior plastic surgery consultants working with Just Clinic Istanbul |
|---|---|
| Author | Just Clinic Istanbul Medical Writing Team |
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