Nose Block Due to Septal Deviation Explained

Article written by Dr Ameen, ENT Specialist KL

A constantly blocked nose is often caused by a deviated nasal septum, swollen turbinates from allergic rhinitis, or nasal polyps. You should see an ENT specialist if the blockage is unilateral, persists despite nasal sprays, or is accompanied by bleeding, as these require endoscopic evaluation to rule out serious conditions.

What actually causes chronic nasal blockage?

Nasal obstruction is rarely a single issue. It is usually a combination of structural and inflammatory factors working together.

Deviated nasal septum: Structural displacement of the cartilage and bone dividing the nostrils.
Turbinate hypertrophy: Swelling of nasal tissues, frequently driven by uncontrolled allergic rhinitis.
Nasal polyps: Benign growths resulting from prolonged sinus inflammation and impaired drainage.

Many patients assume a deviated septum is the sole culprit. In my practice at KPJ Ampang Puteri, I frequently see young patients with a deviated septum who achieve excellent breathing simply by using intranasal steroids to shrink hypertrophied turbinates. This medical management completely avoids the need for surgery. I always try this approach first before recommending any surgical intervention.

Patient holding a tissue to her nose in a medical examination room — Chronic nasal obstruction can be due to deviated nasal septum, turbinate hypertrophy or nasal polyps.

When does a blocked nose require urgent ENT evaluation?

Certain patterns of nasal obstruction are red flags that demand immediate specialist investigation to rule out malignancy or foreign bodies.

Unilateral blockage in the elderly: High suspicion for neoplasms such as nasopharyngeal carcinoma, sinonasal cancer, or lymphoma.
Unilateral blockage in children: Urgent exclusion of a nasal foreign body is required.
Rapidly progressive bilateral blockage: Warrants immediate endoscopic assessment and imaging.

I recently evaluated a man in his mid 30s with a three week history of worsening bilateral blockage unresponsive to GP nasal sprays. During diagnostic nasoendoscopy, I revealed an irregular, bleeding mass involving the septum and turbinates. A biopsy under general anaesthesia confirmed NK/T-cell lymphoma, an aggressive midline malignant tumour. Early oncological referral saved his life. Progressive blockage is not always benign, and this is something GPs need to recognise early.

Nurse writing patient notes at a hospital nurses' station — Urgent evaluation & treatment is needed if cancer is suspected.

How is a deviated septum diagnosed and treated?

Accurate diagnosis requires visualising the internal nasal anatomy, followed by a stepwise treatment approach prioritising medical management before surgery.

Diagnostic or Treatment Step	Details and Costs
Initial Consultation	RM60 to RM235, depending on case complexity.
Diagnostic Nasal Endoscopy	RM315 (visualises septum, turbinates, and polyps directly).
Medical Management	Intranasal steroids, antihistamines, or a targeted “medical polypectomy” protocol.
Surgical Management	Endoscopic septoplasty, often combined with turbinoplasty or sinus surgery.

For patients with small Grade 1 or 2 nasal polyps, I utilise a “medical polypectomy” protocol I learned during my postgraduate training. This involves a two week course of high dose oral steroids, intranasal steroids, clarithromycin as a disease modifying agent, and a proton pump inhibitor for gastric protection. This avoids surgery entirely in non diabetic patients, as oral steroids can cause poor glycaemic control in those with diabetes.

Clinician performs nasal endoscopy on seated patient beside imaging monitor — A clinician performs a nasal endoscopic examination to assess the nasal cavity.

What should I expect from septoplasty surgery and recovery?

Endoscopic septoplasty is a highly effective procedure for structural blockage, with predictable recovery timelines and high patient satisfaction when performed by an experienced specialist.

Procedure volume: Approximately 20 septoplasty involving nasal surgeries performed annually.
Success rate: 90 percent patient satisfaction with significantly improved breathing.
Surgeon fee: RM1,340 (per the 13th Schedule of Fees).
Total estimated cost: RM10,000 to RM15,000 (including anaesthesia, ward stay, and powered instruments).
Recovery time: 2 to 4 weeks. Silicone splints are typically removed at 2 weeks, though quilting stitches can accelerate recovery by allowing easier nasal rinsing.

I exclusively perform endoscopic septoplasty, avoiding open approaches typically done by rhinoplastic or plastic surgeons. Preserving the L-strut of the septal cartilage is critical to maintain nasal tip support. In rare cases with severe caudal deviation, I must leave some cartilage to prevent nasal collapse. One such patient experienced mild residual blockage but declined revision, as it was vastly improved from his preoperative state.

Masked surgical team preparing instruments in an operating room — Reassessment of CT imaging is usually done prior to scrubbing and surgery.

What are the risks and complication rates of nasal surgery?

While generally safe, septoplasty carries specific risks that patients must understand before consenting to the procedure.

Potential Complication	Frequency and Management
Septal perforation	Less than 1 percent in my practice. A tiny anterior perforation may cause a high pitched whistling sound during forceful breathing, which is surgically repairable.
Revision surgery	Required occasionally if caudal deviation limits complete correction.
Bleeding or infection	Standard surgical risks managed with postoperative care and follow up.

Transparency is vital. I had one case of a tiny anterior septal perforation causing a whistling sound during exercise. We successfully closed it, and the patient recovered fully. Setting realistic expectations about L-strut preservation prevents postoperative disappointment. I always explain these risks thoroughly during consultation so patients can make informed decisions.

Healthcare professional reviewing paperwork beside a laptop in a medical office — Surgical consent is an important aspect of surgery process.

Frequently Asked Questions About Nasal Blockage

Can a deviated septum cause a constantly runny nose?

No. A deviated septum causes mechanical blockage, not excess mucus. A constantly runny nose is typically driven by allergic rhinitis or vasomotor rhinitis, which requires medical treatment like intranasal steroids, not surgery.

Will my blocked nose get worse as I get older?

It can. Cartilage continues to grow and weaken with age, potentially worsening a deviation. Additionally, years of untreated allergic rhinitis can lead to permanent turbinate hypertrophy or nasal polyps, compounding the blockage.

Is septoplasty painful, and how long until I can work?

The procedure itself is painless under general anaesthesia. Postoperative discomfort is usually mild to moderate, managed with simple painkillers. Most patients return to desk work within 7 to 10 days, though full internal healing takes 2 to 4 weeks.

Can nasal sprays fix a deviated septum?

Nasal sprays cannot straighten bent cartilage or bone. However, they are highly effective at shrinking swollen turbinates that often accompany a deviation, which is why many patients experience significant relief without needing surgery.

Why do I only feel blocked on one side of my nose?

This could be the nasal cycle, a normal phenomenon where congestion alternates between nostrils every few hours. However, if the blockage is persistently on the exact same side, it strongly suggests a structural deviation, a polyp, or requires urgent investigation to rule out a tumour.