How to Approach Nasal Septal Deviations

Gordon H. Sun, MD, MS

December 21, 2015

Case: Difficult Nasal Breathing

A 22-year-old college student presented to his primary care provider with a long-standing history of difficulty breathing through the left nostril. The patient stated that this symptom began after he was hit in the face with a baseball during a high school game several years ago. He denied nasal pain or tenderness, epistaxis, rhinorrhea, anosmia, or visual deficits. The patient had no other significant medical history. He smoked cigarettes occasionally when socializing and denied alcohol or illicit drug use. The patient reported no use of any prescribed medications and has no known drug allergies.

On examination, the patient had normal vital signs and appeared comfortable, with no apparent difficulty breathing. Extraocular movements were intact. The nasal dorsum appeared straight and was nontender to palpation. There was no external nasal valve collapse on inspiration. On anterior rhinoscopy, the right nasal passage demonstrated a somewhat enlarged inferior turbinate but no other findings of note. Visualization of the left nasal passage was severely obstructed by a large deviation of the anterior nasal septum, which nearly contacted the left inferior turbinate. There was no septal perforation. No rhinorrhea or epistaxis was present. The external auditory canals were patent and the tympanic membranes were clear and intact. An examination of the oral cavity and oropharynx was unremarkable. The neck was flat and supple, with full range of motion.

The clinician was fairly confident that the patient's symptom was caused by the septal deviation. However, he was uncertain whether his examination alone was sufficient documentation of the patient's nasal obstruction.

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