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Dear Doctor Spector,

I injured my nose when I was young and I have sinced developed a deviated septum.  I seem to always have sinus problems. Other than some obvious breathing problems that may occur from a deviated septum, can the chronic sinus be a result of the crooked nose?

Thanks,

Nick

New Orleans

Dear Nick,

For patients that suffer with chronic sinus problems, the cause usually falls into two major categories. In the first, there exists a problem with the "skin" lining of the inside of the nose. Allergy is a very common example of this type, where exposure to substances such as cat dander or dust mites causes an abnormal immune system reaction, with the development of swelling in the nose, leading to symptoms of nasal obstruction and sinusitis.

Also very common, however, are anatomic issues that cause a disruption of the normal "plumbing" inside the nose and sinuses. The septal deviation you have is a very common example of this type of problem. A septal deviation, or crookedness of the middle wall of the nasal cavity, not only causes difficulty in breathing through the nose, but can also cause problems with the sinuses' ability to allow flow of normally produced fluids into the nasal cavity, where the sinuses naturally empty out. Inside the sinuses, this can lead to irritation that causes congestion and further blockage, which only contributes to the flow problem initially caused by the septal deviation. This commonly leads to the classic symptoms of nasal congestion, facial pain and drainage that most people recognize as a sinus infection.

Initial therapy is aimed at reducing inflammation inside the nose with medications such as nasal sprays and antibiotics. If problems persist, a sinus CT scan and allergy test are usually obtained to evaluate the problem further. Allergy shots are often helpful if no anatomic issues are noted. Sometimes, the crooked septum and blocked sinuses have to be addressed directly with a surgical procedure to alleviate the problem if medical therapy is not helpful.

In your particular case, your septal deviation is likely contributing to your sinus problems, but further evaluation by a qualified ENT is necessary to confirm this.

Thank you for your question!

Jared E. Spector, MD

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