How to Approach Nasal Septal Deviations

Gordon H. Sun, MD, MS

December 21, 2015

Case: Bilateral Nasal Congestion

A 51-year-old nurse presented to her nurse practitioner (NP) with a multiyear history of bilateral nasal congestion, worse on the right side. The nasal congestion occurred year-round, but often worsened with accompanying facial pressure, rhinorrhea, or intermittent right-sided nosebleeds when the weather was cold or if she contracted an upper respiratory infection. She denied constitutional symptoms. The patient reported a history of hypertension treated with hydrochlorothiazide, and no other medical problems. She denied tobacco or alcohol use and reported no known drug or environmental allergies.

On physical examination, the patient's vital signs were within normal limits and the patient was in no respiratory distress. The patient had a hyponasal voice. Anterior rhinoscopy demonstrated a very large septal spur emanating from the right aspect of the nasal septum and significantly enlarged bilateral inferior turbinates. The remainder of the patient's head and neck examination was unremarkable.

The patient's NP recalled hearing from one of her physician colleagues that he never requests imaging for patients with nasal septal deviations because "the surgeons never like what I order."

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