What Can Be Done for Septum Pain and Deviation, and Enlarged Turbinates?

You may well have a deviated septum, and enlarged turbinates, but these conditions are not usually associated with pain unless you're having a sinus infection.

If you have a foul, off-colored, nasal discharge along with pain, then you could have sinusitis, and consultation with another ENT might help.



In our experience, the majority of people who suffer with nasal and sinus pain may have a variant of migraine. I agree that steroid nasal sprays will not improve your pain, but might help with your breathing.



I hope this was helpful, and best regards.

Pain of the septum has many causes, but the most common that I see is caused by dryness.  The septum can become chapped similar to your lips and this can cause significant irritation and pain.  There are obviously many other causes, but an in person exam is necessary.  Regarding the deviated septum and turbinate hypertrophy (IT), it is certainly possible you have neither, either or both.  A CT scan is not necessary in most cases to diagnose these conditions.  Europe may be different, but in the US, usually insurance will not cover septoplasty or IT reduction without a trial of nasal steroids.  I have seen patients who have a septum that completely occludes the nasal passages, and there is no physical way that nasal steroids will make a meaningful difference, but this does not change the insurance company's need to check off the box of "tried nasal steroids and failed".  Finally, having a deviated nasal septum can contribute to mucosal drying and irritation because the air flow through the nose is altered and changes from laminar flow to turbulent flow.  This is a frequent cause of nasal dryness.

If your septum is painful or deviated you should be examined intranasally with a speculum and a light source. The septum can be treated by removed the inner core of the septum and straightening the septum.  The turbinates are on each side of the nasal passage laterally and  may be enlarged for a variety of reasons such as allergies.  The treatment is turbinectomy in which a portion of the turbinates are removed.

While you may have a deviated septum and or enlarged turbinates, pain in the nose typically indicates and acute and active process usually involving an inflammatory and or infectious process.  This should be treated appropriately with antibiotics or anti-inflammatory medication.  Once the acute issues have been stabilized and if you  to indeed have a deviated septum or enlarged turbinates these can be addressed with surgery at a later date.

If one has septal or turbinate pain and discomfort and has inferior turbinate hypertrophy and deviation, this can be improved with septal reconstruction and turbinate submucosal resection and/or infracture. I would be very cautious about saying that it will guarantee pain relief. It may improve the nasal airway and breathing but may not always relieve the pain.

Your pain inside the nose could be from two things;
1. Infection
2. Deviated septum pushing against the side wall of the nose.
To differentiate between the two you can do this experiment at home. Get Afrin (Oxymetazolin) spray from any pharmacy. When you are having the pain, spray 3 sprays in each side of the nose and wait for about 15 minutes. If the pain diminshes or goes away then likely you have a deviated septum and when your turbinates swell up the septum pushes against them causing pain.
If you have a deviated septum you should undergo septoplasty and turbinectomy.
The steroid spray will help with any nasal obstruction because of turbinate enlargement but it will not do anything for the deviated septum.
Regards

Hi Ilse,
First of all, if you went to an otolaryngologist who did not examine the inside of your nose, and just looked at the outside, it is time for you to find a different ENT. It is imperative to exam the nose internally to make a proper diagnosis.
Since your symptoms have been only for two weeks, most likely the pain is not from a structural problem with your septum, but rather from a cut or fissure in the mucosa (lining of the nose).
If your turbinates are enlarged, they can be reduced non-surgically with Somnoplasty, an office treatment under local anesthesia that uses radio-frequency energy to heat the inferior nasal turbinate internally to reduce the tissue volume.
Since you have had difficulty breathing through your nose for years, most likely it is due to a combination of a deviated septum and hypertrophied inferior nasal turbinates. Reduce the turbinates first, if you continue to have difficulty breathing through your nose, then consider septoplasty if you are found to have a deviated septum.
Be well.
Dr. P

It is impossible to tell from the pictures what is going on with the nose. Examination of the internal portion of the nose will further delineate the extent of any deviated septum. If you have a deviated septum and enlarged turbinates, this is what usually causes nasal obstruction. A CAT scan of the para-nasal sinuses will also help reveal any chronic sinus issues and a deviated septum. The septum could be deviated from the trauma that you had when you were 11 years old. I would suggest you see another otolaryngologist.

Since the nasal pain is only two weeks in duration, it is probably unrelated to your nasal trauma many years ago. You may have a local infection just inside the nose, where there is hair baring skin.
In looking at your pictures, I suspect you may have a deviated septum, since the lower part of your nose is deviated to the right side. Septum deviation and turbinate enlargement are common causes of nasal obstruction, but not pain. In rare occasions, contact between the septum and the turbinate can cause pain. However, since pain is a new symptom for you, it's unlikely to be due to contact between the septum and turbinate.
It's hard to believe that the ENT did not look inside the nose. If that is the case, you need a new doctor to evaluate you. You should look for another ENT or a facial plastic surgeon. You don't necessarily need a CT scan a nose, but the internal parts of your nose need to be evaluated to look for infection, ulceration, deviated septum, and turbinate enlargement.

I cannot understand WHY a nose doctor would NOT look inside the nose when you present with nose symptoms. It should have been the second thing he did after obtaining your history.
Rather than guessing at what it is or could be, I would suggest you see ANOTHER nose doctor and have him/her examine you.
IF there is an anatomic reason (IE deviated, curled septum, enlarged inferior turbinates etc), those may be addressed with a variety of treatments depending on their extent of blockage, any associated conditions and your preferences and budget.
Prescribing medical advice for a supposed condition is presumptuous.
Good Luck.