Office exam or CT to diagnose a deviated septum?

Question

Went to the dr he did an office exam said I have a deviated septum which is the cause for migraines over left eye and sinus pressure in cheeks and back of neck. Ct came back doctor said I have healthy sinuses even though I had a sinus infection 4 weeks ago and avoided the deviated septum question when I brought it back up. He referred me to a Neuro Optometrist. I feel like I am back to square one and am extremely frustrated. Can someone please help guide me.

Scott Trimas, MD · Answer

Even with a normal ct scan of the sinuses, the septum can still be deviated and may be contributing to your sinus type headaches. A good intranasal examination by an ENT specialist would help to see if the septum is indeed contributing to the issue. In addition, you can still have sinus blockage with a normal ct scan as there could be narrowing in the sinus openings. Good luck in your area.

Roberto E. Garcia, MD, FACS · Answer

Thank you for your question. This is a concern that I see in my office approximately twice a month. Annually I cure rhinogenic headaches about 3 to 4 times a year. Anatomically what is happening is that you have a septal spur that is pushing on the outside wall of the nose. This causes a neurogenic pain into the area around the eyes. A CT scan might confirm a septal spur but clinical exam is often sufficient.  You need to see a specialist in the face who performs rhinoplasty and septoplasty quite frequently. I hope this helps.

Jeffrey Watson, MD · Answer

An office exam is by far the best way to look at the septum. It is also visible on CT. Neither will tell you if it relates to your migraines. An ENT physician and CT scan are the best for looking at sinus disease but your specialist referral and then possibly to a neurologist who is a headache specialist may be helpful steps for you. Don't give up. Headaches can be a puzzle so sometimes it takes seeing a couple different people. 
I hope that helps!

Jeffrey Watson, MD
Fellowship Trained Facial Plastic Surgeon and Rhinoplasty Specialist
Board Certified Ear, Nose, and Throat Surgery
Graduate, Harvard Medical School

Shervin Naderi, MD, FACS · Answer

Hi.  Diagnosis headaches is a tough issue and is not that simple.  If your septum is touching your turbinates then a "contact point" headache may be the cause but not a migraine.  Migraines are due to vascular causes.  Almost everyone has a deviated septum and a perfectly straight septum is rare.  A CT scan will show you a snap shot into the sinuses.  An office exam can diagnose septal deviation but you cant look into the sinuses.  So I would say your frustration is normal.  Do not rush into any surgery.  See several specialists and be skeptical.

William Portuese, MD · Answer

A thorough internal examination of the nose along with a CT scan of the paranasal sinuses is required to make a determination about what may be causing nasal obstruction and headaches. A deviated septum obviously can  cause nasal obstruction, and in some patients facial headaches. Polyps located in the sinuses can account for facial pressure symptoms. As long as the CAT scan is normal and there's no deviated septum present, then  see a headache specialist.

Sahar Nadimi, MD · Answer

A deviated septum can occasionally cause pain/pressure if the deviation is severe or if there is a septal spur that is abutting the nasal side wall. A septoplasty can potentially treat the headache by removing any bony or cartilaginous spurs and bringing the septum back to midline. A proper physical exam is sufficient to diagnose a septal deviation and a CT scan is unnecessary. I recommend you visit a facial plastic surgeon who specializes in nasal surgery.

Darryl J. Blinski, MD · Answer

Obtain a disc copy of the CT than seek a few in person independent second opinions from boarded ENT.

Office exam or CT to diagnose a deviated septum?

Answers (7)

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